‘The silent killer’
Stephanie Tubbs Jones was in excellent medical condition, by all accounts.
The longtime congresswoman from East Cleveland had spent her summer arguing in Congress for a plan to end the wars in Iraq and Afghanistan. And she spent most of that sweltering Tuesday in August 2008 planning for a forthcoming electoral-reform forum at Cleveland State University.
But as she drove through Cleveland Heights that night, Rep. Tubbs suffered a ruptured brain aneurysm and lost consciousness. Her car drove off the road and into an empty field.
At the hospital, less than 24 hours later, medical staff pronounced her dead.
Every year, up to 50,000 Americans suffer a ruptured brain aneurysm. A swollen blood vessel pops near the brain and the blood rushes in, often causing a stroke.
“It’s definitely a very serious disease—the silent killer,” said Tamer Abdelhak, MD, a neurologist who specializes in neurocritical care with Spectrum Health Medical Group. “A cyst grows in a blood vessel and when it pops, it releases blood that gushes through the brain.
“You will feel the worst headache of your life,” Dr. Abdelhak said. “About one out of three will die immediately when that happens, one out of three will go into coma or have severe paralysis, and one out of three will just have the bad headache.”
Even scarier, 1 in 50 Americans—about 6 million people—currently have an unruptured brain aneurysm growing in their skull.
People can be treated for this condition, but how does someone know when to get checked?
There are two good indicators, Dr. Abdelhak said.
The first is if at least two immediate family members have had brain aneurysms.
“Less than 10 percent of these can be related to family disease,” he said. “But if two first-degree family members have had it, the chances of that becoming a familial aneurysm disease become much higher.
“If you come in and tell me, ‘My grandpa and brother both had aneurysms,’ then all first-degree family members have to be screened by pictures,” he said.
The second indication? Unusually bad headaches and other uncommon symptoms.
“If you’re feeling absolutely perfect but you say, ‘My brother had an aneurysm,’ or ‘My sister had an aneurysm,’ no need to get checked,” Dr. Abdelhak said. “But if you have bad headaches, blurry vision, imbalance—especially if you’re not a person who normally gets bad headaches—that gets me worried.
“You know your own body,” the doctor said. “If you’re a young person and you get headaches all the time, migraines are a very benign disease. … But if you’re not typically getting migraines, and suddenly you’re having them every week, every day, and it’s causing sleep deprivation, stress, you should tell your doctors and they’ll start running tests.
“But if you have two in the family, I wouldn’t wait to develop symptoms,” he said. “Get checked every one or two years.”
If doctors do find an unruptured aneurysm, how do they fix it?
The less invasive method: a catheter through the groin.
“We push it all the way up until we go inside your brain, and we pack the aneurysm with small tiny metal coils,” Dr. Abdelhak said. “That requires a lot of skill. The risk of complication if the aneurysm hasn’t started bleeding … is about 1 to 3 percent.”
The tiny metal coils, about the width of a human hair, are shaped like a spring. They’re placed inside the aneurysm and they stay inside the patient permanently, ensuring the aneurysm never bleeds.
The second, more invasive method involves cutting open the patient’s skull.
Doctors then use a metal clip—“kind of like a hair clip,” Dr. Abdelhak said—to ensure the aneurysm doesn’t pop. It’s like tying off a balloon before too much air gets into it to prevent the balloon from reaching a breaking point.
“Coiling and clipping: What makes the decision?” Dr. Abdelhak said. “The size and shape of the aneurysm, as well as the clinical condition of the patient. … We tend to try to be less invasive. We’re lucky at Spectrum because we have all of the above options.
“I have five people who do this for a living and nothing else,” he said. “So, all of this gives us the ability to have layers of defense. If you come in and you have an aneurysm, we can fix it within 24 hours, 365 days a year.”
About 15 percent of patients whose aneurysm ruptures die before reaching the hospital, according to the Brain Aneurysm Foundation.
Last year, the case of pregnant mother Anna Weeber garnered headlines after a harrowing 24 hours. At home and six months pregnant, Weeber suddenly felt the worst headache of her life. She began vomiting and, over a very short period of time, lost control of her bladder before paralysis set in.
She was rushed to Spectrum Health Butterworth Hospital, where doctors decided to perform brain surgery and use the clipping method.
Less than 20 hours later, Weeber emerged safely from surgery. Both she and the baby survived without lingering symptoms.
“I think I’m a walking, talking miracle,” she said. “For me to have no mental or physical disabilities … it is humbling and overwhelming.”