Procedural complication rate of coiling of ruptured aneurysms

This scan compares the brain pre-embolization (top half) and post-embolization (bottom half). Zoom in close for a clear view and details.

Before we continue talking about the recovery process, which is a life-long journey, let’s talk a little bit more about complications that may arise following the treatment of a ruptured brain aneurysm. While we know that out of the 2 major treatment options available throughout the world: endovascular coiling and the clipping surgery, the coiling procedure is the least invasive and most successful. The decision on which option to take lies entirely on your team of healthcare providers. I had the coiling procedure done and so far, so good.

I found a very interesting article from the American Journal of Neuroradiology (AJNR) about a study they carried out from 1985 to 2005 studying 681 consecutive patients with ruptured intracranial aneurysms who were treated with detachable coils. Procedural complications (aneurysm rupture or thromboembolic) of coiling leading to death or neurologic disability at the time of hospital discharge were recorded. For patients with procedural complications, odds ratios with corresponding 95% confidence intervals were calculated for the following patient and aneurysm characteristics: patient age and sex, use of a supporting balloon, aneurysm location, timing of treatment, clinical condition at the time of treatment, and aneurysm size.

Conclusion….

Procedural complication rate of coiling of ruptured aneurysms leading to disability or death was 5.9%. In the series, the use of a temporary supporting balloon in the treatment of wide-necked aneurysms was the only risk factor for the occurrence of complications.

NOTE……

Endovascular coiling of ruptured intracranial aneurysms has become an accepted treatment with good clinical results and adequate protection against rebleeding.

 Adverse outcome after aneurysmal subarachnoid hemorrhage may be the result of the initial impact of the hemorrhage, the occurrence of early rebleeding after treatment, and delayed events such as vasospasm and hydrocephalus.

Moreover, complications during the endovascular treatment itself can result in poor patient outcome.

Complications of endovascular coiling consist of procedural perforation by the microcatheter, microguidewire, or coil and thromboembolic complications.

Thromboembolic complications may be caused by clotting inside the guiding catheter, clot formation on the coil mesh, or clotting in parent vessels caused by induced vasospasm or malpositioned coils.

In the study, they reported the incidence of procedural complications of coiling of ruptured intracranial aneurysms leading to permanent disability or death in a consecutive series of 681 patients.

Result……

Procedural complications occurred in 40 of 681 patients, leading to death in 18 and to disability in 22 patients. There were 8 procedural ruptures and 32 thromboembolic complications. Five of 8 procedural ruptures and 13 of 32 thromboembolic complications led to mortality. Of 22 patients with procedural morbidity, 10 had a nondisabling neurologic deficit and were independent and 12 were dependent at 6 weeks after coiling. There were no patients in vegetative state. Overall procedural complications leading to death or dependency were 30 of 681.

Reference: http://www.ajnr.org/content/ajnr/27/7/1498.full.pdf

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Brain Aneurysm: Recovery


Philippians 4:6-7 New International Version (NIV)
Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God. And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus.

Recovery time following brain aneurysm treatment varies from person to person based on several factors such as age, overall health condition prior to the aneurysm, the severity of the aneurysm, type of treatment that was used, any other health changes that occurred following the aneurysm and the emotional and social support that one receives. Of course, there is more to be added to the list. From a personal standpoint, I think recovery is a lifetime process. I had to deal with so many changes such as physical, social and emotional, memory, challenges with returning to work and continuing education. When you hear people say that “I had to learn how to walk” it is very true. I went through that process. I never thought that 1 week of being bedridden could take away my ability to walk independently but …I guess I was wrong. I took it one day at a time as I learnt how to walk and be able to perform other activities of daily living on my own with the help and dedication of the physiotherapist. My healthcare team was amazed by the rate at which I was recovering as I moved from ICU to High Care then regular ward. The long road to recovery was expected to take between 2-6weeks of hospital stay and additional 4weeks to 6months of a combination of rehab and at-home recovery. However, I ended up staying in the hospital for about 2 weeks, did in-home physiotherapy for 2 weeks and I completed the rest of the recovery on my own and with the support of my family. Well, part of the reason why I was able to go through the process faster was due to my active lifestyle prior to the aneurysm. That is why I would encourage people to maintain a healthy exercise routine. I have always done Zumba and I continue to do it. Recently, I added tai chi just because it helps to improve my memory sharpness and reduce the headaches.

