It was 9:30 at night and Anna Young, 42, was sitting on her bed typing and strategizing on her laptop. She was opening her own business and going to law school and had just returned from working in Europe at her job as a banker-she had many balls in the air. Spread out around her were papers, ideas, plans, the future. As she shifted off of her bed to grab some papers, she felt a pop-bam!-fireworks were exploding inside her head. Her hearing was being muted; she was falling down.
"This isn't right. I am not going to die here and leave so many questions," she thought as she reached for the phone. "Please help me!" she cried into it, "I think I am having a brain aneurysm."
"When she arrived in the Emergency Department, she had developed a seizure and her condition was rapidly declining," remembers Michael Ayad, M.D., neurosurgeon at New York Methodist Hospital. "A CT (computed tomography) scan showed that Ms. Young was indeed experiencing a massive subarachnoid hemorrhage from a burst aneurysm."
A subarachnoid hemorrhage is defined as bleeding in the area between the brain and the membrane that covers the brain, known as the subarachnoid space. It is critically dangerous because not only does the seeping blood injure brain cells, it also increases pressure inside
the skull to dangerous levels. "I immediately inserted a ventricular drain to relieve cranial pressure and rushed Ms. Young to the bi-plane interventional suite to embolize the ruptured aneurysm."
NYM is one of a select number of hospitals in the region with state-of-the-art bi-plane angiography technology. This minimally invasive technology provides sharp, high-resolution images that are displayed on two separate planes, or angles, simultaneously, on separate screens. This allows physicians to access dramatically clear 3-D pictures of arteries and vessels.
Dr. Ayad was able to repair the ruptured aneurysm using coil embolization, in which a catheter is snaked through the femoral artery into the brain. Upon reaching the target, small coils are deposited into the aneurysm, which encourages the blood to clot and seal the site
of bleeding-in Ms. Young's case, the anterior communicator artery, located in the brain's frontal lobe.
"Although we were successful in stopping the bleed and relieving the pressure on the brain, with a massive hemorrhage like Ms. Young's, the aftermath can often be just as challenging," recalls Dr. Ayad. "I explained to her family that although she was remarkably alert and neurologically sharp within the first few days after the procedure, we needed to be prepared for vasospasm, which can materialize after a deceptive calm. We were in no way out of the woods."
Intracranial vasospasm can be extremely debilitating. When a cerebral aneurysm ruptures, blood seeps into the spinal fluid. When the blood begins to break down, usually between five and ten days after the rupture, it releases chemicals that irritate the arteries, causing them to constrict. Constricted arteries reduce blood flow-and its crucial oxygen supply-to the brain, causing a risk of ischemic stroke and brain damage.
"Five days after the hemorrhage, she began experiencing the most intense vasospasm I have ever seen," remembers Dr. Ayad. "In order to keep a massive stroke at bay, we acted immediately with what is known as "Triple H" therapy: hypertension (high blood pressure), hypervolemia (excess fluid in the circulation) and hemodilution (dilution of the blood). The combination of these three courses of therapy dilates the arteries and keeps the blood and oxygen circulating. Her vasospasm was not only intense, it was stubborn. Three separate times we rushed her into the biplane interventional suite for treatment. We were pushing her body to its limits-Triple H therapy is very hard on the heart, the lungs, the liver-her monitors were ringing and lights were flashing, but we needed to do everything at our disposal to prevent a potentially fatal stroke."
At day 15, the violent storm of vasospasm began to lift and Ms. Young began to stabilize. And the CT scan showed no sign of stroke. By day 18, she was conscious and following commands.
"I remember waking up and feeling this sense of calm," recalls Ms. Young, "which is ironic considering everything that happened. My sister kept asking me, 'Do you know what you just went through?' I could only answer 'no,' I didn't remember a thing. I kept hearing my family talk of the 'brilliant Dr. Ayad.' When I met him, I saw that they were right. I knew I was in good hands."
After growing stronger in the Intensive Care Unit, Ms. Young was transferred to the Inpatient Rehabilitation Unit, where she would start the work of rebuilding some of the neuromuscular fallout from her traumatic aneurysm and reverse the atrophy that resulted from being bedridden for weeks. "Each day brought marked improvement," says Dr. Ayad. "Hers was truly a striking recovery in a very short period of time. Her prognosis is very good." Ms. Young continued to gain strength and agility, and 57 days after she arrived at NYM in the throes of a brain hemorrhage, she was walking out its doors with the support of her friends, family and a sturdy cane."
I am still adjusting-physically and emotionally-to life after my hemorrhage. My days now consist of more rehab appointments than business meetings, but that will change. I am focusing on staying strong and letting myself heal as I need to. What is important is that I have a life to adjust to, and for that I am so thankful to Dr. Ayad and everyone at NYM."
Read this story, other inspiring patient stories and more in the Annual Report to the Community 2012-2013.
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