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.

Brain Aneurysm: Definition

Let’s be honest, how many people are familiar with brain aneurysm? Even with a background in healthcare, I did not know what brain aneurysms were all about except for the definition. Often, we find ourselves becoming quite familiar with a condition once we experience it either directly or indirectly.

According to WebMD, https://www.webmd.com/brain/brain-aneurysm#1 , brain aneurysm is defined as below:

Think of a weak spot in a balloon and how it feels stretched out and thin. A brain aneurysm is like that. It’s a weak spot in the wall of a blood vessel inside the brain.

That area of the blood vessel gets worn out from constant flow of blood and bulges out, almost like a bubble. It can grow to the size of a small berry.

Although brain aneurysms sound alarming, most don’t cause symptoms or health problems. You can enjoy a long life without ever realizing that you have a brain aneurysm.

But in rare cases, aneurysms can grow big, leak, or explode. Bleeding in the brain, known as hemorrhagic stroke, is very serious and requires urgent medical care.

A ruptured brain aneurysm can be life-threatening and lead to:


Recap from last post: How did it happen? My brain aneurysm story- details unfolded Part 1

  • Let’s just highlight some of the details from how it happened. So, now we know that I have been diagnosed with a ruptured brain aneurysm a.k.a cerebral hemorrhaging and 1 still intact. The doctor has made it clear that I am in the best hospital in the country and he has no equipment of performing the urgent procedure to stop the bleeding. He also notes that I only have about 3days to do something about it. Also, it seems like most of my memory has been affected and I’m only able to remember my husband (thank goodness) and a set of 7 questions that I’m asking in the same order. The other thing that I did not mention in the last post is that, at that time when I arrived at the hospital, my BP was in the 60’s/40’s. If you are familiar with the way BP functions, that is a very low number. My oxygen level was in the 70’s and my respirations ranged between 4-6 per minute. My initial vital signs were abnormal but promising. As soon as I arrived in the ICU and after obtaining those vital signs, they began treatment to stabilize me, thus, my regain of consciousness and ability to ask those 7 questions.  

Fact:

Approximately 15% of patients with aneurysmal subarachnoid hemorrhage (SAH) die before reaching the hospital. Most of the deaths from subarachnoid hemorrhage are due to rapid and massive brain injury from the initial bleeding which is not correctable by medical and surgical interventions. https://www.bafound.org/about-brain-aneurysms/brain-aneurysm-basics/brain-aneurysm-statistics-and-facts/

What really saved me???

  1. I must say that taking that aspirin when I first asked my husband to give it to me initially before things got worse prevented my blood from coagulating and forming a blood clot that might have caused severe brain damage or even resulted in death https://www.webmd.com/drugs/2/drug-1082-3/aspirin-oral/aspirin-oral/details  
  2. The other thing and perhaps very crucial is the knowledge of CPR on my husband’s side. He was the caregiver and his actions kept me alive. First, he established a safe environment to allow him to concentrate on me by keeping the baby in her crib even though she was crying. Second, when he realized that I was vomiting uncontrollably, his goal was to keep the airway open and place me in an upright position or side laying position to prevent possible aspiration. At this stage, most people die from food and fluid aspiration. If you can’t use your hands to keep the victims mouth open, use anything closest to you that is steady such as a nicely folded big piece of clothing, a book…etc. Third, he called for help by screaming and hoping that the guards could hear him and by grabbing the walkie talkie to communicate with post one.  Calling for help is very important because you really can’t tell how things are going to turn out. As a caregiver, you need reassurance and a confirmation that help is on the way. You are exhausted. This is why it is a must you know the emergency phone number of your country’s emergency response system. Teach your children too. Kids will amaze you on how much they are capable of doing. When you shout for help and a lot of bystanders arrive, instruct them on what to do rather than have them crowd the area and limit the oxygen supply and just be observers…..they can be a big distraction. For my case it was different because we were in Uganda under Diplomatic status so we had to follow a different chain of emergency response system. Whatever your circumstance is…prepare for an emergency and know what to do when you are faced with one.
  3. Upon arrival at the hospital, they demanded an admission fee before they could attend to me. As sadly as it sounds, unfortunately, it is the common system in most developing countries. Most people make it to the hospital on time but they die in the waiting room due to lack of funds. I was fortunate that when one of our embassy nurses arrived, she took charge because it was a diplomatic medical emergency and they had to act fast unless they were ready to carry the blame incase things turned out for the worst. My goal is to advocate for the common person in the developing countries who is treated different upon arrival to medical facilities due to lack of funds or insufficient funds that could allow them access to proper medical care.
  4. Now that we know the diagnosis, we probably should dig deeper to learn more about it before we move onto the next step of treatment. In the next postings, I’m going to talk about:
  • Definition
  • Risk factors
  • Symptoms
  • Diagnosis
  • Basic CPR

How did it happen? My brain aneurysm story: details unfolded Part 1

Since I have no idea how it happened. Here is the account of the details from my husband who was with me. This is absolutely crazy and it can happen to anybody at any time. The more information you know the better off you are to help someone caught in a similar situation (I hope you or your loved ones never have to go through this incident). However, knowledge is power.

