“I survived an aneurysm, a giant aneurysm,” says Nelson, 61, a United Methodist pastor who is on a family leave of absence. “Thankfully, it never burst. Why it didn’t burst, I don’t know. I’m just really glad it didn’t because I’m sure it would have killed me if it had.”
Nelson’s symptoms started in the spring of 2014, just before she took a leave of absence to care for her elderly parents and spend time with her young grandchildren.
“I started seeing double,” Nelson says. “I’d get real dizzy when I stood up and at different times. I couldn’t put my finger on when I would get double vision. It was kind of off and on. I finally went to the eye doctor, but she couldn’t find anything wrong. She sent me to my regular doctor, and she thought maybe vertigo or something.
“But it kept getting worse and worse through the summer. I’d go hiking, and we’d have to stop. We’d go on a fishing trip, and I’d get dizzy. I had to stop driving.
“And then my eye started aching, behind my left eye, and my eyelid started drooping (my daughter said it looked like I had had a stroke). I went back into the optometrist and said, ‘We’ve got to figure out what’s going on here.’ She called in the ophthalmologist who ordered an MRI.
“That’s when they discovered the aneurysm.”
A SCARY NIGHT
Cerebral aneurysms, according to the American Heart Association, occur when the wall of a blood vessel in the brain becomes weakened and bulges or balloons out.
“We usually discover aneurysms three ways,” says Dr. Josser Delgado, a neurointerventionalist for Consulting Radiologists, Ltd. (CRL) at Abbott Northwestern Hospital in Minneapolis who treated Nelson. “People get scanning for something else and we find an aneurysm,” Dr. Delgado says.
“Or they can present like Diane presented — which is that they can cause symptoms by pushing on something … a symptomatic aneurysm.”
“Or, unfortunately, they can rupture. That’s the worst way to discover them. Some patients don’t make it even to the hospital.”
Nelson’s aneurysm was discovered on Oct. 30, 2014.
“I had had the MRI at 8 p.m. (at the hospital in Cambridge), and then they rushed me to the emergency room. It was like the technician couldn’t get me there fast enough. I had no idea what was going on. I said, ‘Would you tell me what’s going on here because my blood pressure is going through the roof.’ The ER nurse said, ‘You’re going to Abbott tonight.’ My husband asked, ‘Can I drive her?’ They said, ‘No, you’ll be going by helicopter, we’re just waiting for Dr. Delgado to look at the results and tell us what to do,’ ” Nelson says.
Delgado was not panicked.
“Three to four percent of the general population has a brain aneurysm — so maybe one in 20 to 25 people,” Delgado says. “The truth is, most aneurysms don’t rupture.”
Says Nelson: “Eventually, he called the emergency room, after talking with the ophthalmologist about whether there were signs of the aneurysm bleeding, and there weren’t. So he called me and in this nice, calm voice told me to go home and get a good night’s sleep.
“I thought, ‘I’m going home to sleep?’ ”
Delgado explained the next step:
“They didn’t know at first if it was behind the eye or in the brain,” Nelson says. “They needed to do a CT scan with dye to know exactly where it was located. He said, ‘Come down tomorrow and we’ll do a CT scan with the dye, and we’ll meet and talk about how we’re going to approach this.”
Still, despite the doctor’s calm bedside manner, “I didn’t sleep a lot that night,” Nelson says. “It was pretty shocking news.”
A HALLOWEEN FRIGHT
The next day, Oct. 31, Nelson learned more about the aneurysm:
“It was in the brain, which made it more serious,” she says. “It was so big that it was putting pressure on the optic nerve.”
“It was a giant aneurysm, one of the biggest we’ve seen here at Abbott,” Delgado says. “It probably had been there for a long time.”
“That’s why I was having symptoms with the eye,” Nelson says. “Which was good, because that’s why they found it. Because of the headaches, the aching, the double and blurry vision.”
What next, she wondered?
“They told me that it could burst at any time,” she said.
Still, she would not be rushed into surgery.
