Hometown: Parma, Ohio
Diagnosis: Ruptured Brain Aneurysm
Treatment: Minimally Invasive Coil Embolization
Karen Bender remembers the moment her ordeal began. Every detail is etched in her memory. The date: Tuesday, June 16, 2009. The place: the market where she works as a chef. The event: a sharp pain in the back of her neck as she flipped a skillet of gluten-free fried rice. She had the sensation of “an electric current going down my back” and she felt woozy for a brief time. Her on-the-spot diagnosis: a pulled muscle, perhaps from flipping that rice too energetically.
The neck pain persisted, and soon a headache developed. As a long-time migraine sufferer, Ms. Bender wasn’t unduly alarmed. She started taking her usual headache medication. It was a busy week in the kitchen and she had no time to worry about being ill. Or so she thought.
In fact, Ms. Bender’s symptoms signaled far more than a pulled muscle or another migraine. For the next six days, she would function with a ruptured brain aneurysm, a medical emergency that kills 25 percent of sufferers immediately and 10 percent during hospitalization. Another 25 percent survive with long-term complications.
Ms. Bender is among the lucky 40 percent who survive and prosper. She credits her recovery to the care she received at Cleveland Clinic.
Looking back, Ms. Bender, 43, is stunned at how a health-conscious person like herself could rationalize all the warning signs.
“For the past few years, I’ve said, ‘Just listen to your body. It tells you what it needs. The foods you eat can heal and satisfy,’ “ she says. “Well, I hope I like crow because I didn’t practice what I preached!”
Peter Rasmussen, MD, Director of Cleveland Clinic’s Cerebrovascular Center, is less surprised at Ms. Bender’s behavior: “People with a stoic outlook assume they can tough it out even when they feel terrible. If they have a history of migraine, they think this is just another headache.”
Hours after the onset of her symptoms, Ms. Bender had a deep-tissue massage that brought her no relief. The back of her neck was tender and her headache worsened for the next two days, even though she continued to take her medication and slept with a bag of frozen peas behind her neck in a futile attempt to ease the pain.
“Every time I bent forward, my head would throb like my brain was going to fall out,” she recalls. “By Thursday, I couldn’t even bend over to feed my dogs.”
Concerned, Ms. Bender did some online research. When she typed in “throbbing headache with neck pain,” information on cerebral aneurysm came up. She went through the list of symptoms: Worst headache of your life? Not for a migraine veteran. Neck pain? Yes, but she clung to the theory that the rice flip was responsible. Marshaling more evidence against an aneurysm diagnosis, she noted that her lower back was quite painful.
“I had heard of people throwing their back out by picking up a toothbrush, so I was sure that the pain at the base of my spine was another sign of muscle involvement,” she says.
Besides, Ms. Bender had to prepare for a wedding she was catering that Saturday. In 18 years, she had never called in sick.
She worked 17 hours that Saturday, and the experience was not pleasant. She kept losing track of time and, as a result, she overcooked the food. Her knife felt strange in her hand. The drive home took her twice as long to make, and she had trouble finding her exit on Interstate 77. It was so easy to attribute everything to stress, exhaustion and the rigors of an extended workday. Reaching home at last, she let her two Labrador retrievers, Jack and Louie, outside and, fortified with another dose of medication, fell into bed.
The next day, Father’s Day, brought more struggles. Expected to bring two salads to a family gathering, Ms. Bender slogged through the preparation, surprised once more at how long it took. Ready at last, she drove 1-1/2 hours to the picnic. By now, the ever-present headache qualified as the worst of her life.
“The sun hurt my eyes,” she says, “but I chalked that up to not wearing sunglasses. We were on a lake and my sister wanted me to go jet skiing but, thank God, I said no. It was uncomfortable to sit, and all I wanted to do was lay down on the dock.”
Heading home, Ms. Bender vowed that if she did not improve by morning, she would go to the emergency room. Monday morning, she could barely raise her head from the pillow. She drove to Kaiser Permanente, where the physician she saw told her he would need to do a computed tomography (CT) scan.
“He came back and told me I had an 8mm brain aneurysm or a mass,” Ms. Bender says. “They couldn’t tell which without an MRI (magnetic resonance imaging) exam. The MRI confirmed a ruptured cerebral aneurysm.”
Asked where she wanted to be transferred for specialty care, Ms. Bender was unsure. Her sister, a nurse, recommended Cleveland Clinic. Whisked there by ambulance, Ms. Bender was awed by the care she received from the multidisciplinary team in the Neurological Institute’s Cerebrovascular Center.
“It was unbelievable,” she recalls. “The doctors drew a picture and explained everything to me. It sounded bad but I didn’t feel fear, thanks to an incredible team. The nurses on the neurological unit seemed to know what I wanted to ask before I could ask it. The doctors could not have done more than they did. They fixed me.”
A spinal tap showed blood, further supporting the diagnosis of a rupture – in essence, a stroke. Surgery was considered but deferred because, six days after the event, the possibility of cerebral vasospasm was extremely high. Vasospasm is the narrowing of an artery, which impedes blood flow to the brain and can lead to a second stroke and/or death.
Ms. Bender received medication to lessen the risk of vasospasm. On Wednesday, doctors coiled the aneurysm. In this procedure, a catheter inserted through an incision in her groin was threaded through an artery to the aneurysm, which was then packed with metal coils to prevent blood from flowing into the bulge.
“We do this because the threat of a re-rupture and re-bleed doesn’t go away after the initial event,” Dr. Rasmussen explains. “If that occurs, the risk of death rises dramatically.”
On Saturday, an appreciative Ms. Bender was released to recover at home. “Cleveland Clinic used all its resources and the latest technology to take care of me. A million thank you's would still be too few to convey my gratitude,” she says. “Cleveland Clinic saved my body, God saved my soul, and my family and friends saved my spirit.”
Eager to help spread the word about warning signs, Ms. Bender has joined the Brain Aneurysm Foundation, which provides support and education to patients, families, the medical community and the public. Dr. Rasmussen serves on the group’s Medical Advisory Board.
“If you smoke, your risk of ruptured cerebral aneurysm and lung cancer is equivalent, but lung cancer gets the attention,” he says. “We underestimate the magnitude of this problem. Mortality data are drawn from death certificates, which often list cause of death as pneumonia or pulmonary embolism, for example, instead of cerebral aneurysm.”
Ms. Bender returned to work full time in September. Her memory is not quite as sharp as before and her energy level has not fully rebounded, but she is improving steadily. The ache in her back is becoming less noticeable. And there’s nothing wrong with her outlook. As she puts it, “I am reminded that today is a bonus day.”