His Story…

“The time was approximately 1 o’clock in the morning on the night of July 29th, early hours of July 30th.  You put on all the lights, woke me up and stated that you were experiencing a terrible headache with symptoms that made you feel like you were having a heart attack. In the rush of it all, you instructed me to give you an aspirin, one tablet of the labetalol, and grab the blood pressure machine to check your blood pressure. All that time, you were holding your head and complaining of the terrible pain.  I knew right away it was serious and I had to act immediately. Moving as fast as my legs could allow me, I grabbed the aspirin and gave it to you with a bottle of water. As soon as you took the medicine, you fell down on the floor still holding the bottle of water by your mouth. It was crazy! I put you in a sitting position and run downstairs to grab the blood pressure machine. As I was hurrying up back to the bedroom, I heard the baby screaming. I didn’t know what do. I wanted to go and get her but I wanted to attend to you. I made a split second decision to go in the bedroom, take your blood pressure and then checked on the baby moving as fast as I could. When I returned to the bedroom, you were still sitting down in the same position and still complaining of the terrible headache. I decided to go and get the baby so she wouldn’t wake up her brother and placed her on our bed. Before I could even get her comfortable, you fell over and started throwing up. The baby started screaming too. It was chaos and I had to make another split second decision. I decided to take the baby back to her room and placed her in the crib where I knew she would be safe even if she was crying. That would allow me time and concentration to take care of you. When I returned to the bedroom, you appeared unconscious. I was panicking and it hit me that I really didn’t have much time and I needed help. I tried to scream for help but I don’t know if the guard outside heard me. I wanted to make a call but I couldn’t locate my phone. Through all that confusion, I decided to focus on you. There was fluid and waste coming from almost all of your openings. There was blood, there was vomit, and there was feces. My heart was pounding, and you were dying right in front of me. All the training that I had in DC before we departed for Uganda started ringing in my head. I knew I had to keep your airway open while I waited and called for help. I cried to God for courage, begged him to save your life, and to guide me. I focused on keeping your airways open. You kept on throwing up but you were unconscious and I was afraid you might aspirate on the vomit and die. So, I kept you on your side with your head on my thighs and placed my fingers inside your mouth. It was a real struggle trying to keep your mouth open since you were biting your teeth together so hard. I still have a bruise on my hand from when you bit me while trying to keep your mouth open. Everything seemed to be happening so fast, it was worse than a horror movie. I begged you to hold on and help me fight for your life. You have always been strong in every way imaginable and I knew you had it in you even though you were not responding. With one hand still in your mouth, I managed to drag you along and grab the walkie talkie. I called post one and the marine corps on duty responded. I can’t recall the whole conversation but I know I kept on telling him that you were dying and I needed urgent help. He kept on telling me to do CPR and not to stop until help arrived. That kept me going until I heard a knock on the door. The Marine Corps told me that help had arrived and if the door was locked they could cut it down or I could run downstairs and open the door. I was left in a dilemma again. Cutting down, would take longer than necessary since it was a heavy duty door made out of wood and steel. So, I made a quick decision to run downstairs and open the door while I had you on your side with a piece of clothing in between your teeth. I hurried up to find you in the same position. The two security guards came up to get you and take you to the hospital. Everything was so quiet at that time, your respirations were down to less than 6 per minute, your eyes were rolled back, I was panicking but still very hopeful. The security guards thought you were dead already but I saw life in you. “Banange banange….madam is dead!” Screamed the guard on duty. He was crying but I stopped him and begged him to pray rather than cry. I told him you were still breathing just a little bit slow. We covered you in the blanket and carried you down to the security guard’s SUV. I requested our guard to watch the children while I went to the hospital with the other guard and organized for more help. I was worried about the children but I knew they will survive even if they cried and they would be more than happy to see you alive. I sat in the back of the SUV with your head on my laps. It was the longest ride of my life. My phone was ringing nonstop but I did not have the nerve to answer, I couldn’t talk, I didn’t know what to say, I kept on begging you to hang onto life, I kept on calling the name of God asking him to guide us, to keep you alive. Part of me was telling me that it was too late to save you and I should just accept that but another part of was telling me that you were going to be alright and I should keep the faith till we restore your life back. Your respirations were still so low, becoming less and less to probably less than 4 per minute, your eyes were still rolled back, you couldn’t respond to anything. I kept on telling the driver to go as fast as she could to the nearest hospital. She was communicating on the walkie talkie almost the entire time trying to organize the best hospital possible in Kampala to take me to. I heard her say that the nurse on duty had instructed her to go to International Hospital Kampala and she was making her way there.

