STEPHANIE TUBBS JONES, the first black woman from Ohio elected to the U.S. House of Representatives, passed away yesterday after suffering a ruptured brain aneurysm.
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Stephanie Tubbs Jones—the first black woman elected to the U.S. House of Representatives from the state of Ohio—died yesterday evening in a Cleveland hospital, according to several news reports. The Democratic congresswoman was 58 years old.
According to her aides, Jones suffered a ruptured brain aneurysm while driving in Cleveland Heights, a suburb of Cleveland. A police officer saw her car swerve on the road and stopped her. She was rushed to Huron Hospital—part of the Cleveland Clinic—where officials said her condition deteriorated due to complications from a brain hemorrhage.
Tubbs Jones was pronounced dead at 6:12 P.M. Eastern time on Wednesday.
The five-term congresswoman was best known, according to a CNN report, as an outspoken critic of the war in Iraq and was the only representative from the Ohio delegation who voted against the war.
According to neurologist Sean Savitz of the University of Texas Medical School at Houston, two to six percent of the population has an aneurysm somewhere in their body that does not cause them any discomfort. ScientificAmerican.com called Savitz to get more information on brain aneurysms, like the one that precipitated the death of Tubbs Jones. An edited transcript of the conversation follows.
What's an aneurysm?
What happens is a blood vessel becomes like a bulge, and that's due to a weakening of the wall of the blood vessel itself. The ones that we're most concerned about are occurring in the arteries. They can occur in arteries that feed the brain and they can occur in arteries in the body, as well.
[In the case of brain aneurysms] the concern is that eventually that bulge will burst. And when it does burst, it leads to bleeding in one of the spaces of the brain called the subarachnoid space—the area [under the skull] that is actually covering the brain tissue. If the blood vessel bursts and you have all this blood that's on top of the brain there's going to be pressure that builds up in the brain itself and that can lead to all kinds of problems because the brain is in a closed box—and there's a very limited number of openings. The brain can get squished through the hole in the skull.
Is there a typical part of the brain where aneurysms take place? According to Rep. Tubbs Jones' doctors, the aneurysm took place in an "inaccessible" part of the brain.
Inaccessible is maybe accessible depending upon the experience of the surgeon. And so, it's hard to know unless they gave us the real location what they mean by that.
Sometimes they're so deep in the brain that it would make it surgically difficult to be able to access it. There are lots of different sites that are known where aneurysms can form. They can occur for instance at areas where arteries are coming together. There are some common ones that occur: For instance, there's the anterior communicating artery, there's the posterior communicating artery. For the ones that occur in the brain that bulge occurs in a specific artery and then it can just expand over time. And eventually it can burst.
Unfortunately other arteries get affected and they start to constrict. This goes on for awhile. It classically happens between three and 12 days and it's not really clear why the arteries spasm, but it's a major cause of morbidity.
Are aneurysms normally found before they burst?
They often are found during routine workups. For instance, I don't know whether the congresswoman had a known aneurysm or if it was found after the workup was done for the hemorrhage that she had.
Often patients will be evaluated for various different reasons and during that workup, they are found to have an aneurysm. Sometimes the aneurysm is considered to be the cause of the patient's problems and sometimes it's considered to be incidental.
What would a patient be experiencing if an aneurysm is the cause of their discomfort?
There's a spectrum of possibilities with respect to the clinical symptoms that they have. The most common presentation for someone who is having a hemorrhage from an aneurysm is [a] severe and sudden headache.
Some people will say, "This is the worst headache of my life." And when people hear that phrase—they're taught this in medial school—they should be very worried that [the patient] just had an aneurysmal hemorrhage.
What we've come to recognize over time is that's only one presentation. The presentation that should alert the physician to the possibility of an aneurysmal hemorrhage is sudden and severe [headaches]. You can imagine that there are a lot of people out there who have headaches, have migraine disorders. The tip-off is when the headache is different than their typical headache.
People can present with a range of different possibilities: They can lose consciousness. If the aneurysm is big enough, it can cause symptoms without actually bleeding. An aneurysm can cause pressure depending on where it exists in the brain and a number of different symptoms depending on where it is located in the brain.
So that would turn up as numbness or pain?
Not usually pain, but weakness in a limb is certainly a possibility. People can get seizures. Cranial neuropathies. The one that is classically taught in neurology is when you may have a visual problem and there's an exam finding that you have a problem with your pupils. That sometimes can point to an aneurysm in the posterior communicating artery.
Some aneurysms can actually harbor clots. And the clots can get released, and that can cause a stroke, so then they can have the symptoms of a stroke.
What's the risk that an aneurysm will bleed out?
The incidence of a subarachnoid hemorrhage from a ruptured intracranial aneurysm is one case per 10,000. There's a two to one predominance women to men and peak incidence is 55 to 60 years old. Roughly half of people who have an aneurysmal subarachnoid hemorrhage will die within 30-days
If someone came into the hospital with a ruptured aneurysm, what could you do to treat it?