“What they wanted to do was optimize the chances of making it through the surgery,” she says. “I had to go on Plavix (a blood thinner). If the (blood-platelet) number wasn’t just right, I’d stroke out or bleed to death.”
It took awhile for her blood to reach that “magic” number.
“It was about a month later that I went in for the surgery,” Nelson says. “So it was a month of thinking, if I coughed, ‘Oh, gosh is it going to burst,’ ” Nelson says. “That was probably the scariest month — being afraid of doing anything. I quit watching my grandkids alone after I found out I had an aneurysm. I thought, it could burst at any time.”
Once again, her doctor was the voice of calm.
“He said, ‘You’ve probably had this for years and years. Most likely, nothing will happen in a month.’ But still … .”
PRIMUM NON NOCERE
When it comes to managing an aneurysm, the Latin phrase “Primum non nocere” — “First, do no harm” — comes to mind.
With more patients getting imaging for headaches or other reasons, Delgado says, “incidental aneurysms” are more common.
“The truth is, most aneurysms don’t rupture,” Delgado says. “That’s the problem, when we find an incidental aneurysm. It’s pretty tough for us to know whether to treat or not. We do it on a case-by-case basis. You don’t want to treat them when they’re too small or too big. Medium is when the risk of treatment is low.
In Nelson’s case however, treatment was imperative. The surgery was Dec. 2.
“I had a granddaughter born the week before the surgery,” Nelson says, “so I told Dr. Delgado, ‘Please, get me through this.’ ”
Delgado used a newer piece of technology — a Pipeline Embolization Device, manufactured by Medtronic and approved for use in 2011 — as well as traditional metal (platinum) coils to defuse the bomb inside Nelson’s head.
The tiny device features a braided cylindrical mesh tube that is implanted across the base or neck of the balloon-like aneurysm. The life-saving device cuts off blood flow to the aneurysm.
“It’s a major surgery,” Nelson says. “What surprised me is they didn’t have to go in through the head. They go through the groin area, like when they put stents in the heart. They go up to the brain that way. He packed the aneurysm with coils, and he put in the Pipeline device. He suggested doing both because the aneurysm was so big.”
Dealing with the aneurysm was one thing, but the optic nerve was another. Delgado could not offer reassurances about her pain, vision or droopy eye.
“He told me, ‘I don’t know what will happen after surgery. It might get worse — with the nerve reacting. I don’t know how much you’ll get back. He said I might need to be referred to a neuro ophthalmologist.”
Thankfully, Nelson has had a good outcome.
“It ended up taking a lot of time. The healing process is long. But now I’m looking pretty darn good, considering. Every once in a while, I feel a little bit of pain, but I just take a Tylenol. I’m back to doing whatever I could do before now. It’s pretty amazing.”
Delgado is glad to have helped.
“She’s lucky. Previously, the only thing we would have been able to offer her was to go inside the brain and put in as many coils as possible,” Delgado says. “That would decrease the chances of the aneurysm bleeding. But the pushing effect (on the nerve) may or may not get better. In most cases, it doesn’t get better with coils only.”
The pipeline, Delgado says, “allows doctors to treat the aneurysm with fewer coils.” This device “allows the aneurysm to shrink and relieves the mass’s effect on the nerves.” Also, “with coils alone, they can come back.” With this new device, “chances of it coming back are as low as they can be.”
‘IT’S A MIRACLE’
Nelson’s aneurysm was checked in June and will always need monitoring.
“I was kind of awake for it (the procedure),” Nelson says. “I asked, ‘How is it?’ Dr. Delgado said, ‘It’s gone’ … there’s no blood flow in it anymore … in essence, the worries about it bursting are gone.
“I just feel so fortunate to be alive,” Nelson says. “I really do.
“To me, it’s a miracle,” she says.
“I am thankful for every minute I have with my grandchildren, family and friends. As I spend time with each grandchild, I am acutely aware that I could have missed this precious time. I feel very blessed.”