Dr. Oliver’s Aneurysm

When Tina Oliver had a sudden, severe headache, she knew what it was, and what to do: Get help fast.

It was Easter morning, and Dr. Tina P. Oliver was supposed to be helping direct the choir at her church. But she’d been feeling a little under the weather from what she presumed were allergies, so she stayed home with her two young-adult kids instead and asked one of her choirmates to stand in for her.

She was getting ready to run to the store when she blew her nose and felt something pop. “It was like an explosion in my head,” she says. “It was big.” Two terrifying words came to mind: brain aneurysm. But the 60-year-old podiatrist couldn’t believe that was a real possibility. She was in good health. She’d never had any neurological issues. There was no family history of aneurysm.

“I was just in shock,” she recalls. “I was thinking, ‘It couldn’t be. It couldn’t be.’ ” She keeps a blood pressure cuff in her bedroom, and she put it on. Her blood pressure was sky-high. By then, she could feel the neck stiffness that she knew was a hallmark of a ruptured brain aneurysm. She was suddenly overwhelmed by nausea. She slid to the floor.

Her daughter, Martina, was upstairs. A freshman at the University of St. Thomas, Martina is planning to pursue a medical career like her mom. Dr. Oliver called out to her and briefly explained what was happening. Then she dialed 9-1-1. “I said, ‘Please take me to Memorial Hermann,’ ” she recalls. “All I could think of was that I had worked with a lady who had a brain aneurysm, and she went to Memorial Hermann and she’s still here today to talk about it. So I knew where I wanted to go.”

In the few minutes before the ambulance arrived, Martina comforted her older brother, who is on the autism spectrum. She was careful not to overwhelm him with the magnitude of the situation. She told him, “Mom has a bad headache. We’re going to take her to the hospital.”

Cerebral aneurysms are balloon-like protrusions that form at a weak spot on an artery in the brain. They’re uncommon, although the exact numbers aren’t known, since some aneurysms never cause symptoms and therefore go unreported. The National Institutes of Health estimates that between three and five percent of Americans may have an aneurysm in their lifetime. While they can happen to anyone at any time, they typically occur in adults between ages 30 and 60, and they’re more common in women than in men. About 30,000 Americans suffer a brain aneurysm rupture every year.

A sudden, severe headache is the most common symptom. Stiff neck, nausea, vomiting, sensitivity to light and double vision can also signal a rupture. Once the bleeding starts, however, time is of the essence.

“Depending on the severity, you may lose consciousness or have a seizure, or it may just be a bad headache,” says Dr. Arthur Day, MD, a neurosurgeon with Memorial Hermann and the McGovern Medical School at UTHealth. “If you have a headache unlike any you’ve ever had before, get to the hospital. They’ll do testing, which usually includes a brain CT scan, but could also include an MRI or spinal tap, to look for bleeding. If these tests are positive, you need to be treated right away.” 

Getting immediate treatment can significantly improve a patient’s odds of survival, but the size of the aneurysm and the extent of the bleeding also play a part. About 25 percent of patients die within 24 hours of a rupture; another 25 percent die from complications shortly thereafter, according to the NIH. Some suffer permanent neurological damage, while others recover completely.  

“If you have a really bad bleed, you might be done for before you get to the hospital. Much of the survival rate depends on how good the patient looks after their bleed. If they’re in a deep coma, the survival rates are much worse than someone who just has a headache or is a little sleepy. If we can get you before irreversible injury has occurred and repair the aneurysm before it has a chance to rebleed, then your prognosis is really much brighter, and there’s a good chance you’ll be fine,” says Dr. Day. “You have to be lucky that the damage done by the bleeding doesn’t hurt you before we have a chance to stop it.”

Martina rode with her mom in the ambulance to Memorial Hermann Pearland Hospital, the closest hospital to their house. Doctors in the emergency department did a scan that confirmed what Dr. Oliver suspected. She needed brain surgery, and she needed it quickly. They put her in another ambulance and sent her to the Mischer Neuroscience Institute at Memorial Hermann-Texas Medical Center, where Dr. Day works.

She was conscious but not herself, and she has no memory of the ride to the second hospital. “My daughter says I was trying to sign my consent forms,” she says. “I was insisting, ‘I can do it! Let me do it!’ but my hand was all over the place, so she did it for me.”

Dr. Day had two options for surgery: coil embolization or microvascular clipping. Each carries risks.

If an aneurysm is a balloon coming off of the side of an artery, then when it ruptures the balloon pops, forming a hole through which blood pours into the brain or the spinal fluid surrounding the brain. The two treatment options are essentially to plug the hole or to tie the neck of the balloon. With the former method, surgeons thread a catheter into the femoral artery through the groin, sending it up the aorta and all the way into the brain, then into the aneurysm itself. They push a wire through the catheter that, when it comes out the other end, forms tight coils inside the aneurysm, blocking the hole. With the latter method, surgeons take a more direct approach: They open the skull and use a clothespin-like titanium clip to seal the aneurysm off at its point of origin on the artery.

“With the coil procedure, the risk is that it might perforate the aneurysm and make it bleed again. Since the work is done through the groin, it’s less invasive, but a certain percentage of aneurysms treated with the coil will reform later, so we have to watch them for several years afterward to make sure that doesn’t happen,” says Dr. Day. “When we open the head, it is more invasive, and we have to give you a haircut. But the benefit of the clip is that most of the time, the aneurysm is cured for life.”