Recovery is a continuing process for me. I have had to make changes with my lifestyle that benefits my overall health. In order to help reduce stress-related headaches and anxiety, I have had to cut off or reduce communication with some people including friends and family. Some people just luck the ability to be compassionate and sympathetic. These kind of people try to find ways to put the blame on you (…yes, I know, they exist) for suffering a sickness that you had no control over. Every conversation you have with them, leaves you with anxiety or a headache. Oh well, if I want to live a long life and be there for my family, I have to focus on myself and do what benefits me. Basically, it is about learning to let go and not allowing yourself to be a victim of every circumstance in your life.

Other things that I have had to do is trying to stay in the loop by educating myself on brain aneurysm and being involved in any kind of group, project or activity that keeps me talking about the condition. It is my wish to do more on spreading the awareness.

To stay positive and feel like I’m living my life to the fullest, I have had to change the approach on how I achieve my goals. I do not spend too much time in the thinking/planning process, I spend most of the time in the implementing process. In other words, I go by a check list.

Below is an article from the Brain Aneurysm Foundation that I found to be very informative on the recovery process following a brain aneurysm treatment. I hope you like it too. To make it more interesting, I will break it into 2 segments. The next segment will be included in my next article.

From Brain Aneurysm Foundation…

https://bafound.org/recovery/

Undergoing treatment for a brain aneurysm is a major life event that continues long after discharge from the hospital. Survivors face the potential for physical, emotional, and cognitive changes that can be minor or significant, short-term or long-lasting.

Recovery for patients who suffered a ruptured aneurysm tends to be longer and more difficult than it is for patients whose aneurysm did not rupture. Older people and those with chronic medical problems may also recover more slowly than younger, healthier individuals. Some patients may require rehabilitation. Others are able to care for themselves after a short period of recovery. As these examples demonstrate, each individual and situation is unique and recovery times will vary.

One of the most frequently asked questions by brain aneurysm survivors is, “How long until I get better?” Unfortunately, there is no way to predict how long it will take to improve, or even how much improvement will occur.

There will be a better chance for recovery if the survivor and the family maintain hope, even when facing a long recovery process. Rehabilitation pioneer George Prigatano, PhD, points out, “If the brain is alive, it can learn.” Remind yourself often of this: the brain can learn new skills for a lifetime.

Patients recovering from aneurysm treatment experience many changes and challenges. This section of the website will provide you and your caregivers with information about many of the most common changes, with suggestions for how to deal with them.

Click here to listen to a webinar on brain aneurysms and the recovery process in “The Care of Cerebral Aneurysms: What the patient needs to know for improved recovery” presented by Dr. Aaron Cohen-Gadol.

Physical Changes

After Your Treatment
You can expect some changes in the first few days and weeks following your treatment. Which of these you experience and how long they last depends on a number of factors, including whether your aneurysm had ruptured prior to treatment and the type of treatment (open or endovascularWithin the blood vessels/vascular system.) you had.

After Open Surgery
Issues after open surgery (clippingThe surgical method for treating an aneurysm. The surgeon exposes the aneurysm with a craniotomy and places a metal clip across the base of the aneurysm so that blood cannot enter it.) may include:

Incision Pain/Numbness
The pain usually occurs at the incision site. It may take several weeks for the incision to heal. After this time, you may experience brief episodes of sharp pain in the incision area as the nerves grow back. This is not cause for concern. The pain will go away with time. The incision area can also feel numb; this may or may not get better with time. It may be uncomfortable to sleep on the side with the incision, but it is safe to do so.

Hearing Loss
You may notice muffled hearing in the ear on the same side as the incision. This is due to fluid accumulation and will get better with time. However, it may take several weeks to notice improvement.

Jaw Pain
Jaw pain may occur when you open your mouth to eat or brush your teeth. This is due to manipulation of the muscles during surgery. The pain will improve over time. You may be able to speed up your recovery by opening and closing your mouth (about 10 times) at least four to five times a day, gradually increasing how wide you open it. Let your surgeon know if the pain persists after six weeks; in this case, physical therapy may be advised.

Clicking Noise in Head
This commonly occurs when you position your head in different ways. While alarming, there is no need to be concerned. This is the bone healing and a normal part of the recovery process. The clicking goes away after several weeks.