There is a high rate of morbidity and mortality when it comes to an aneurysmal bleed. If the patient makes it in, doctors will grade them in terms of how bad off they are. There's actually grading scales for aneurysmal hemorrhages. It gives you some prognostic information if you were to do something. For instance, it depends upon what you're intending to do.
With subarachnoid hemorrhages, they can cause, as I said, increased pressure on the brain, and people can die from intracranial pressure. So, you might need to put a drain [in] to be able to relieve the pressure. If there's a huge amount of blood, it may be necessary to try to evacuate the blood.
But, a big issue for surgery is that the aneurysm is still bleeding, so you've got to do something about it. You may need to go in and try to clip the aneurysm or try to coil the aneurysm.
What do you mean by "clip" and "coil?"
Imagine you've got this bulge. And if there's a neck that's coming off the artery, you could actually clamp it—put a clip on it. Coiling techniques are not surgery, they're actually endovascular approaches with a catheter. You go up there and you seal off the bulge
If a patient does not die from a rupture, is he or she more or less certain to suffer lasting brain damage?
Among those that don't, it's roughly estimated that a third can be disabled.
Would that be both cognitive and movement difficulties?
That would be everything. Those people would be disabled because of cognitive problems or because they are weak. They can't move a limb or are having difficulty moving a limb.
How do avoid having an undiagnosed aneurysm burst? Get screened if you have high blood pressure?
Just high blood pressure has not been found to be enough of a risk factor to say those are the ones that should get screened. Family history of cerebral aneurysm is a reason to actually be screened. There are genetic predispositions to aneurysms.
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5 Comments
Add CommentThis is a warning I must extend to my friend. Her mother died from an
Reply | Report Abuse | Link to thisaneurism, and her sister is disabled from this illness. Thank you for a
warning worth passing on.
When I saw the headline , I thought I would comment" potentially fatal" , but that seems unnecessary now.
Reply | Report Abuse | Link to thisUnfortunately those with an aneurysm are often totally unaware of it. I know of a teenager who died of one
Best to enjoy life to the maximum , as you may not be here tomorrow.
I am one of 3% which survied a brain hemorrage ,I had severe hedaches but the worst was my eyes I felt like they were going to explode,at the time I had a new business abd was working 60/70 hrs a week I dnt know I had high blood pressure until I went to the docs for something else he told me it was dangerously high and had to go every other day for a check which the nurse done after 2wks the nurse said I need medication the doctor said give her another week and three days later I had the hemorrage , I went hospital they sent me home with a migrane I knew it wasnt but didnt know what was wrong I went home I live alone and stayed in bed for 2more days I had lost alot of my senses eg taste, smell hearing was being sick all the time by the 3rd day I phoned my daughter to come take me to the hosp by now both eyes are black and blue and I have 2 sacks of blood in the corner of my eye/nose anyway the got me through A&E within 15mins by now I fell like I'm going to die the pain in my head I cannot describe they got me in the cat scan then they seen the brain hemorrage and it was all action stations, next day I was operated on via my grion it was 6/7 hr operation and I live to tell the tale .I'm very lucky to be alive but I do have a few little problems eg still get very tired and as it was a front hemorrage it has changed my character eg before I was very laid back now I'm firy lots of little things but nothing I cant deal with and my doctors are great and have explained it all to me and what to expect and the after effects they have been spot on and I understand it all now so it makes it easier to live with and I understand why I feel the way I do etc etc. I also belive we all have an allocated time on earth and illness is sent to us for differnt reasons ,in my case my 29yrs marrige had broke up as he was having an affair we were in France living our dream then it was all gone my operation was on our wedding anniversary odd eh! but when I looked up what it meant brain hemorrage is Emotional Anger which was spot on my wonderfull life I was living was all gone I was back in the UK working my butt off so as I thought I had dealt with everything emotionlly from my ex I hadnt but I also understand there is more to life than we understand and our thoughts can kill or cure us so we must be aware I believe what we think and thoughts we have about ouself our lives . Life is not all medical and science we must learn to combine all of it .
Reply | Report Abuse | Link to thisIf your sister has one, how do you get screened. My younger sister had an MRI to rule out cerebral aneurysm & her insurance denied the claim. What diagnosis can you use to ensure the claim will be paid. My older sister has an anuerysm & her Doctor told her we should all be tested. Susan Larson
Reply | Report Abuse | Link to thisAn aneurysm or abnormal ballooning of a section of blood vessel in the brain is termed cerebral aneurysm. This ballooning might be the result of a weakness in the wall of a cerebral artery or vein.
Reply | Report Abuse | Link to thisThe Circle of Willis forms a loop of arteries joining a circle at the base of the brain, sending out branches to every region. Nutrition is provided to the entire brain through these arteries that branch out. There are junctions where these arteries come together and these areas form weak spots having a high probability of developing cerebral aneurysms, specifically the anterior part of the Circle of Willis.
http://www.heart-consult.com/articles/cerebral-aneurysm-symptomsdiagnosis-and-treatment