Anna's Story

I've often thought about what a brain aneurysm patient must go through. What impact does the unanticipated existence and sudden rupture of a brain aneurysm have on that person and his or her loved ones? How does their world change? How and when do they heal? Will I ever truly understand?

Below is an account of a brief but critical epoch in the life of Anna, a brain aneurysm patient. "Anna" is her pseudonym. While I recognize that Anna's story is unique to Anna and her loved ones, there are threads of her story that are woven into those of many other brain aneurysm patients. I have included it in this Site to offer you hope and to focus on positivity. However, it is important to note that although Anna's outcome was excellent, many ruptured brain aneurysm survivors have very different experiences and outcomes. For the gamut of experiences in this condition, I refer you to the numerous narratives posted on the Website of Dr. Bill Maples ( take me to the narratives on the Aneurysm & AVM Support Website). The Brain Aneurysm Foundation also provides information and services related to support and recovery for patients with brain aneurysms ( take me to the Brain Aneurysm Foundation's Support and Recovery Section).

For families of ruptured brain aneurysm survivors, you may come across times when you are forced to make very difficult decisions, and deal with circumstances that you may never have imagined before such an event. Please be strong, persistent, and united. Your loved one is likely facing a life-altering event, whose recovery frequently requires considerable patience and ongoing love and support, even if the event seems to have changed them physically or psychologically. Such changes are not necessarily permanent. For persons who survive brain aneurysm rupture, you may need more help than you were previously used to or more than you are willing to accept. Such help is critical and should benefit you significantly. It may be in the form of physical therapy, a home nurse, a temporary stay in a Skilled Nursing Facility, Rehabilitation Center or a Nursing Home, more contact and support from your family members and your friends, more interaction with a Priest or Church, or an equivalent reglious or spiritual person or group. Time and positivity are so essential.

Anna's Warning Headache

Six weeks after completing her doctorate, Anna experienced what she described as the worst headache of her life while playing a tennis match on a bright and warm day with her Fiance. A headache was no complete stranger to Anna. She had experienced some relatively benign tension-band headaches during her final year at Grad School while writing and defending her Thesis, and also the rare migraine with nausea during her young life of 28 years thus far. While her mother carried a diagnosis of "migraine sufferer", Anna had no medical diagnosis, nor had she ever smoked. In any case, this particular severe headache of Anna's was very different to any that she or her mother had ever experienced. Anna reported that, uniquely, it came on suddenly, like a lightning bolt. Although she did not collapse or experience any vomiting or neurological disability with the onset of the headache, Anna felt as if her head had been struck suddenly and forcefully with a baseball bat. Her head was now pounding like it had never done before. She came off the court and sat for a while comforted by her Fiance, before he helped her to the car and home. During that short drive, she became nauseous, "dizzy", and vomitted. She didn't think of going to an Emergency Room. She was healthy, somewhat stoic, and as the headache improved slightly after an hour, she mistakenly wrote-off her headache to a bout of "heatstroke" during her Tennis match. Within four or five hours of lying down, her headache had improved more, but it took nearly two days before it resolved substantially. In the interim, Anna's Fiance had searched the Internet for causes of headache, and suggested to her that she might have experienced a "head bleed" or brain hemorrhage; because of this, he urged Anna to see her family doctor at once. Anna refused, citing that no one had suffered a head bleed in her family, and that she was only 28 years old, and thought it very unlikely for a young and healthy woman to have a brain hemorrhage. While Anna was correct in thinking that most young and healthy women are not likely to have spontaneous brain hemorrhages, her Fiance was correct in thinking that regardless of age, gender and previous health status, the kind of headache that Anna had experienced was very highly suggestive of a brain hemorrhage-related headache. That is, a headache caused by the sudden rupture of a diseased brain vessel. It turns out that this headache of Anna's represented a "warning leak" from a brain aneurysm she didn't know she had.

Anna's Life Suddenly Changes

Within two weeks of her warning headache and this time during sexual intercourse, Anna experienced another sudden-onset, severe headache. Her Fiance didn't need to be asked to call 9-1-1. Within minutes of their arrival, her paramedics strongly suspected a brain hemorrhage as the cause of Anna's headache. Her account was viewed as classic for this. She was rushed to the local Emergency Room. Upon arrival, Anna was found to be alert and neurologically intact, despite having a persistent severe headache, along with some neck stiffness and now a strong aversion to bright lights (holding her head, she just wanted to lie down in a dark room). She was taken to the CAT scanner. She recalled being transferred from her ER cart to the CAT scan table: A somewhat cold and unfamiliar experience, only made tolerable by the comforting voices of the two nurses and one technician who helped move her. Rolling into the relatively roomy doughnut opening of the Scanner was something like she had seen on Television. She could breathe comfortably within the central open space of the scanner, but couldn't help staring at the Unit's monotonous and motionless whitish interior, while hearing the strange whirring as its hidden Xray camera spun about her rapidly taking its many images. The scan itself only took three minutes, although she felt like it took much longer. Upon returning to her ER cubicle in the "Critical" area, she was seen and examined by the on-call neurology and neurosurgery residents, both of whom confirmed for Anna that her CAT scan revealed diffuse blood consistent with a bleed from a ruptured brain aneurysm, which they referred to as aneurysmal subarachnoid hemorrhage. Based on the CAT scan, they couldn't tell the precise origin of the bleed, and so had organized for Anna to have an emergent cerebral angiogram. They explained this procedure to Anna and her Fiance, including its benefits and risks. As she was transported from the ER to the Angiography suite, she stared at the bright lights and the face of her Orderly looming above and behind her. Through the unfamiliar corridoors which seemed to stretch on forever, all that Anna could think about were the words "brain hemorrhage". Her Fiance called her parents from the Emergency Room. He reassured them that she was okay, but his voice couldn't hide his own fear and uncertainty. No parent ever wants to hear such news. There were many tears. Although they lived over one-thousand miles away, Anna's parents would drive overnight to be with her. Her Fiance told them to drive carefully.