Seizures
Seizures may occur at the time of aneurysm rupture or sometimes as a result of surgery on certain parts of the brain. Your neurosurgeon may put you on an anti-seizure medication in the hospital. In certain cases your doctor will have you continue this medicine after you go home. If there are no further seizures, the medicine is usually continued for only a short time. If you are on anti-seizure medicine, it is important that you take the medicine as prescribed.

After Endovascular Treatment
Issues after endovascular treatment (also called embolizationA technique performed by a neuroradiologist or a neurosurgeon in the treatment of brain aneurysms or brain AVMs. As an extension of an angiogram, a catheter is passed up into the arteries inside the brain into the arteries supplying blood flow to the AVM or inside an aneurysm. The blood vessel or aneurysm is then blocked off from the inside with either glue, metal coils or other substances. This is often performed as a prelude to surgery in brain AVMs, but occasionally may be curative without additional therapy.) may include:

Groin Pain
There may be bruising and discomfort where the catheterA flexible tube for insertion into a vessel, body cavity, or duct; used for an angiogram of the brain arteries and in the endovascular treatment of brain aneurysms to provide access to the aneurysm site. was inserted in the groin. You should avoid strenuous activity and hot baths for one week after treatment. A hematoma (hard large blood clot) can develop at the site. Should this happen, or if there is increased pain or swelling in the area, contact the doctor who performed the procedure.

Hair Loss
Radiation or the contrast dye used during the procedure can occasionally result in hair loss. This usually only affects a small area and is temporary — the hair will grow back. Keep in mind that stress and medicines can also cause temporary hair loss.

Longer-Term Changes

Fatigue
Fatigue is the most common problem in the recovery process. You may feel tired all the time and have no energy or “get up and go.” Normal everyday activities, even simple ones such as taking a shower, may wear you out. You may take more naps, only to find that you have trouble sleeping at night.

This is normal. Keep in mind your body has been through a lot and needs rest before it can function well again. As time goes on, gradually increase your activities and the amount of time you spend doing them. It can take months before your activity level returns to where it was before your treatment. Try not to get discouraged, and take it one day at a time.

If you frequently have trouble sleeping, talk with your healthcare provider. Sometimes the short-term use of a sleeping medication may be helpful.

Also, have your family limit your visitors. Visitors mean well but can wear you out. If they want to help, suggest they prepare a meal or do shopping for you.

Diminished Sense of Smell and/or Taste
Survivors often report changes in their ability to taste and/or smell. If the aneurysm ruptured, smell and taste deficits can be caused by blood that irritates the nerves that control these senses. If the aneurysm did not rupture, smell and taste deficits can occur if the aneurysm compresses the surrounding nerves. Unfortunately, these deficits may not get better with time.

Headaches
Many patients experience headaches. Headaches are usually more of a problem for those whose aneurysm ruptured. The headaches can vary in intensity from day to day, and last for several weeks or longer. Please note that some aneurysm patients have a long history of headaches. These headaches will not be cured by treatment of the aneurysm, as they are not related. The headaches may seem to go away for a while but unfortunately usually return.

Headaches can be frightening, particularly if you had an aneurysm rupture. Keep in mind that the likelihood that a treated aneurysm will rupture is almost zero. Headaches due to aneurysm rupture are not only severe, but sudden. Call 911 in the rare case that a severe and sudden headache occurs.

In general, prescription pain medications may be needed for the first couple of weeks after your treatment. You should switch to over-the-counter pain medications, such as Tylenol, as soon as possible. If headaches are not eased by pain medications — or if the headaches continue even after several weeks — notify your doctor.

Vision Problems
Some people have specific problems with vision due to the location of the aneurysm. Others have problems with focusing or blurry vision as a result of subarachnoid hemorrhage. Problems with focus and blurred vision are common and tend to improve over time. If vision problems do not improve, contact your doctor. Consultation with a neuro-ophthalmologist might be helpful.

Low Back Pain
Some people experience low back pain and/or shooting pain down the back of the leg. If the aneurysm ruptured, your back pain may be caused by blood in your spinal fluid that is irritating the nerves. This will get better with time. Low back pain can also be due to lying in bed for many days and lack of activity. This type of back pain usually gets better as you increase your activity level, but may require physical therapy. Gentle stretching or a heating pad may help relieve the pain. Notify your healthcare provider if low back pain persists.

Constipation
Constipation is common and may be due to inactivity and/or a diet low in fiber or fluids. The major cause of constipation after aneurysm treatment is the use of narcotic medications. Constipation usually improves with increased activity and decreased use of pain medications. Stool softeners like Colace can be helpful, as are mild laxatives such as Metamucil. Avoid straining when having a bowel movement.

