Connecticut Post (Sunday)
I just kept saying, ‘My head hurts, my head hurts’
(Ad) There are headaches, and then there are headaches. Tamra Cox, a 47-year-old business analyst in Trumbull, was just retiring for the evening one cold night in January when her head started pounding in a way she’d never felt before.
She called her sister, who was downstairs, and her sister sent her niece up to check on her. By the time her niece got there, Cox was unresponsive. The paramedics arrived, and throughout the ordeal Cox was in and out of consciousness, but she asked to go to St. Vincent’s Medical Center. It was the only hospital she’d ever been to, and it may well have saved her life.
“My head was pounding so badly, and when they brought me to registration I just couldn’t do it,” Cox said. “Every machine that you could hook up to me, I think they hooked up to me. And that night it didn’t even matter, as long as they gave me something to make the headache go away. I was answering questions, but I don’t remember any of that.”
Cox had a subarachnoid hemorrhage — a ruptured brain aneurysm that caused a hemorrhagic stroke.
“Fatality rates and disability rates are high in Tamra’s type of stroke,” said Dr. Daniel Cavalcanti, a neurosurgeon at St. Vincent’s Medical Center’s Ayer Neuroscience Institute. “She got to the hospital very quickly, so we were able to obliterate her aneurysm within 24 hours of it happening.”
Research shows that there’s a 40 percent mortality rate within a year of this type of hemorrhage, Cavalcanti said. Fifteen percent of patients die before they even get to the hospital. The fact that Cox has nearly completely recovered from this stroke is a testament to the quick thinking and immediate action on both her part as well as St. Vincent’s.
“I didn’t lose any function. I do forget some things, and sometimes my speech gets a little halted, but other than that I’m doing well,” Cox said. She’s even back at work full time. But it wasn’t all smooth sailing.
To eliminate the aneurysm in the first 24 hours, Cavalcanti could have chosen one of two treatments: a craniotomy with micro-surgery on the brain, known as clipping; or the more modern endovascular treatment, called embolization.
In most stroke cases, the brain is deprived of oxygen due to a blockage in the vessels. These are ischemic strokes. In Cox’s case, she had a brain bleed — a hemorrhagic stroke.
“I felt with Cox, with a mini-craniotomy, we could treat the aneurysm in one single stage,” Cavalcanti said. “It was a microsurgery with minimal manipulation of the brain.
The small openings of the skull allow for quicker healing.”
The surgery was a success. Cox recovered in the ICU, but suffered a common complication of a subarachnoid hemorrhage. Days after the surgery, she experienced a vasospasm. This is when a blood vessel in the brain narrows, blocking blood flow again. It typically occurs within two weeks after the rupture of a brain aneurysm.
“I was getting up from the bed, and then I just paused. I was about to faint when the nurse caught me,” Cox said.
Because she was in the ICU, St. Vincent’s was able to perform a second procedure immediately.
“The teamwork and collaboration in the
ICU allowed constant monitoring, which allowed us to intervene immediately before consequences came in,” Cavalcanti said. “We did an endovascular arterial infusion of a drug we use, which dilates the brain vessel.”
The care team inserted a catheter through the groin and delivered the drug directly to the area of the brain that needed it.
St. Vincent’s Medical Center’s Ayer Neuroscience Institute recently installed a neuro-endovascular suite that includes a state-of-theart machine with many new features, giving doctors better image quality of brain vessels with minimal amounts of radiation. It eliminates any necessity to transfer patients to a larger facility.
After Cox’s second procedure, she was out of the hospital within a week, recovering at her parents’ home. She credits the staff at St. Vincent’s and her family for saving her life.
“I feel like my sister and niece saved my life. The firefighters who knew what to do with the oxygen saved my life. Dr. Cavalcanti saved my life,” she said. “And his personality is just wonderful; he’s a very nice person with great bedside manner. He doesn’t just tell you that something needs to be done, he tells you why it needs to be done.”
Cox still suffers headaches occasionally, but Cavalcanti says with the kind of aneurysm rupture she suffered, headaches are common and a result of the hemorrhage, not the surgery. Cox is just glad she’s back to life as usual.
“I know it’s major, and I know that I almost died, but honestly I didn’t feel like I was dying. I saw it because my dad doesn’t do hospitals, and he came to the hospital to see me. But at no time did I feel like I was going to die,” Cox said. “I was a rock star in there. Those nurses were awesome. The ICU nurses, they took care of me. There is not one of them that did not make sure I had what I needed. They were just great.”
This is just one example of Hartford HealthCare St. Vincent’s Medical Center bringing more specialists and providers to the community. Tune in to Hartford HealthCare St. Vincent’s Medical Center’s Facebook Live discussion, where you can ask questions, on Thursday, May 25, at noon. For more information, visit hartfordhealthcare.org/ stroke.