Anna's Aneurysm

Anna's battle had begun. The Neurosurgery Chief Resident whom she was now meeting for the first time, informed her that she had a middle cerebral artery aneurysm on the left side that had ruptured. There were no other aneurysms found on this study. Her aneurysm measured 9 mm in size, that is, at the very upper end of "small" aneurysm size, but it bore an irregular outpouching or "daughter sac" on its dome. This was felt to be the culprit site of rupture. Because of the wide "neck" of this aneurysm and the configuration of the two normal blood vessel branches coming out of its base, the neurosurgeon and his interventional neuroradiology colleague felt that this aneurysm would be better treated by surgery. They felt that putting platinum microcoils in it using the nonsurgical "catheter" or "endovascular" method posed a greater risk in sacrificing one of the two big vessel branches at the aneurysm's base, and might leave an unacceptable aneurysm remnant and therefore a higher risk of a stroke during the procedure, or delayed regrowth and rehemorrhage from the aneurysm. Direct surgical visualization and clipping of Anna's particular aneurysm might allow for a better and safer result, although for certain other aneurysms, endovascular treatment may have been a very appropriate alternative to surgery.

There was no question that Anna's aneurysm should be treated soon. Her doctors explained that rerupture, which they referred to as aneurysmal rebleeding, was associated with a very high mortality rate. The Neurosurgery Chief Resident and his Consultant had opted for treatment of the aneurysm first thing in the morning. It was already 2 a.m. at the time of their conversation, and they preferred to wait for the "regular" surgical day-team to be at hand during the operation, the commencement of which would be another five to six hours away. The neurosurgeon explained the type of surgery he planned to carry out, in addition to its risks and benefits, the treatment alternatives, the overall rationale for the surgical option in Anna's case, and the team approach. Anna later recalled that she in fact didn't take much of this in. Her Fiance did, but more so because he wrote down what was being communicated. It was a lot to take in for a young person all of a sudden. Anna could only think of the words "brain surgery" now, and how her previously full and vibrant life had suddenly taken a new and completely unexpected direction, with no certainty of its outcome.

The Days that Followed

At 7 a.m., with her Fiance by her bedside in the Neurointensive Care Unit and her parents still somewhere in transit, Anna was taken down to the Operating Room Holding Area. She wasn't nervous any more. She had resigned herself to the fact that being nervous wouldn't help her, even though for the next several hours, her life would be in a complete stranger's hands. A bizarre circumstance, but nonetheless true. She reassured herself that her surgical team wanted the very best for her, and were well trained to do what they were about to do. Her surgeon had told her she had "age on her side", being only 28 years old and otherwise completely healthy. She regretted not being able to see her parents before her operation, but kissed her husband goodbye, telling him to be brave for her. Her surgeon came by to ask her if she had any questions before surgery. She wanted to know how long it would take, and he replied: "As long as need be, but I think we should be out of there by noon if all goes to plan. Don't worry, we'll take good care of you". Her anesthesiologist, the physician who was going to put her to sleep for surgery and monitor her closely throughout, introduced himself, explaining what his role was and what she should expect. He told her that when she awoke, she would probably be breathing on her own without any tube or ventilator support, she would be "groggy" or woozy for several hours after surgery, and that she would have a small drainage tube called a lumbar drain coming from the small of her back. That was going to drain her blood-mixed cerebrospinal fluid like a spinal tap needle (except without the needle) to allow the blood to clear from the fluid filled spaces of her brain. The team then wheeled her into the OR.

Anna's surgery went to plan. In the early afternoon, her Surgeon came to her husband with a smile on his face and told him that the aneurysm had been clipped without any perceived complication, and that he was very hopeful that Anna would awaken with no new neurological problems. He said that the daughter sac coming from the dome of the aneurysm appeared to be the point of rupture as they had suspected, and he was confident that the postoperative angiogram would show the aneurysm obliterated by the single clip he placed across the neck of the aneurysm. Anna's husband was overcome with a mixture of profound relief, gratitude to persons he didn't know except for their brief words, and uncertainty about how Anna would wake up and what the future would hold. Nonetheless, for the moment, joy was his to hold on to. He sat down and wept.