Slowed Reaction Times
In most people, reaction time is slower during recovery for at least some period of time. It is not safe to drive under these circumstances. Follow your doctor’s advice as to when you can resume driving. If you have memory/cognition, visual, or certain other physical problems, you should not attempt to drive. The Department of Motor Vehicles provides testing to determine whether/when you can return to driving.

Social and Emotional Changes

Some patients may experience some or all of the following social-emotional changes.

Loss of Emotional Control/Confusion
Most survivors experience temporary loss of control over emotions. This can manifest itself in anger, frustration, and lashing out at yourself and others. You may find that you get tearful for no reason at all. Confusion about what is happening to you is also common, so do not be reluctant to talk about it. These symptoms will get better with time. If it becomes too difficult to deal with, seek counseling.

Self-Esteem/Relationships
You may have changes in your self-esteem and self-confidence as a result of new physical and mental limitations. It is important to talk to your family, doctor, and therapist about how you feel and how to adjust to the “new” you.

You are not any less capable of leading a normal life. It is just going to require adjusting and giving yourself time to heal. You may notice changes in relationships with family and friends, so it is important to discuss your feelings with them. Many times these changes are temporary and as you recover, your relationships often return to normal.

Isolation
You may feel different, or isolated, as a result of the aneurysm treatment. But you are not alone. Attend Brain Aneurysm Support Group meetings or connect with others on the Brain Aneurysm Foundation’s online support community.

Depression and Anxiety
Depression and anxiety are very common among survivors, whether you suffered a ruptured aneurysm or were treated for an unruptured aneurysm. These may be caused by the aneurysm itself and also by the many life changes that may occur as a result of the aneurysm. But there is no need to suffer in silence.

Depression is not simply a passing blue mood or a sudden feeling of sadness that goes away as quickly as it came. It is an illness that affects your body, mood, and thoughts. Depression impacts your appetite and sleep, how you feel about yourself and others, and how you think about life. Treatment, which usually consists of a combination of medication and talk therapy, can help you deal with depression and feel better.

If you experience some of these symptoms below, it is important that you openly share your concerns and feelings with someone close to you, as well as a healthcare professional who understands your condition, such as a neuropsychiatrist or neuropsychologist, licensed psychologist, psychiatric nurse, licensed social worker, or counselor.

  • Feelings of sadness on a daily basis; crying more than usual
  • Guilt and regret about past events and current problems
  • Anger, irritability
  • Disturbing, morbid, or suicidal thoughts
  • Lethargy/no motivation
  • Loss of interest or pleasure in activities, including sex
  • Altered appetite: weight loss or gain
  • Disturbed sleep (early-morning awakening, disturbing dreams)

Brain Aneurysm: Treatment

Hope is what makes us believe in the promise of tomorrow

https://www.mayoclinic.org/diseases-conditions/brain-aneurysm/diagnosis-treatment/drc-20361595

There are two common treatment options for a ruptured brain aneurysm.

  • Surgical clipping is a procedure to close off an aneurysm. The neurosurgeon removes a section of your skull to access the aneurysm and locates the blood vessel that feeds the aneurysm. Then he or she places a tiny metal clip on the neck of the aneurysm to stop blood flow to it.
  • Endovascular coiling is a less invasive procedure than surgical clipping. The surgeon inserts a hollow plastic tube (catheter) into an artery, usually in your groin, and threads it through your body to the aneurysm. He or she then uses a guide wire to push a soft platinum wire through the catheter and into the aneurysm. The wire coils up inside the aneurysm, disrupts the blood flow and essentially seals off the aneurysm from the artery. This is what I had done.

Both procedures pose potential risks, particularly bleeding in the brain or loss of blood flow to the brain. The endovascular coil is less invasive and may be initially safer, but it may have a slightly higher risk of need for a repeat procedure in the future due to reopening of the aneurysm.

Flow diverters

Newer treatments available for brain aneurysm include flow diverters, tubular stent-like implants that work by diverting blood flow away from an aneurysm sac. The diversion stops blood movement within the aneurysm and so stimulates the body to heal the site, encouraging reconstruction of the parent artery. Flow diverters may be particularly useful in larger aneurysms that can’t be safely treated with other options.

