A Subarachnoid Hemorrhage Patient’s Journey

Pacal Jabbour INR screens 584x342Brian Smith is a career army man. He joined at the age of 22. At 36, Brian had done three tours in the Middle East, including two combat tours in Iraq, and had risen to the rank of sergeant.

In late 2009, after his most recent Middle East tour, he was back home in South Jersey and had been sick all week with what he thought was a bad cold.

One night that week, Brian’s wife came home from work to find him sleeping on the couch. As she watched, he sat up suddenly and then fell to the floor in convulsions.

At the local hospital emergency room, Brian was incoherent and his condition grew worse and worse. He lost consciousness and he stopped breathing on his own. He was intubated and transferred to Jefferson.

Brian had had a subarachnoid hemorrhage – a brain bleed – and aneurysms. On top of that, he had a serious case of pneumonia. The South Jersey man needed around the clock care and monitoring in a neuro-intensive care unit at Jefferson Hospital for Neuroscience.

At first Brian’s condition was too critical for Jefferson neurosurgeon, Pascal M. Jabbour, MD, to attempt to repair the aneurysm in his brain that had bled for a brief instant. After several days in the ICU, Brian had stabilized enough for Dr. Jabbour to attempt to a repair.

Although Brian remained in critical condition, Dr. Jabbour felt he could attempt to treat him using minimally invasive endovascular techniques in Jefferson’s interventional neuro-radiology (INR) laboratory. Jefferson’s experienced team of vascular neurosurgeons specializes in both endovascular and open approaches to treating cerebral vascular problems.

Dr. Jabbour made a small incision in Brian’s thigh, just below his groin, and punctured his femoral artery. He then steered a thin hollow wire through six feet of blood vessels into Brian’s brain to repair both aneurysms.

The procedure went well, but Brian’s saga didn’t end there. Although one of the aneurysms had bled for only a few seconds, there was enough blood to irritate the vessel putting Brian at risk of vasospasms – a condition when the vessel spasms and can clamp shut. These vasospasms are often treated with medication in an effort to reopen the vessel. If that doesn’t work an endovascular technique using a balloon to reopen the blood vessel is the only alternative.

Brian in fact developed vasospasms.

When medications didn’t work, Dr. Jabbour took Brian back into the INR lab, wound a wire back into his brain, and the technique known as balloon angioplasty reopened the vessel.

It happened again the next night. And the next. And the next. And the next.

Each night Dr. Jabbour returned, with his patient, to the INR lab, wound the catheter through the man’s arteries into his brain and inflated a balloon to reopen the blood vessel and restore blood flow to the rest of his brain.

Brian began to slowly recover, however his long-term prospects remained unclear. Would he ever breathe on his own again? Would he be able to talk? To walk? Would he be “neurologically” intact?

Brian made steady progress to the point where he could begin to undergo rehabilitation and eventually return home.

Six months later, to Dr. Jabbour’s surprise and relief, Brian walked on his own into the physician’s office for a checkup! He was talking, perhaps a little more slowly, but clearly he’d made stunning progress.

A year later, Brian again surprised Dr. Jabbour. This time it was a baby. Brian and his wife were starting their family.

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2 Responses to A Subarachnoid Hemorrhage Patient’s Journey

  1. Frank B Smith (Father) April 20, 2013 at 11:59 am #

    I thank God daily for guiding us to send Brian to Jefferson Hospital. The Doctors, Nurses and staff there…and God…saved him. It’s easier to say ” It was a jount venture betweed God and Jeff” that saved Brian. I only wish that MORE “Wounded Warriers” could be fortunate enough to have their life threatning injuries tended to by the marvelous Jefferson Team.

    Also, Magee Rehab did a fantastic job and Brian reclaimed his life there.

    Thank you all.

    Frank, (Brian’s Dad)

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