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Stroke is the leading cause of serious, long-term disability in the United States, with about 6.5 million stroke survivors alive today. Listen to free audio files from Cleveland Clinic’s Cerebrovascular Center about stroke risk factors, warning signs and treatment options.

Patient Guides

 

 

 

Symptomatic Moyamoya Disease»

Teresa Martens

Age: 23
Hometown: Higginsville, Missouri
Diagnosis: Symptomatic moyamoya disease
Treatment: Bypass Surgery and encephalo duraterio myosynangiosis (EDAMS)

Teresa Martens was having a series of mini-strokes, but she was busy with school and planning her wedding, so she ignored them. When she finally went to see a local neurologist, he wanted to do a brain biopsy, which would have required her to shave her head. As a bride to be, she was quite hesitant. Meanwhile, her insurance company noticed all the tests she was having and called to suggest she travel to Cleveland Clinic to see Peter Rasmussen, MD. She agreed, and was diagnosed, treated and ready to go home within 10 days of arriving in Cleveland. Today, she feels great and is back to her busy life.

“This was such a scary thing to go through. I really needed answers and hope. Since my treatment, I have talked with a few people who know someone who is suffering from similar mini-stroke-like episodes, and I always refer them to Cleveland Clinic. I even carry the phone number to Cleveland Clinic in my cell phone to have ready to hand out! Without Cleveland Clinic, I really could have suffered irreversible brain damage.”

Stroke Due to Carotid Dissection»

Dale Wessell

Age: 67
Hometown: Fort Walton Beach, Florida
Diagnosis: Stroke due to carotid dissection
Treatment: Emergency carotid artery stenting

Dale Wessell and his wife were up from Florida visiting family over the holidays. On Christmas Eve, while driving from Oberlin to Elyria to go shopping, his vision suddenly became blurred. He pulled over to let his wife, Debbie, drive, and was near crawling just to get to the passenger seat. A former nurse, Debbie recognized the symptoms of stroke and rushed to a nearby Oberlin hospital. Doctors there confirmed an evolving stroke, initiated treatment and, recognizing an impending catastrophe, summoned an emergency helicopter. Upon arrival at Cleveland Clinic, Mr. Wessell was unable to speak and paralyzed on the right side; his family was told he might not survive. He was rushed to the operating room for emergency treatment, where he was found to have a carotid dissection, a spontaneous injury to the inner wall of the artery to the left side of the brain. With the consent of his wife and approval from the institutional review board, an experimental flexible stent was used to re-open the artery before significant permanent damage to the brain. Several hours later, he was able to speak and move his entire body again. Today, he is completely recovered.

“Thank the Lord I was near Cleveland when this happened. They did an awesome job and saved my life. Afterward, the doctors answered all my questions and never made me feel like they had another patient in the world. They gave me as much time as I needed. I can’t say enough about my care. It was miraculous.”

Ruptured Brain Aneurysm »

Karen Bender

Age: 43
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.”

Brain Aneurysm »

Danielle DeBerry

Age: 26
Hometown: Shaker Heights, Ohio
Diagnosis: Brain Aneurysm
Treatment: Minimally Invasive Coil Embolization

The golf ball-sized aneurysm might have been in Danielle DeBerry’s brain for years. She would not have known. The active 26-year-old woman rarely got a headache or felt pain of any kind, unless she was recovering from a tough workout at the gym.

“I didn’t have any symptoms at all,” she says. Luckily for her, a timely trip to the Emergency Department led to the surprise discovery.

Six months ago, Danielle DeBerry had a very large aneurysm at the center of her head, located on what is known as the tip of the basilar artery. Left untreated, it might have resulted in her becoming severely disabled or worse.

A brain aneurysm is a bulge or sac that develops in an artery because the vessel wall is weak. The bulging aneurysm can push up against surrounding nerves and brain tissue, causing paralysis, headache, back pain and nausea.

“The danger with an aneurysm is that it can rupture and bleed. About half the time, it does result in death,” says Peter Rasmussen, MD, Director of the Cerebrovascular Center at Cleveland Clinic. This was the case with U.S. Rep. Stephanie Tubbs Jones of Cleveland, who died in August 2008 at age 58. The other half of brain aneurysm patients are left disabled after a rupture.

Ms. DeBerry is comfortable talking about her brain surgery. “My life is happy,” she says simply. “I think God has a way of doing things.”

Athletic and vibrant, Ms. DeBerry works in fan services for the Cleveland Indians, answering customer phone calls and making special arrangements for season ticket holders. She graduated with a marketing degree from Hampton University in Virginia. When she’s not behind the scenes at Tribe games, you’ll find her on campus at Cleveland State University, where she is earning a master’s degree in sports management.

The trigger for the discovery of Ms. DeBerry’s aneurysm was a car accident in November 2008 that occurred just two and a half blocks from the house in Shaker Heights, Ohio, where she grew up and lives with her parents.

“I went to the hospital and I was OK,” she says, with only a swollen hand. Routine X-rays, however, revealed the aneurysm. Ms. DeBerry immediately was transported to Cleveland Clinic’s main campus, where physicians performed life-saving surgery before the aneurysm could rupture.

Ms. DeBerry’s case was rare for several reasons, Dr. Rasmussen explains. For one, she is at least 20 years younger than most aneurysm patients. Also, she is healthy, and presented with no common risk factors such as smoking, high blood pressure or atherosclerosis, a chronic inflammatory syndrome affecting blood vessels.

Ms. DeBerry’s aneurysm was larger than most, but Dr. Rasmussen describes it as “odd and unusual” for another reason. Normally, an aneurysm is a pouch (similar to a berry) that protrudes from the side of a blood vessel. Aneurysms usually occur at branch points where a larger vessel gives rise to a smaller one. Rarely do aneurysms involve a vessel that supplies blood to other parts of the brain.

Not so in Ms. DeBerry’s case. Two arteries from her aneurysm were supplying critical portions of her brain.

“In order to treat her, we had to be certain we could occlude her aneurysm completely without compromising the blood flow to other areas of the brain,” Dr. Rasmussen says. “If we didn't, she would have a stroke, and that would be devastating.

“Fortunately for Danielle, we were able to determine that other blood vessels would take over for the vessels that would be lost when we closed off her aneurysm,” he continues. “This allowed us to perform a simple and secure treatment for her.”

To occlude the aneurysm, a surgical team headed by Dr. Rasmussen performed a minimally invasive coil embolization, in which a catheter as thick as a strand of spaghetti is inserted through an incision in the groin and maneuvered through an artery to the site of the aneurysm. Metal coils are then inserted into the catheter and placed next to the aneurysm. The body responds by forming blood clots around the coils, resulting in scar tissue that prevents blood from flowing into the bulge. That way, the vessel will not rupture.

“The procedure takes a few hours, and the only scars are in the groin area where the catheter is inserted,” Dr. Rasmussen says. “Patients usually go home the next day.”

Ms. DeBerry sailed through the surgery and recovered at Cleveland Clinic for three days, while physicians and nurses monitored her. “I was back to work the day after I got out of the hospital,” she says.

She didn’t play in the company softball game this year, but she’s back on the treadmill of life—and her usual rigorous activity schedule. “You would never know that I had brain surgery,” she says. “There’s nothing about me today that’s different.”

Dr. Rasmussen says Ms. DeBerry will have follow-up visits at Cleveland Clinic to ensure that she does not develop another aneurysm but, “for the most part, she is cured,” he says. “She shouldn’t have further problems, and she should live a normal life expectancy.”

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