Klemens Haselsteiner died on Friday, January 17, 2025, at the age of 44. The Austrian construction group Strabag provides information about this on its website. Haselsteiner was CEO of the Europe-wide construction technology group. His death was “sudden and unexpected”.
In the video: Neurologist reveals what type of headache could indicate an aneurysm
Haselsteiner’s doctor Rainer Schroth spoke to the Austrian daily newspaper “Kleine Zeitung” about aneurysm bleeding. “Medically speaking, we had no chance,” said the doctor. He accompanied Haselsteiner in the last minutes of his life and informed the Red Cross. “He died of an aneurysm hemorrhage, so any help comes too late.”
At the time of his death, Haselsteiner was undergoing a fasting treatment at the Obervellacher Kurklinik in Carinthia, Austria.
More than two million Germans live with an aneurysm in the brain
Doctors refer to a bulging of the arteries as an aneurysm. In principle, aneurysms can form in any artery in the body. It is currently not known where it occurred for Strabag boss Klemens Haselsteiner.
The vascular bulges in the brain pose a particular problem. More than two million Germans have a brain aneurysm, many of whom don’t know about it. If it bursts, a cerebral hemorrhage can occur and, as a result, a vascular blockage.
The comparison is often made to a ticking time bomb, because only a crack becomes a life-threatening risk or can lead to serious, often permanent disabilities. Only very few of those affected recover completely.
How those affected can tell whether they have a brain aneurysm
However, not all aneurysms are at risk of rupture. How can those affected tell whether they have a brain aneurysm – and whether it will rupture? Would screening for early detection make sense?
Bernhard Meyer, Director of the Clinic for Neurosurgery at the Rechts der Isar Clinic at the Technical University of Munich, answered the most important questions about brain aneurysms for FOCUS online.
FOCUS online: How dangerous is the aneurysm in the head actually – and is it “only” dangerous if it bursts?
Bernhard Meyer: In fact, the main danger in the vast majority of cases is when it bursts. Aneurysms that become problematic even though they have not ruptured are very rare. This occurs when they are so large that they press on a structure in the brain, causing symptoms, or small blood clots break out of a large aneurysm, causing a stroke. However, both are rare. The main danger is the rupture and the bleeding that this causes.
What is the risk of a brain aneurysm bursting?
Meyer: This cannot be said generally. It depends on various factors: Size is important. If the largest diameter of the aneurysm is less than 7 millimeters, the risk of bleeding is almost negligible. If it is larger, the risk of bleeding increases exponentially and reaches the single-digit range of bleeding occurring within a year.
Based on the numbers of those affected, would that mean that if 100 people had a brain aneurysm larger than seven millimeters, three of them would experience a rupture within a year?
Meyer: Yes, this is how the risk can be calculated. In addition to the size of the aneurysm, there are also two external factors that significantly increase the risk: constantly elevated blood pressure and smoking. Studies show that smoking is an independent risk factor in this context.
What can cause a brain aneurysm to burst?
Meyer: When you know that, you would be one step further. It’s probably something banal – at some point the thin skin of the aneurysm tears. Under the microscope you can clearly see that an aneurysm is much thinner than a normal vessel and at some point a leak occurs.
The rupture in the aneurysm causes dangerous bleeding in the brain. What exactly happens?
Meyer: It is a subarachnoid hemorrhage, abbreviated as SAH. This means that the bleeding does not flow into a limited area of the brain, but rather spreads across the surface and base of the brain, under the arachnoid, i.e. the fine skin that lies directly on the brain.
What does this mean for those affected, how life-threatening is the rupture of the aneurysm?
Meyer: According to current studies, one in five dies on site, i.e. before they can be taken to a clinic. Of course, what the local medical care is like, how quickly an ambulance can arrive, and how far away the nearest hospital is also play a role here. Of those who survive, at least a third remain severely disabled for the rest of their lives, and another third live with a disability that is detrimental but allows independence. And less than a third survive the rupture without any consequences.
What causes an aneurysm in the head?
Meyer: There must probably be a genetic defect that causes the middle layer of the arteries, the so-called media, to have defects in some parts of the cerebral circulation. That’s the starting point, but we don’t yet know which gene mutations are involved. Unlike aneurysms in other areas of the body, these bulges in the brain always form at branches of the vessel where there is weakness in the wall. The pulsating blood pressure can then expand this area over time.
Are there early signs before a brain aneurysm ruptures?
