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
factors for developing an aneurysm
cerebral aneurysms are the result of inherited risk factors, including:
connective tissue disorders that weaken artery walls
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.)
of aneurysm in a first-degree family member (child, sibling, or parent).
risk factors develop over time and include:
high blood pressure
abuse, especially cocaine or amphetamines, which raise blood pressure to
dangerous levels. Intravenous drug abuse is a cause of infectious mycotic
common risk factors include:
in the arterial wall (mycotic aneurysm).
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
factors for an aneurysm to rupture
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.
Smoking is linked to both the development and rupture of cerebral aneurysms.
Smoking may even cause multiple aneurysms to form in the brain.
blood pressure. High blood pressure damages and weakens arteries, making
them more likely to form and to rupture.
The largest aneurysms are the ones most likely to rupture in a person who
previously did not show symptoms.
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.
Aneurysms that grow, even if they are small, are at increased risk of rupture.
history. A family history of aneurysm rupture suggests a higher
risk of rupture for aneurysms detected in family members.
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
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
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.
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.
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.
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:
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.
“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 .
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.
From the last post, I shared my experiences on how I started to regain my consciousness ‘waking up from the nightmare’. I had a lot of confusion, anxiety, and general disorientation. The ‘obvious’ seemed to be ‘rare’ to me but I am forever thankful for the gift of life.
17: I shall not die, but live, and declare the works of the Lord.
Things are always better in the morning!
Have you ever had a really really bad nightmare only to wake up and find out that nothing really happened and it was just a very bad dream? Well, I have had those nightmares too only that one day I woke up to find out that I was living my worst nightmare!
The world around me seemed to be moving faster than I could comprehend. There were people talking, paging, mentioning the ICU room 3, elevator doors opening and closing, and the stretcher moving faster that there was no time to ask a question. Everyone around me seemed to know exactly what they were doing, everything seemed to evolve around me. Then before I could open my eyes, I froze in time.
Suddenly, the silence occupied the air and everything came to a complete stop. I found myself in a hypnopompic state listening to this song: I’m only human, I’m just a woman. Help me believe in what I could be And all that I am. Show me the stairway, I have to climb. Lord for my sake, teach me to take One day at a time.
One day at a time sweet Jesus
That’s all I’m asking from you.
Just give me the strength
To do everyday what I have to do.
Yesterday’s gone sweet Jesus
And tomorrow may never be mine.
Lord help me today, show me the way
One day at a time.
Do you remember, when you walked among men?
Well Jesus you know if you’re looking below
It’s worse now, than then.
Cheating and stealing, violence and crime
So for my sake, teach me to take
One day at a time.
One day at a time sweet Jesus
That’s all I’m asking from you.
Just give me the strength
To do everyday what I have to do.
Yesterday’s gone sweet Jesus
And tomorrow may never be mine.
Lord help me today, show me the way
One day at a time.
The lyrics to the song: One day at a Time https://www.youtube.com/watch?v=JhUvFqOY00I, were sounding so clear to me being sung in a very soothing female voice. When I opened my eyes, there was a lady standing by my bedside. She asked: Lady: ‘Mè, what kind of tea would you like to drink? Me: What kind do you have? Lady: Bush tea and black tea. You should drink the bush tea, it will help you heal sooner. Me: What is Bush tea and who are you and where am I? Are you the one who has been singing to me? Lady: (smiling) I will give you the Bush tea, the English call it Rooibos tea. We have been praying for you and waiting for you to wake up. Your husband just stepped outside but he should be back shortly. He came with the children, however, they would not let them in your room. Shame! It is okay take it easy. Here is your tea and some rusks.
She left the room without giving me another chance to ask more questions or give me time to comprehend what was going on. Furthermore, I was experiencing a really bad headache that I could barely get the strength to reach out for my special tea. Just then, the nurse came back. She asked me how I was doing and if I needed any medicine for the headache. It was as though she was quite familiar with the pain that I was having. I told her it was about a 9 out of 10 and she gave me some medicine that went under my tongue. The medicine acted instantly and I was able to drink my tea. The nurse told me she would be around if I needed anything. Apparently, she was my private nurse since I needed much attention.
