Back in the Driver’s Seat
Skippack grandmother regains control of her life after brain bleed.
Glue saved Georgia Slater’s life. Of course, the highly skilled neurointerventional and neurocritical care team at Abington Memorial Hospital (AMH) played a significant role as well. They injected the liquid glue inside Georgia’s brain to stop the bleeding that could have killed her. Amazingly, they did so without performing surgery.
The series of events that landed Georgia, 63, in the Neurovascular Laboratory at Abington’s Neurosciences Institute began in August 2010. She’d been taking Advil for a few days to alleviate afternoon headache pain. One morning, Georgia didn’t place her daily telephone call to her mother Edith, 88. By 9 p.m., a worried Edith couldn’t reach Georgia on the phone and contacted Georgia’s son, Matt.
“When my son called, for some reason,I answered the phone,” says Georgia. “Matt tells me I was talking but not making any sense, although I don’t remember it.” Matt took his mom to Lansdale Hospital. There, the Emergency Medicine team evaluated Georgia and determined she was hemorrhaging on the right side of the brain. They had her transported immediately to AJH, where she would get the highly specialized care she needed.
At AJH, specialists determined that diagnostic imaging techniques (a CT scan and subsequent CT angiogram) suggested a malformation of blood vessels was causing Georgia’s brain bleed. Based on information from those test results, Neurointerventionalist Osman Kozak, MD, decided to perform a catheter angiogram in the Neurovascular Lab. This technique involves the use of a special dye (contrast agent), X-rays and computer analysis to give a detailed picture of the blood vessels and blood flow in the brain. Georgia’s angiogram revealed a dural arteriovenous fistula (AVF) – an abnormal connection between an artery and vein in the covering of her brain. “In Georgia’s case, the high pressure blood flow from the artery was draining into a vein, which is not designed to handle that pressure and flow, so the vein burst and blood leaked into the surrounding brain tissue,” explains Larami MacKenzie, MD, associate director, Neurocritical Care. Blood also had accumulated in the ventricles – spaces in the brain that contain cerebral spinal fluid.
Glue for Brain Bleeds
To stop the hemorrhage, Dr. Kozak, associate director, Neurointerventional Care in our Neurosciences Institute, performed an endovascular embolization. Through a small incision in Georgia’s groin, he inserted a micro-catheter (a tiny tube) and using X-ray guidance, navigated to the precise location of the AVF. Working with specialized instruments through the catheter, Dr. Kozak injected a slowly polymerizing liquid resin into the AVF to block it and prevent it from bleeding again. “This new liquid embolic agent is easier to use and safer than a previously used agent,” explains Dr. MacKenzie. “It is like a plastic molasses, which dribbles very slowly and thickly out of the catheter and then slowly becomes solid inside the blood vessel.”
Once Georgia’s AVF was successfully obliterated, the neurointerventional care team placed a temporary external ventricular drain to ensure that Georgia’s spinal fluid continued to drain. “When blood leaks into the brain tissue and ventricles, it clots and can block drainage of spinal fluid,” says Dr. MacKenzie. Because spinal fluid is continuously made, it has to drain, or it accumulates, causing increased pressure on the brain, which can lead to brain damage. Dr. MacKenzie drilled a small hole in Georgia’s skull and inserted a narrow tube into the ventricles to drain the spinal fluid. The tube was connected to an external drainage bag and monitor. A physician would remove the drain when it was safe to do so.
Georgia remained in the hospital for a couple weeks. Once she was medically stable, she was transferred closer to home, to Lansdale Hospital’s Acute Rehabilitation Unit. For three hours a day, Georgia pushed through sessions with physical, occupational and speech therapists to regain skills and her independence. Upon discharge from rehab, Georgia lived with her son for a few weeks as she continued to heal and build strength. Nearly six months after her brain bleed, Georgia achieved what she considered her final step to independent living. She completed behind-the-wheel training at a specialized driving school for people with disabilities.
In November 2012, Georgia joined her mother, daughter and two grandchildren for a four-generation trip to Orlando, FL. “The kids loved the amusement parks,” says Georgia. “The rest of us simply loved being together. I have my doctors to thank for that.”