Your neurosurgeon or interventional neuroradiologist, in collaboration with your neurologist, will make a recommendation based on the size, location and overall appearance of the brain aneurysm, your ability to undergo a procedure, and other factors.

Other treatments (ruptured aneurysms)

Other treatments for ruptured brain aneurysms are aimed at relieving symptoms and managing complications.

  • Pain relievers, such as acetaminophen (Tylenol, others), may be used to treat headache pain.
  • Calcium channel blockers prevent calcium from entering cells of the blood vessel walls. These medications may lessen the erratic narrowing of blood vessels (vasospasm) that may be a complication of a ruptured aneurysm. One of these medications, nimodipine (Nymalize, Nimotop), has been shown to reduce the risk of delayed brain injury caused by insufficient blood flow after subarachnoid hemorrhage from a ruptured aneurysm.
  • Interventions to prevent stroke from insufficient blood flow include intravenous injections of a drug called a vasopressor, which elevates blood pressure to overcome the resistance of narrowed blood vessels. An alternative intervention to prevent stroke is angioplasty. In this procedure, a surgeon uses a catheter to inflate a tiny balloon that expands a narrowed blood vessel in the brain. A drug known as a vasodilator also may be used to expand blood vessels in the affected area.
  • Anti-seizure medications may be used to treat seizures related to a ruptured aneurysm. These medications include levetiracetam (Keppra), phenytoin (Dilantin, Phenytek, others), valproic acid (Depakene) and others. Their use has been debated by several experts, and is generally subject to caregiver discretion, based on the medical needs of each patient.
  • Ventricular or lumbar draining catheters and shunt surgery can lessen pressure on the brain from excess cerebrospinal fluid (hydrocephalus) associated with a ruptured aneurysm. A catheter may be placed in the spaces filled with fluid inside of the brain (ventricles) or surrounding your brain and spinal cord to drain the excess fluid into an external bag. Sometimes it may then be necessary to introduce a shunt system — which consists of a flexible silicone rubber tube (shunt) and a valve — that creates a drainage channel starting in your brain and ending in your abdominal cavity.
  • Rehabilitative therapy. Damage to the brain from a subarachnoid hemorrhage may result in the need for physical, speech and occupational therapy to relearn skills.

Treating unruptured brain aneurysms

  • Aneurysm clip
  • Endovascular coiling

Surgical clipping or endovascular coiling or a flow diverter can be used to seal off an unruptured brain aneurysm and help prevent a future rupture. However, in some unruptured aneurysms, the known risks of the procedures may outweigh the potential benefit.

A neurologist, in collaboration with a neurosurgeon or interventional neuroradiologist, can help you determine whether the treatment is appropriate for you.

Factors to consider in making treatment recommendations include:

  • The size, location and overall appearance of the aneurysm
  • Your age and general health
  • Family history of ruptured aneurysm
  • Congenital conditions that increase the risk of a ruptured aneurysm

If you have high blood pressure, talk to your doctor about medication to manage the condition. If you have a brain aneurysm, proper control of blood pressure may lower the risk of rupture.

In addition, if you smoke cigarettes, talk with your provider about strategies to stop smoking since cigarette smoking is a risk factor for formation, growth and rupture of the aneurysm.

Mayo Clinic neurosurgeons are experts in each of these procedures and have pioneered many new techniques. They also regularly use advanced technology, such as 3D-printed models and computer simulations, to better understand the structure of the blood vessels and to plan surgery.

Mayo Clinic surgeons are trained in open vascular and endovascular neurosurgery, including minimally invasive techniques, such as the modified eyebrow incision, endoscopic skull base surgery and transnasal endoscopy. They are also experts in using computer-assisted technologies to navigate the brain during surgery and microvascular surgery.

Lifestyle changes to lower your risk

If you have an unruptured brain aneurysm, you may lower the risk of its rupture by making these lifestyle changes:

  • Don’t smoke or use recreational drugs. If you smoke or use recreational drugs, talk to your doctor about strategies or an appropriate treatment program to help you quit.
  • Eat a healthy diet and exercise. Changes in diet and exercise can help lower blood pressure. Talk to your doctor about changes appropriate for you.
Aneurysm clip
Endovascular coiling

How did it happen? My brain aneurysm story: details unfolded Part II-Treatment

His story continues…

They decided to airlift you to Pretoria, South Africa, close enough to the medevac center for US Diplomats in the region. We all agreed that despite the risks involved with flying, it was the only best option to help save your life. AMREF air ambulance from Nairobi, Kenya, was organized and by 4pm on Saturday, about 15hours from when the aneurysm happened, you were on the tarmac in Entebbe airport ready to depart for South Africa.