When Anna first awoke that afternoon, she found herself in the Recovery Area, or at least that is what she kept hearing as she emerged from anesthesia. Her throat was sore from the breathing tube that had just been removed, and her vision a little blurry, but she could make out the faces of her surgeon and her anesthesiologist. They were telling her to lift up her arms, squeeze their fingers, and wiggle her toes, so she did. Her surgeon patted her on the arm and said all went well. She mumbled "thank you", then just closed her eyes and with the help of a little morphine, drifted back into a more peaceful sleep. When she reawoke, she was in her neuro ICU bed. The mechanical alarms and lights and nursing uniforms were all familiar to her from the night before. She soon registered that her parents and her husband were at the foot of her bed watching her. Her mother's eyes were red, and she looked weary, choking back the tears with difficulty. Anna knew she was trying to be brave. Anna smiled, and told them "See, I made it." Her mother burst out in tears as she hugged her. Being a parent must be so difficult in such times.

How Anna Healed

Anna spent a total of three nights in the neuro ICU. She was neurologically intact as far as strength and sensation were concerned, the special cranial nerves of her head appeared all normal to her physicians, and she appeared appropriately alert and interactive. Her scalp incision hurt a little, and she didn't like the urinary catheter. She had asked her mother to show her a mirror, and to her delight, found that only a thin strip of her wavy brown hair had been shaved. Her mother and nurse had already shampooed her hair. Her surgeon had stapled her incision closed, it looked neat, her left eye was a touch puffy maybe, but she reassured herself that this wasn't much of a big deal just then. After a head CAT scan on day three, she was told the blood in the subarachnoid space was clearing with the help of the lumbar drain that was placed at the time of surgery. Her surgeon had elected to also obtain a cerebral angiogram on day three, and brought them the good news that the aneurysm had been obliterated, without any compromise of the large arterial branches coming off just before its neck. He told them that she was good enough to "go to the Floor", but they would keep her in hospital a few more days so they could check on her for the development of cerebral vasospasm and hydrocephalus. He explained what these things were, and how they would check for hydrocephalus using a few more CAT scans, and for vasopasm using an ultrasound probe placed on her scalp every few days.

When Anna was transferred to the general neurosurgical care ward, she didn't take long to get herself out of bed to a chair, and with the assistance of her family and nursing staff, was walking in the hallway within four days of surgery. On the fifth day, with the lumbar drain still attached securely and draining her spinal fluid which was no longer significantly blood tinged, she was moving about the ward by herself, and was already keen to go home. On day eight, her CAT scans showed no hydrocephalus after the lumbar drain had been clamped 24 hours beforehand, and her ultrasound studies showed no vasospasm. Anna's doctors gave her the green light to leave the hospital. She was given some medications for pain, which she was told to wean in the next four to five days, and also given a Hospital Summary with a followup appointment set for the following week for staple removal.

Anna's drive home was a remarkable milestone for her. She still felt tired from the ordeal of the main hemorrhage, her surgery, the medications, and her altered sleep-wake cycle and relative physical inactivity as an inpatient, but she knew she was on the road to recovery. Her surgeon told her that he thought it would take about three months to recover substantially from her hemorrhage and surgery, but he felt she would make a complete recovery. When she had time to read about brain aneurysms and the death and disability associated with their rupture and repeat rupture, she thanked her lucky stars for her second lease on life. Focussed on maintaing a positive attitude, a balanced and healthy diet and a graded exercise program, and with the love and support of her immediate family, Anna made a complete recovery by the time of her three-month followup visit. Her surgeon was happy, and told her that he didn't want to see her for another three years, at which time he would obtain a follow up angiogram. If that was negative, she was "free" for another ten years thereafter, at which time if she had no further aneurysms develop, she would no longer have to see him. The whole ordeal had revealed to Anna and her husband just how precious every living and breathing moment of every day was. Anna fell pregnant six months after her operation, and went on to deliver and healthy and happy girl.

Concluding Remarks

How can I possibly even begin to describe to you how much I abhore the existence of brain aneurysms? Of all the medical diagnoses and entities I have encountered, I find brain aneurysms almost unique in their ability to strike like lightning, without rhyme or reason, and too often without mercy. For those whose precious lives are snuffed out in a brief moment, and whose loved ones' lives are dramatically altered forever by the same event, there seems to be no justice that I can comprehend. For those fortunate enough to survive the rupture, a battle begins for the amount and quality of life that can be recaptured. Your doctors and nurses are only one part of your armor. The key to your victory, your healing, is your will not only to survive, but to conquer. Here, mental positivity and, for some, spirituality, along with a focus on personal health and well being (not smoking, a nutritious diet, lots of sunlight, and a regular exercise program), and a strong social support network (relatives or friends in a social circle) are all critical. Do not be burdened by statistics. Every battle is unique and, if fought well, won.

With gratitude to Anna,

Vini G. Khurana