44-year-old young man who was diagnosed with severe brain bleeding during the COVID pandemic, was successfully revived to life at Artemis Agrim Hospital, Gurugram. Patient Ratiram (Name Changed) a resident of Jaipur (city name changed) had episode of sudden severe headache and became unconscious and was rushed to the emergency of local hospital. CT scan revealed major brain haemorrhage.
Further Investigations revealed that one of his brain arteries known as vertebral arteries which supplies the posterior half of the brain had burst causing a subarachnoid haemorrhage due to a brain aneurysm (bulge in the brain blood vessels). As a first line of treatment, a small tube was inserted into the fluid cavity of the brain through the skull to drain out the fluid and blood in order to reduce the pressure in the brain and to prevent the patient from going into coma. Tests also revealed the patient to be positive for COVID infection.
For further management, he was transferred to Artemis Hospital, where the emergency team was swift to respond with the COVID protocols. A quick assessment was done in the isolation room in emergency and investigations revealed extensive changes in his lungs. The management of this patient was very challenging as the patient was admitted in the COVID ICU and his Covid symptoms started worsening with time.
The neuro intervention team, with full precautions, performed the angiography to study the damaged blood vessels in the brain. Since one of the arteries was found to be swollen and ruptured causing severe bleeding, it was important to seal it as soon as possible to prevent fatality. To repair the damaged blood vessel, a new procedure known as flow diverter stent placement was done which is a pipe-like device made up of very fine meshwork wires that reduces the flow into the aneurysm while maintaining flow in the normal vessels. After giving the blood thinners the device placement was done. A small tube was taken from the leg vessels in the damaged artery and the device was deployed to initiate the healing. This procedure allowed slow and gradual healing of the aneurysm and the repair of the arterial walls.” Said Dr Vipul Gupta, Director, Neurointervention, Artemis-Agrim Institute for Neurosciences, Artemis Hospital.
With time body tissue completely covers the flow diverter and in a way it becomes an integral part of a blood vessel leading to a permanent cure. Flow Diversion can be used to treat large or giant wide-necked brain aneurysms and is the most effective and the newest technology available for the treatment.
One of the major complications in carrying out the procedure was his co-morbidity of COVID infection-causing lung damage. Due to deterioration in his breathing ability, a small hole was made in the neck to allow direct ventilation.
The patient had a turbulent course and his COVID symptoms progressed and lung changes started worsening with time. Despite his complicated state, the teams of neuro intervention, critical care and neurosurgery coordinated with each other and the patient made gradual recovery, and the patient was discharged in a stable condition. A follow-up angiography was done after few months which revealed that the aneurysm had completely healed and the patient had made almost a complete recovery and gone back to his normal life. The teamwork and as well as modern technology helped in the recovery of this extremely critical patient.