I think I must have fallen back asleep because when I woke up, my husband was sitting next to me on a chair holding my hand with tears rolling down his eyes. I could not comprehend the world around me. Before I could gather my thoughts and ask him why he was crying, a lady came in my room. She told me that she was the physiotherapist and was going to give me a breathing treatment. She also told me that she was glad to see me awake and alert with a lot of improvement. She asked me if I was still coughing and how bad my headache was. Before I could gather my thoughts and say something, the mask was already on my face and the breathing treatment had been started.
A lot of questions were going through my mind and I wished for someone to tell me where I was, where my children were and what was going on with me. I started staring at the pictures on the wall while the breathing treatment was going on. Then, I started to realize that perhaps I was in the hospital but was not quite sure where. The words in the pictures on the wall were written in English and Afrikaans. How could this have happened so fast? The last thing I remembered was getting my kids ready for bed as usual in our residency in Uganda. It was on Friday, my husband usually came home early from work. Our house help had requested to have off on that day and was to come to work the following day, Saturday, instead. My husband went to bed early because he was feeling a bit tired. My oldest child wasn’t feeling well and he needed a lot of attention from me. He must have caught a cold or flu from his new school. My little one, who was only 5 months, was fine but needed mommy the most. That evening was a bit busy but nothing out of the ordinary that I couldn’t manage. We did our evening routing as usually and after the kids fell asleep, I went back to the family room to have a quiet moment where I could talk to God, something that I do often. After my prayer, I went to bed.
As I was still doing my flashback, the physiotherapist told me that my treatment was done and she will come back in 4hours time to give me another one. My husband was still sitting on the chair by my bed. I noticed a great sense of relief on his face. I tried to talk but I don’t think he heard me or maybe I just did not say anything out loud. He held my hand again and told me that he loved me so much and he vows to take care of me no matter what happened. He also told me that my family was praying for me and my sister was in the process of acquiring her Visa to come and see me. It appeared as though he was reading my mind and he had started answering some of the questions I had in my head.
Finally, I opened my mouth and was able to speak. The first thing I told him was to give me something for the headache. He told me he would notify the nurse immediately. While we were waiting for the nurse, I managed to ask him a question that was bothering me the most: where were the children. He told me the children were in the hotel with a nanny that the staff from the CLO office at the embassy had recommended. He said that besides the flu, they were doing well. I wanted to know what they were feeding the baby since I had never introduced her to formula and she had refused to use the bottle. He said that she was taking formula from the bottle and she was also eating baby cereal. Then I wanted to know how my son was doing. He said that he was fairing on well and was taking medication that the doctor had ordered for him from the health unit at the embassy. He said that he would not eat any food but was drinking pediasure that I had instructed him to buy the day we left Kampala for South Africa. When I heard the mention of South Africa, I asked him if that is where we were and what had happened to me exactly. So, that led him to start narrating to me what had happened exactly. Before he could start, however, the nurse interrupted when she brought me the pain medicine. At the same time, a man came in with a stethoscope around his neck and introduced himself as one of the neurosurgeons who had done my procedure. He had come to check on me and see how I was progressing. He was concerned about the severe cough I had developed following the coiling procedure but was glad to hear the positive report from the physiotherapist. He listened to my lungs and said that I was fine but will continue with the breathing treatments and he would come back the following day to check on me.
Again, I found myself very confused with all the bits and pieces of information that I was gathering from various people. I was ready for everyone to leave so I could have time with my husband to know exactly what had happened to me. Unfortunately, as soon as the doctor left the room, the nurse told my husband that he had to leave too since the visiting hours were done and he had overstayed. I begged with her to let him stay a little bit longer but she insisted he had to leave and that I needed to rest. My husband kissed me goodnight and told me that he would see me the following day. Everything was dim in my room and I had no idea what time, day, date or place I was. The nurse stayed in my room with me the entire night.