The kids and I flew separate on a commercial airline after the plan to go with you in the air ambulance failed. We arrived in early Sunday morning and I had a lot of help from the Embassy. They helped organize for nannies, transportation, accommodation, and treatment for the kids.

You were send straight to Kloff Hospital where the neurosurgeons immediately started working on your case. Surgery was scheduled for Monday, August 1st. At that time, it was all up to God to guide everything. Almost all of the family members, friends, and relatives who were aware of your condition, were praying. Everything was being done by the hospital staff to keep you stable until the bleeding was stopped. I was anxious but hopeful.

The long awaited day came for the procedure to be done, I signed the papers and off they took you. I waited anxiously in the waiting room for the doctor to come out with good news. The procedure was to take 3-4hours. As I was gazing at the postings on the wall related to all types of aneurysms, the door opened and it was your neurosurgeon. It had only been 30minutes since they took you in. What could he be doing here right now? I asked myself as I starred at the disappointment look on his face. “Mr. Field, I am sorry to disappoint you, I know how anxious you are but things didn’t turn out the way we had planned. There has been a change of plan.” I don’t recall if I said anything to him or heard the rest of what he had to say. All I remember is feeling like somebody had just punched me right in the chest and removed my heart. I felt like I had stopped breathing. My whole body was shaking, my vision was blurry and my mind was blank all to the thought of having lost you. I must have fallen back or perhaps fainted but I recall the doctor calling a nurse to bring me some water and a cold wash cloth. After a few minutes, he explained to me that they had not lost me but rather cancelled the procedure after it was deemed to be more risky than previously assumed. He then added that he was going to consult with other neurosurgeons and the Embassy Doctor in order to come up with the safest yet most effective plan.

They brought you out of the surgery room looking a little bit drowsy from the anesthesia but still had your beautiful smile. I was so happy to see you even though I was dying inside from the anxiety. Your memory was still bad and you asked the same repetitive questions but every time I looked into your eyes, I saw hope, I saw life, I saw outstanding strength. One side of me was telling me that I shouldn’t sign the papers to give them authority to perform the procedure and accept all the complications, including death, which might occur. It was better to have you alive at that moment, bedridden, and confused than not to have you at all. I wished badly to freeze that moment in time because that was all I was sure of. The kids and I would wanted to see you and have your presence in our lives despite the disorientation. The thought of losing you especially after the procedure was stopped that day was impossible for me to accept and carry on with life. The other side of me was telling me to take the risk and have them do the procedure. Despite all the risks involved, somehow, I knew you were going to be fine. My heart was content with that decision. I tried to ask you what you wanted me to do but you were not able to answer. You did not respond to any questions that I asked other than the programed ones.

Later that day, the neurosurgeon came in and told me that they were going to transfer you to Netcare Unitas Hospital in Centurion where the other neurosurgeon would take lead on carrying out the procedure the following day. At this point, time was critical, every second was counting. The ambulance was organized and you were transferred to the ICU unit in Unitas Hospital. I went back to the hotel to organize for early checkout to another hotel that would be closer to Unitas Hospital and relieve the nanny from her job. At this point, all the kids were sick, the oldest one had refused to eat food insisting that he only wanted mama to feed him. Luckily, there was one nanny who agreed to stay for almost a week until your sister arrived. This nanny was so kind to the kids and was able to gain trust from our son, who later agreed to take food from her. This allowed me time to focus on you, the children’s medical needs, and my job.

The following day, I headed to the Hospital where you had been transferred to prepare for your procedure. I signed the documents as required and the two neurosurgeons together with the medical doctor informed me that after a careful review of the procedure, they decided to go ahead and do it using a different but safer approach. Both neurosurgeons were going to perform the coiling procedure. Well, that was enough to reassure me that God was in control and no matter what the outcome would be, the best available approach was being used. So, off you went. I kissed you softly and told you that I would see you shortly. You smiled back and that is all I needed.

Approximately three and half hours later, the lead neurosurgeon came to me in the waiting area. He seemed relaxed and content. Without wasting time, he told me “Mr. Field, your wife should be out shortly, the procedure went very well and she is expected to make full recovery in 2-8weeks but the memory should start improving as soon as the anesthesia wears off.” Tears of joy were dripping down my cheeks as I reached out to him and extended my gratitude. I was overjoyed, I wanted everyone to know that you were okay, I could not stopping smiling and thanking God. I did not mind waiting for an extra 30minutes while you were still in recovery room because I knew you were alright.