-Meyer: Only around five percent experience a so-called warning leak, a very small warning bleeding that is only accompanied by severe but short-term headaches. Most people don’t even pay attention to it.
The symptoms when an aneurysm in the brain ruptures are, on the other hand, very severe?
Meyer: This is the so-called annihilation headache, which is severe pain and is the classic symptom of a subarachnoid hemorrhage. These are often accompanied by nausea, vomiting and loss of consciousness.
How is the diagnosis made in the clinic?
Meyer: Computed tomography can be used to show the typical appearance in the brain – the extensive distribution of blood at the base of the brain, where the arteries run. The cause is then an SAH and the patient most likely has an aneurysm rupture. At the same time, a vascular image can be made using CT, which means that angiography is often no longer necessary today.
This concerns the diagnosis in acute cases. Is an aneurysm in the head sometimes discovered by chance?
Meyer: This is becoming more and more common. If someone keeps having headaches – which have nothing to do with the aneurysm – and wants to have it checked out, a magnetic resonance imaging scan will be carried out and an aneurysm in the brain may be discovered as an incidental finding.
Is this aneurysm then treated preventively?
Meyer: Attitudes towards prophylactic treatment have changed significantly. 20 years ago, an aneurysm discovered by chance was treated immediately without discussion in order to rule out later rupture and bleeding. Then there were studies that made it more nuanced. The size criterion mentioned at the beginning is therefore important for the decision; the risk of bleeding is very low with an aneurysm smaller than seven millimeters – and lower than the risks with prophylactic treatment.
Presumably the presence of risk factors such as high blood pressure also plays a role?
Meyer: High blood pressure is one of the additional factors that influence the decision for or against preventive treatment – as well as the age of the patient and whether there is a blood relative who has already had SAH caused by an aneurysm. There are a number of scores that can be used to at least estimate the probability of bleeding in a patient individually. If the risk of waiting outweighs that of treatment, prophylactic therapy is usually chosen.
The treatment, even in acute cases, i.e. in the event of a rupture, means stabilizing the vessel again?
Meyer: There are two methods for this – one is to insert spirals made of platinum through the catheter or to embolize structures made of other materials, such as special nets, which seal the aneurysm from the inside. This is called coiling, which is an endovascular treatment. The traditional treatment is surgery through an opening in the skull, whereby a metal clamp is placed on the aneurysm, so that it is switched off, so to speak.
Which method is currently used more frequently and why?
Meyer: The decision as to which form of therapy is used is discussed by the team of treating doctors. If possible, coiling is performed because this treatment is less risky than open surgery. Today, when a patient is admitted to hospital in an acute case with a ruptured aneurysm, in 70 percent of cases the aneurysm is closed using a catheter. Only around 30 percent of patients undergo surgery.
If it is an aneurysm that was discovered by chance and has not yet ruptured but needs to be treated, for example because it is very large or there are other risk factors, surgery is usually still carried out more frequently – in our case, for example, it is exactly the opposite ratio: around 70 percent Surgery, 30 percent via the catheter. However, this decision-making is always a joint one between neurosurgeons and neuroradiologists, as the weighing up in individual cases is very complex.
What happens next for the patient after the treatment?
Meyer: The disease is very complex. So at the beginning there is a bloody, hemorrhagic stroke, which is ultimately the rupture of the aneurysm. This often results in an ischemic stroke, i.e. an infarction. The cause is the blood that is around the arteries as a result of the rupture. When blood breaks down, products are created that in turn cause the artery walls to thicken. Inflammation occurs and the lumen of the vessels narrows. As with a heart attack, this can lead to a cerebral infarction.
This risk is very high within the first twelve days. Even those who have survived the first part with the bleeding can still lose their life or suffer permanent damage as a result of the second event. These are the impairments typical of strokes, such as paralysis, speech and vision problems.
Can an aneurysm be prevented? Is prevention possible?
Meyer: The easiest and probably most effective way is to reduce the risk factors – i.e. don’t smoke and make sure that your blood pressure is well controlled. As is well known, this prevention can protect against many diseases – including, to a certain extent, against an aneurysm.
Would screening make sense to detect an aneurysm early?
Meyer: This only makes sense if someone in the family was already affected and had SAH caused by an aneurysm. There are areas of the world where this occurs more often in families – for example in some parts of Finland. This is where screening makes sense. In Germany that would make little sense, as large aneurysms in the brain are too rare. If smaller ones are discovered, it only unsettles those affected and there is a risk of overtreatment.
Related News :