As I was laying there in my bed trying to put all the pieces together and try to understand what was going on with me, the nurse approached me with a message. She said that my brother from the US had called to check on my progress and he had extended his well wishes. She also said that he wanted to talk to me but the doctor wanted me to rest and limit a lot of brain stimulation for that day following the procedure. There was a lot of new information that I was receiving but nobody had told me even a third of the information that I needed to know. I managed to ask the nurse to give me some information on where I was exactly and why. She told me that I was at Unitus hospital in Centurion, South Africa in the ICU unit and I had suffered a brain aneurysm approximately 5 days ago while in Uganda. I wanted to know more but she advised me to get some rest and the following day my husband, the doctor, and nurses would give me full details. With a bit sense of relief, I was able to relax knowing at least some of the key details that I was dying to know.
That was probably one of the longest nights I can remember. I was resting but not sleeping. My mind was wandering all over the place with so many questions to ask but no one to talk to at the time. I wished and hoped for that moment to be a nightmare and I will wake up the following day to my normal life. I truly missed my kids and I just wanted to hug them and spend time with them, I wanted to cook for them, I wanted to play with them. Even though I had a lot to be worried about, I knew that I had something great to be thankful for. That was the gift of life.
Brain Aneurysm Statistics and Facts • An estimated 6 million people in the United States have an unruptured brain aneurysm, or 1 in 50 people. • The annual rate of rupture is approximately 8 – 10 per 100,000 people or about 30,000 people in the United States suffer a brain aneurysm rupture. There is a brain aneurysm rupturing every 18 minutes. Ruptured brain aneurysms are fatal in about 40% of cases. Of those who survive, about 66% suffer some permanent neurological deficit. • 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. • 4 out of 7 people who recover from a ruptured brain aneurysm will have disabilities. • Brain aneurysms are most prevalent in people ages 35 – 60, but can occur in children as well. The median age when aneurysmal hemorrhagic stroke occurs is 50 years old and there are typically no warning signs. Most aneurysms develop after the age of 40. • Most aneurysms are small, about 1/8 inch to nearly one inch, and an estimated 50 to 80 percent of all aneurysms do not rupture during the course of a person’s lifetime. Aneurysms larger than one inch are referred to as “giant” aneurysms and can pose a particularly high risk and can be difficult to treat. • Women, more than men, suffer from brain aneurysms at a ratio of 3:2. • African-Americans at twice the rate of rupture of whites (a 2.1:1 ratio) • Hispanics at nearly twice the rate of rupture of whites (a 1.67:1 ratio) • Ruptured brain aneurysms account for 3 – 5% of all new strokes. • Subarachnoid hemorrhage (SAH) is one of the most feared causes of acute headache upon presentation to the emergency department. Headache accounts for 1 – 2% of the emergency room visits and up to 4% of visits to the primary care offices. Among all the patients who present to the emergency room with headaches, approximately 1% has subarachnoid hemorrhage. One study put the figure at 4%. • Accurate early diagnosis is critical, as the initial hemorrhage may be fatal, may result in devastating neurologic outcomes, or may produce minor symptoms. Despite widespread neuroimaging availability, misdiagnosis or delays in diagnosis occurs in up to 25% of patients with subarachnoid hemorrhage (SAH) when initially presenting for medical treatment. Failure to do a scan results in 73% of these misdiagnoses. This makes SAH a low-frequency, high-risk disease. • There are almost 500,000 deaths worldwide each year caused by brain aneurysms and half the victims are younger than 50. • Based on a 2004 study, the combined lost wages of survivors of brain aneurysm rupture and their caretaker for a year were $138,000,000 • The cost of a brain aneurysm treated by clipping via open brain surgery more than doubles in cost after the aneurysm has ruptured. The cost of a brain aneurysm treated by coiling, which is less invasive and is done through a catheter, increases by about 70% after the aneurysm has ruptured. • 10 – 15% of patients diagnosed with a brain aneurysm will harbor more than one aneurysm. • The federal government only spends approximately $0.83 per year on brain aneurysm research for each person afflicted.