It was not too long before they brought you out on the stretcher and we started making our way to your room. As soon as we entered the elevator, however, you started coughing uncontrollably that the nurse started paging for help. She rushed you into your room where we found a team of care providers waiting. The physiotherapy took the lead to stabilize you. Fortunately, she was able to stabile you within 30minutes. I think she gave you a breathing treatment and bumped up your oxygen supply. After that, you started to verbalize more but you still complained of a severe headache. The nurse requested that I leave so she could give you some pain medicine and allow you time to rest. So, I left with a heart filled with joy ready to go and deliver the good news to the kids and our loved ones who had all been praying tirelessly and waiting anxiously to hear about the outcome of the procedure.

When I returned in the evening, you could talk to me, ask me different questions about the kids and what had happened to you and how we ended up in South Africa. You were able to follow a conversation although your memory, short term memory in particular, was not as sharp as it used to be.  When I came back the following morning, however, you had improved a lot. The focus was now on your recovery.

Brain Aneurysm: Diagnosis

Can you spot the 2 aneurysms? The big balloon was the largest and below it was the smallest one that is still intact. This is one of the pictures from my angio showing the aneurysm before the embolization. Zoom in close for details.
This scan compares the brain pre-embolization (top half) and post-embolization (bottom half). Zoom in close for a clear view and details.

Most brain aneurysms go unnoticed until they rupture or are detected during medical imaging tests for another condition. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Cerebral-Aneurysms-Fact-Sheet#5

If you have experienced a severe headache or have any other symptoms related to a ruptured aneurysm your doctor will order tests to determine if blood has leaked into the space between the skull bone and brain. 

Several tests are available to diagnose brain aneurysms and determine the best treatment. These include: 

  • Computed tomography (CT)This fast and painless scan is often the first test a physician will order to determine if blood has leaked into the brain.  CT uses x-rays to create two-dimensional images, or “slices,” of the brain and skull.  Occasionally a contrast dye is injected into the bloodstream prior to scanning to assess the arteries, and look for a possible aneurysm.  This process, called CT angiography (CTA), produces sharper, more detailed images of blood flow in the brain arteries.  CTA can show the size, location, and shape of an unruptured or a ruptured aneurysm. 
  • Magnetic resonance imaging (MRI).   An MRI uses computer-generated radio waves and a magnetic field to create two- and three-dimensional detailed images of the brain and can determine if there has been bleeding into the brain.  Magnetic resonance angiography (MRA) produces detailed images of the brain arteries and can show the size, location, and shape of an aneurysm. 
  • Cerebral angiography.  This imaging technique can find blockages in arteries in the brain or neck.  It also can identify weak spots in an artery, like an aneurysm.  The test is used to determine the cause of the bleeding in the brain and the exact location, size, and shape of an aneurysm.  Your doctor will pass a catheter (long, flexible tube) typically from the groin arteries to inject a small amount of contrast dye into your neck and brain arteries.  The contrast dye helps the X-ray create a detailed picture of the appearance of an aneurysm and a clear picture of any blockage in the arteries. 
  • Cerebrospinal fluid (CSF) analysis.  This test measures the chemicals in the fluid that cushions and protects the brain and spinal cord (cerebrospinal fluid).  Most often a doctor will collect the CSF by performing a spinal tap (lumbar puncture), in which a thin needle is inserted into the lower back (lumbar spine) and a small amount of fluid is removed and tested.   The results will help detect any bleeding around the brain.  If bleeding is detected, additional tests would be needed to identify the exact cause of the bleeding. 

In the next segment, I will talk about treatment.

Brain Aneurysm: Symptoms

From a Distance by Bette Midler.
https://www.youtube.com/watch?v=hLHE9jrb_N4

I remember having a constant headache for 2 days or so prior to the rapture. The pain wasn’t overwhelming and I could tolerate it. I would rate it a 2 on the scale of 1-10 with 10 being the worst. New mothers, me being one of them, tend to ignore little things that their bodies are trying to communicate. We give excuses in order to make ourselves feel better. It is very true we are tired most of the time with little to no adequate rest most of the time. We prioritize the needs of our children and our loved ones. The question that still ponders my mind is – ‘was the aneurysm ruptured already prior to my hospital admission and the bleeding just got worse or did it rapture on that hectic night?’ The doctors that I have met with haven’t given me a conclusive answer yet. They tend to say…..in so many words——“we just don’t know”

So what are the actual symptoms of a brain aneurysm?