Finally, we arrived at the Hospital. They put on you on the stretcher and wheeled you to the Emergency room. You were still non responsive at that time. The receptionist told me that they couldn’t see you until I paid an admission fee. I went to reach out for my wallet and then realized that I didn’t have it with me. Through all that hustle, I forgot my wallet in the house. I explained it to her but she insisted that it was the hospital policy. I begged, yelled, cried but all that didn’t make a difference. Luckily, I received a call from one of the embassy duty officers who had been in touch with the health unit nurse on duty and the Marine Corps who received my call for help. He told me that he had organized for help and someone from the embassy family was on her way to our house to stay with the kids and he was making his way to the hospital to assist as needed. He called to know if I needed anything from the house before he came to the hospital. I told him I needed my wallet to pay the admission fee so they could initiate treatment. Just as I was finishing up with him, the nurse from the embassy health unit arrived. I explained to her why they couldn’t see you and she immediately took charge. They took you to the ICU and told me, they would initiate care while I still waited for my wallet. As soon as we arrived in the ICU, the doctor evaluated you and ordered many diagnostic tests. While we were waiting in the hallway for one of the tests to be done, you opened your eyes and started talking. You were complaining of a really bad headache. I was so happy to see you awake and know that you were in the hospital. You asked me 7 questions: where you were, what time it was, was it daytime or night time, where were the kids, did the kids get something to eat….. You asked the same questions approximately every 10 minutes and I did not mind answering them at all, I was happy you were still alive. Sometimes I started answering the questions even before you asked because I had mastered them and was glad to be communicating to me. You did not remember anything else, you did not even remember the familial faces like that of the nurse from the health unit whom you had interacted with several times in the past. But I was glad you remembered who I was.

After the tests were done, the doctor came in to deliver the news of your diagnosis. He said that you had suffered a brain aneurysm. One had ruptured but there was still another small one unruptured. I asked him what they could do to save you and your chances of survival. He said that, he could perform a procedure to stop the bleeding but he did not have all the necessary equipment to do the procedure. He added that if the bleeding was not stopped, you might not last for 3days. Besides that, there was not another hospital within Kampala or anywhere in Uganda capable of handling your condition. Basically, the choice was to leave you there while they control the pain and let things turn out for the worst or transfer you to Nairobi, Kenya or South Africa for the treatment to be done. Even though the transfer was the best and only option, the biggest risk and threat was inability to tolerate altitude and increased air pressure which could increase the bleeding and/or cause the other aneurysm to burst which could turn out to be catastrophic. The debate began between the local medical provider and the regional medical provider to come up with the best plan possible. “

Father, let your Holy Spirit come down and take control over my life and in the lives of my brothers and sisters all over the world who need you right now in their lives. Let your living water pour over their souls and in every aspect of their lives. Let them witness your everlasting love and miraculous powers. We thank you Lord, we adore you King of Kings and we Praise your Holy name. https://www.youtube.com/watch?v=bzxWhUv8dyg .

Part 11 to follow very soon.

How did it happen? My brain aneurysm story: Overview

It’s in the raw hours of Saturday morning on July 29th, 2017, 1:00AM to be exact. Nothing much seems to be going on in this posh neighborhood of Kampala, except for the security guards struggling to stay awake.  On the street of Naguru Vale, however, in one house, something is happening that will change the lives of this young aspiring family forever. “Somebody help, help me please, call the ambulance” A male voice is heard by the security guard on duty that night. Through the confusion, the security guard doesn’t know what do but listen keenly again for the voice. Meanwhile, the situation in this house is worsening. It’s a matter of life and death and time is of essence. “Post one, post one, can you read me? My wife is unresponsive, I need somebody to help me right now” My husband managed to get hold of the walkie talkie and placed a call that he hoped would end the nightmare.