Brain Trust

Neurosurgeon repairs deadly bleeding disorder with catheter procedure.

In late April, Alison* feared she had contracted COVID-19. She had good reason, based on her symptoms, which included a great deal of fatigue, fever and headaches.

“I very rarely run a temperature, which is why I thought it must be COVID,” the 75-year-old says. “The other thing was that I was so dreadfully tired. All I wanted to do was sleep. And for two days, that’s pretty much all I did, which wasn’t very smart.

“I probably should have gone to a doctor straight away, but I didn’t want to move because I was so tired and had this massive headache. Finally, after two days, I decided I had to go see someone because I couldn’t talk straight. I could speak, but the words were all gibberish. I knew exactly what I wanted to say, but I couldn’t put the words into a sentence that made any sense. It was like I couldn’t connect them properly.”

Concerned about her condition but uncertain of where to go because her primary care physician retired in January, Alison visited an urgent care facility. It was there that she received a shocking diagnosis.

“They didn’t think it was COVID, so they decided to take a CT scan of my brain to see if there was anything going on there,” Alison remembers. “As it turns out, there was something going on, so it’s a good thing they did the CT scan.”

Thick and Thin

The CT scan showed that Alison had suffered a subdural hematoma. Commonly known as a brain bleed, a subdural hematoma occurs when a blood vessel near the surface of the brain bursts and blood collects between the brain and its outer lining, called the dura mater.
The collection of blood can put pressure on the brain. That pressure, in turn, can result in a variety of symptoms that range from headaches, dizziness and vomiting to loss of consciousness, paralysis and even death.

Brain bleeds are often caused by trauma to the head, but as Alison learned after she was rushed to Lakewood Ranch Medical Center, a member of the Manatee Healthcare System, they can also occur as a result of taking certain medications such as anticoagulants,
or blood thinners.

“I’ve been on blood thinners for about 30 years, ever since I was diagnosed with atrial fibrillation, which is an irregular heart beat,” Alison reveals. “I take them to keep me from having a stroke. In particular, I’ve been taking warfarin.”

The fact that Alison had been taking blood thinners somewhat complicated her situation, so it wasn’t long after she arrived at the medical center that she was moved to the intensive care unit.

It was there that her case was turned over to Huan Wang, MD, the medical director of Neurosurgery/Neocritical Care at Lakewood Ranch Medical Center and Manatee Memorial Hospital.

Dr. Wang is a board-certified neurosurgeon who specializes in complex brain and spine surgeries. He began his care for Alison by ordering a reversal of her blood thinners, which calls for the introduction of blood thickening agents into the body.

“That’s a critical step because a brain bleed in a patient on blood thinners such as Alison can lead to rapid death,” Dr. Wang educates. “So the first thing to do in a situation like that is stabilize the patient medically, which we were able to do.

“Had we not been able to stabilize Alison, I would have had to take her for surgery emergently, and in that case, I would have had to open the skull, stop the bleeding and then plate and screw the skull back into place. That’s obviously a very invasive surgery, and you really can’t put someone back on blood thinners after that, so we were fortunate that we were able to get her stabilized. That also allowed us to repair her brain bleed through a minimally invasive approach.”

Light the Way

The minimally invasive repair is called an artery embolization. In the Manatee-Sarasota county area, the only hospital equipped for such a procedure is Manatee Memorial Hospital, which is where Alison was moved to a day later when
the procedure was performed.

“In addition to the latest technology needed for this procedure, Manatee Memorial Hospital also has the qualified staff,” Dr. Wang reports. “They have the nurses, the technologists and the kind of procedural area necessary to perform this delicate procedure.”

Also known as a catheter intervention of the brain, an artery embolization is conducted through a small puncture in the patient’s groin, through which a microcatheter is inserted and fed through the blood vessel and into the cranial compartment.

The path of the microcatheter is aided by the use of a real-time x-ray imaging system called fluoroscopy, but Dr. Wang still has to know exactly where to route the microcatheter, which must bypass the heart in order to reach the brain and the site of the bleed.

“Think of the blood vessel as a highway system with a lot of exits,” he says. “It’s my job to know which exit to take to get to the brain. I have driven that highway many times, so I know exactly where to go.”

In Alison’s case, Dr. Wang needed to reach the left side of the brain. The CT scan showed that was where her brain bleed was. Once he got there, Dr. Wang completed the embolization by releasing a substance that closes up the artery and stops the bleeding.

“The embolization material is a polymer that remains a liquid while it’s in the catheter but polymerizes once it’s in the blood environment,” Dr. Wang explains. “You can actually embolize an entire territory to stop any seeping, which is what I did with Alison.”

Alison’s treatment didn’t end there. In addition to undergoing the artery embolization, she was treated by a cardiologist who followed Dr. Wang’s work by placing a device in Alison’s heart that eliminated her need for blood thinners.

“Someone knew what they were doing when they sent me to Manatee Memorial, because they took great care of me.” – Alison

“Once someone has a brain bleed, they are at increased risk for recurrent brain bleeding, especially if they’re on a blood thinner,”
Dr. Wang says. “So, if it can be done, a patient such as Alison is going to benefit greatly from having this heart procedure as well.

“Thankfully, the cardiology department was able to quickly evaluate Alison, who did qualify for the heart device, which she received shortly thereafter. Since then, she has slowly been taken off the blood thinners, and she’s doing exceptionally well.”

Alison confirms that diagnosis. She was given a CT scan the morning after the embolization and another two weeks later; no bleeding in the brain was visible.

“I was able to go home the day after the procedure, which was great,” Alison exudes. “Now I feel like my old self again. I feel fantastic, actually. I really do. And I can’t thank Dr. Wang and all the people at Manatee Memorial Hospital enough for that.

“Someone knew what they were doing when they sent me to Manatee Memorial, because they took great care of me. And Dr. Wang and his staff did a great job of keeping my husband informed of what was happening, because I sure didn’t know what was going on.

“I was out of it pretty much the whole time, but I know that they got Dr. Wang involved right away and that he took care of things very quickly. He’s a real lifesaver because I don’t know what would have become of me had I kept on bleeding.”

*Patient’s name changed at her request.
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    • Manatee Memorial Hospital

      When it comes to choosing a hospital, one thing is clear: quality counts. Manatee Memorial Hospital has a long tradition of providing medical care in a comfortable and convenient environment each year for thousands of patients... Read More

    • Huan (John) Wang, MD

      Huan (John) Wang, MD, is a board-certified neurosurgeon specializing in cerebrovascular diseases, skull-base tumors and neuroendovascular pathologies.  He is also certified in neurocritical care and regenerative medicine. He performs compl... Read More