Please do not sit and start guessing what could be wrong with you or your loved one. Get emergency care if you suddenly get an intensely painful headache, lose consciousness, or have some of these other symptoms of an aneurysm that has ruptured: I cannot emphasize enough to you how critical it is to get that medical care urgently. Get help if you think something is wrong with your body. DO NOT WAIT.

Although brain aneurysms usually don’t show symptoms, they can press on the brain and nerves as they get bigger. See a doctor at once if you’re having the following symptoms of an unruptured aneurysm:

  • Headache
  • Dilated pupils
  • Blurred or double vision
  • Pain above and behind an eye
  • Drooping eyelid
  • Hard time speaking
  • Weakness and numbness in one side of your face

Please remember that no matter what you are going through or how things turn out, you are not alone. God is with you and He has everything under control. He will lead you to where you need be at the right time. He will bring the right people to your case. God is watching us from a distance. You are a very special child of Him. Have faith and trust in nothing else but in Him. https://www.youtube.com/watch?v=hLHE9jrb_N4

Brain Aneurysm: Risk Factors/causes

Brain aneurysms/cerebral aneurysms form when the walls of the arteries in the brain become thin and weaken.  Aneurysms typically form at branch points in arteries because these sections are the weakest.  Occasionally, cerebral aneurysms may be present from birth, usually resulting from an abnormality in an artery wall. Reference          

Risk factors for developing an aneurysm

Sometimes cerebral aneurysms are the result of inherited risk factors, including:

  • genetic connective tissue disorders that weaken artery walls
  • polycystic kidney disease (in which numerous cysts form in the kidneys)
  • arteriovenous malformations (snarled tangles of arteries and veins in the brain that disrupt blood flow.  Some AVMs develop sporadically, or on their own.)
  • history of aneurysm in a first-degree family member (child, sibling, or parent).

Other risk factors develop over time and include:

  • untreated high blood pressure
  • cigarette smoking
  • drug abuse, especially cocaine or amphetamines, which raise blood pressure to dangerous levels. Intravenous drug abuse is a cause of infectious mycotic aneurysms.
  • age over 40.

Less common risk factors include:

  • head trauma
  • brain tumor
  • infection in the arterial wall (mycotic aneurysm).

Additionally, high blood pressure, cigarette smoking, diabetes, and high cholesterol puts one at risk of atherosclerosis (a blood vessel disease in which fats build up on the inside of artery walls), which can increase the risk of developing a fusiform aneurysm.

Risk factors for an aneurysm to rupture

Not all aneurysms will rupture.  Aneurysm characteristics such as size, location, and growth during follow-up evaluation may affect the risk that an aneurysm will rupture. In addition, medical conditions may influence aneurysm rupture.

Risk factors include:

  • Smoking.  Smoking is linked to both the development and rupture of cerebral aneurysms. Smoking may even cause multiple aneurysms to form in the brain.
  • High blood pressure.  High blood pressure damages and weakens arteries, making them more likely to form and to rupture. 
  • Size.  The largest aneurysms are the ones most likely to rupture in a person who previously did not show symptoms.
  • Location.  Aneurysms located on the posterior communicating arteries (a pair of arteries in the back part of the brain) and possibly those on the anterior communicating artery (a single artery in the front of the brain) have a higher risk of rupturing than those at other locations in the brain.
  • Growth.  Aneurysms that grow, even if they are small, are at increased risk of rupture.
  • Family history.  A family history of aneurysm rupture suggests a higher risk of rupture for aneurysms detected in family members.
  • The greatest risk occurs in individuals with multiple aneurysms who have already suffered a previous rupture or sentinel bleed.

For my case, I had been diagnosed with high blood pressure in the first trimester of my second pregnancy and the condition was being managed when I suffered the brain aneurysm. No family history of brain aneurysms that I am aware of. No smoking, no alcohol abuse, and absolutely no drug use except for the ones for BP and vitamins. My take from this is that we are all pretty much at risk. I have heard stories of completely healthy people, very athletic, and with no family history get them. The more information we know about brain aneurysms, the more lives we can help save.

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