Somewhere in the middle of belting out "Total Eclipse of the Heart," Lauren Marks' life changed forever. A cranial aneurysm, silent and symptomless until that fateful night in a Scottish karaoke bar, ruptured, causing hemorrhaging in parts of her brain.
Within hours this 27-year-old graduate student would wake up from emergency brain surgery to find that she could no longer read and could barely speak coherently. The bleeding in her skull had damaged parts of her brain associated with language, leaving her with acquired aphasia, a loss of the ability to use or understand words.
Although smoking, hypertension, being female or having a family history of aneurysms are all chronic risk factors for these abnormal blood-filled bulges -- which can show up in a CT scan -- less is known about what causes a longstanding aneurysm to rupture.
New research from the Netherlands, published Thursday, offers some insight into how certain everyday activities and emotional states, such as having sex, drinking caffeinated drinks and being startled can increase the likelihood of an aneurysm erupting.
A brain aneurysm rupture such as Marks' occurs when a section of brain artery becomes weakened, resulting in stroke or hemorrhaging.
Although the effects of a ruptured aneurysm can be devastating, it's important to remember that aneurysms themselves are somewhat rare: It is estimated that between 2 percent and 5 percent of Americans live with a brain aneurysm, and the vast majority will never experience a rupture. Among those who do, half will die, and half of those who survive will live with permanent disability.
Doctors suspect that a sudden increase in blood pressure puts strain on the wall of an aneurysm, increasing the chances that it will break, says Dr. Khaled Aziz, director of the Center for Complex Intracranial Surgery at Allegheny General Hospital in Pennsylvania.
Thursday's study, which identifies eight activities or states most associated with a rupture, supports this theory: They can all be tied to a sudden spike in blood pressure.
"We want to sort out whether the prescription of anti-hypertensive drugs in persons with [brain aneurysms] may prevent the growth and rupture of these aneurysms," says Dr. Ale Algra, co-author of the study and a neurologist at the University Medical Center Utrecht in the Netherlands.
Doctors have long had anecdotal evidence that certain activities, such as sex or straining on the toilet, were risk factors for ruptures, but this study is the first to assess just how risky these behaviors can be for those who have aneurysms.
The following are the eight routine activities that researchers found to be associated with an increased risk of aneurysm rupture.
Daily Cup O' Joe
Drinking coffee was the risk factor most commonly associated with a ruptured aneurysm, although the study found it increased the likelihood of rupture only slightly. After surveying 250 patients who had aneurysms, researchers found that the odds of a rupture were 1.7 times higher in the hour after drinking a cup of joe.
While the increased risk among coffee drinkers was not huge, the frequency with which most people drink coffee makes it a good target for change, says Algra. For those in the population who know they have an aneurysm -- or who have a family history of aneurysms -- this data suggests that they should refrain from drinking coffee.