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A daunting condition

May 10, 2004|by KATE COLEMAN

katec@herald-mail.com

As many as 2 million people in the United States have unruptured brain aneurysms, according to statistics cited on the Web site of Boston-based Brain Aneurysm Foundation at www.bafound.org.

An aneurysm is a weak, bulging spot on the wall of an artery - similar to a weak spot on a thin balloon or the inner tube of a tire. Aneurysms form from wear and tear on arterial walls over an extended period of time.

Contributing factors include smoking, high blood pressure, traumatic head injury, family history and some connective tissue diseases. Brain aneurysms are most common in people ages 35 to 60, and they are more likely to occur in women than men.

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Some would say she's lucky, but Lydia Hines said she considers her survival from multiple aneurysms a miracle.

The numbers are daunting. Ruptured brain aneurysms cause about 32,000 deaths each year. Half of people with ruptured brain aneurysms die immediately, according to the Brain Aneurysm Foundation. Among survivors, a third recover with some deficit, another third with "substantial" deficit, the remaining third with problems severe enough to require institutionalization.

An aneurysm bursts


Hines, 44, didn't know she had an aneurysm in her brain when it began to rupture late one night in early April 1999. Her homeschooled children, Michael, 13, Mark, 10, and 5-year-old Meredith, were in bed, as was her husband, Ken Hines. She was happy for the opportunity to work on preparations for the mother-daughter banquet at her family's church, Emmanuel Baptist Temple in Hagerstown.

Hines became tired and decided to go to bed. She walked to the kitchen and felt a sudden "gunshot" pain in the back of her head. Her head, neck and shoulders began to throb. She saw "black, flashing halos of light."

She stumbled upstairs and told her husband she needed to go to the hospital.

While they waited for the ambulance to arrive at their Hancock home, Hines worried about her children, filling bowls with cereal for their breakfast, placing a spoon by each.

She prayed.

The rupturing aneurysm was bleeding, causing pressure on her brain. By late the next morning, she was in a coma. Emergency surgery was performed at Washington County Hospital. A hole was drilled in her skull to allow the buildup of fluid to drain. At 11 p.m. the decision was made to transport Hines by helicopter to the Neurological Intensive Care Unit at University of Maryland Medical Center in Baltimore.

She had surgery to repair the aneurysm as well as physical and occupational therapy during her nearly three-week hospitalization.

Choosing a procedure


A week after Hines came home, she was back in the Baltimore hospital, having a permanent shunt installed to drain cerebrospinal fluid from the brain to her peritoneal cavity. She returned in November 2000 to have a second aneurysm "clipped." Clipping involves surgery during which a tiny titanium clip is placed to cut off the flow of blood to the aneurysm. During that procedure, the surgeon noticed a third aneurysm. An attempt to "coil" it the next day failed.

Coiling is the other technique approved for treating aneurysms, said Dr. Bernadette Stallmeyer, assistant professor of radiology at University of Maryland School of Medicine. Stallmeyer, an interventional neuroradiologist at University of Maryland Medical Center, performs the coiling procedure.

Coiling involves guiding a thin catheter through an artery from the groin to the brain. Platinum wire is threaded through the catheter to the aneurysm, and coiled into a "little ball" inside it, causing the blood to clot around it and the aneurysm to eventually scar, Stallmeyer said.

A surgeon finally clipped the third aneurysm.

The decision whether to clip or coil an aneurysm depends on its shape, size and location, Stallmeyer said. Research indicates that about 20 percent should be clipped and 20 percent coiled.

"It's a coin toss" - treatment results are about the same - for the remaining 60 percent of aneurysms, she said.

Treatment is possible when aneurysms are diagnosed, but most people who have unruptured aneurysms have no symptoms. Symptoms of untreated aneurysms include loss of sensation, dilated pupils, double vision, eye pain and localized headache, immensely severe headache. Signs of aneurysm rupture include nausea and vomiting, sensitivity to light and blurred or double vision, according to the Brain Aneurysm Foundation.

Screening by several available means is recommended for people who have a "familial occurrence" of brain aneurysms, defined by the Brain Aneursym Foundation as having two or more blood relatives with the condition.

If a first-degree relative - a parent, sibling or child - has a brain aneurysm, it's probably worth getting screened, Stallmeyer said.

Recovery and a move


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