In Dr. Oliver’s case, Dr. Day chose the latter.

Assuming a patient survives the initial rupture, the week following a brain bleed is the most dangerous, even if the aneurysm has been successfully repaired. That’s because the leaked blood mixes with the spinal fluid surrounding the brain, where, over time, it starts to degrade. Dr. Day likens the process to a bruise on your arm that’s initially black and blue, then turns orange and yellow before fading away. When blood escapes from a blood vessel, the enzymes in our bodies clean it up by breaking it down into its component parts: iron and other chemicals. Those chemical changes create the different colors of a bruise as it heals. But in the meantime, the degraded blood is an irritant.

“When the blood in the spinal fluid that was initially bright red turns orange or yellow, that change makes the blood very irritating to the brain arteries, sometimes to the point where they seize up or spasm,” Dr. Day says. “If that happens, it can block the blood going through the artery, causing a stroke. The peak of that danger is a week after the bleeding. If you make it through that week, chances are good that you’ll make a full recovery.”

Martina watched her mom carefully in the days following her seven-hour surgery. Loopy from medication and the effects of the brain bleed, Dr. Oliver sent selfies to her church friends from her hospital bed, showing off her bald head and surgical staples. She doesn’t remember sending them. When her friends came to visit her, she was belligerent. She doesn’t remember that, either.

“I told them, ‘Why are you bringing those blankets in here like I’m an old lady?’” she recalls. “For four days, I was saying ugly things to people that I have no memory of saying. But that’s normal with a brain injury.”

By the end of the week, her uncharacteristic rudeness had subsided. She was starting to feel like herself again. And the worst danger of a stroke had passed. Her recovery could begin.

Because she has treated patients at TIRR Memorial Hermann for the past 29 years, she opted to go there for rehab. “I wanted to be around people I know, in a place I felt comfortable,” she says. But didn’t let herself get too comfortable. Her turbocharged convalescence only took a week. “I went from a wheelchair to a walker to just running around the hospital, giving my therapist a heart attack,” she says. “After I got back home, I started walking every day.” By August, she was back at work.

While she was recovering, Dr. Oliver had a follow-up appointment with Dr. Day. There was one burning question she wanted to ask: “Why did this happen to me?”

“You just had bad luck,” the neurosurgeon answered.

There’s very little anyone can do to prevent an aneurysm from forming. It’s just something that happens to a few unlucky people, through no fault of their own. “It’s like putting 50,000 miles on your car and then one of the tires blows out. It’s just the wear and tear on it. With all the times your artery pulses over the course of your life, eventually, for some people, there’s a spot that becomes weak, and an aneurysm can form,” Dr. Day explained. “There’s nothing you did to deserve it.”

That was reassuring. High blood pressure and a history of smoking are associated with a higher risk that an aneurysm will rupture, but Dr. Oliver has neither, and Dr. Day was careful to stress that there’s no evidence they contribute to an aneurysm forming in the first place.

Even more reassuring for Dr. Oliver: family history isn’t typically a risk factor, except in rare cases where a genetic disorder impairs collagen production, making blood vessels more fragile. Which means her kids aren’t any likelier to develop an aneurysm because she did.

Dr. Oliver’s next question was about her future. Was there anything she couldn’t do anymore? “Kickboxing,” said Dr. Day. Dr. Oliver wasn’t sure if he was joking, but she explained that, in fact, she used to compete nationally in Shotokan karate and judo. She agreed to hang up her black belt.   

That had nothing to do with the aneurysm itself, Dr. Day clarified: it was just that the surgical team had to remove a bone from her skull to perform the operation. “Because you’re a nice person, we put it back when we were done,” he kidded. “But the skull bones don’t heal the way other bones in your body heal. We had to wire it in place with a titanium plate. It’s plenty strong for most things, but we don’t really want someone to go out of their way to kick you in the head where you had a craniotomy.”

Dr. Oliver’s aneurysm, meanwhile, couldn’t start any more trouble. “With the clip, the aneurysm is punctured, it shrivels up and then it’s gone,” Dr. Day explained.

These days, Dr. Oliver is back to her normal activities: treating patients, performing surgeries, singing in the choir and spending time with her kids. She has shown no sign of lasting neurological damage and hasn’t even had to take medication for seizures, as some patients do after an aneurysm.

“The only downside in her prognosis is that she won’t get sympathy anymore, because she used to have an aneurysm and now she doesn’t,” Dr. Day says. “There’s nothing wrong with her.”

For Martina, the medical emergency made for a rocky end to her first year of college. But it also inspired a new interest in understanding the human brain. She now plans to study neuroscience.

In most cases, as in Dr. Oliver’s, there’s no way to know you have an aneurysm until the moment it ruptures. The condition is rare enough that doctors don’t recommend screening for it unless you have symptoms. The one thing you can control is how quickly you seek medical attention if you do. Getting immediate help from highly skilled doctors, and being incredibly lucky, were what saved Dr. Oliver’s life.

Her daughter, however, suspects her personality may have helped as well.

“My mom’s a fighter,” Martina says.   

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Ali Vise