Mount Sinai Hospital

Minimally Invasive Aneurysm Treatment Saves Mother’s Life

When Brunilda Ayala, a police officer at a busy hospital in Harlem, experienced subarachnoid hemorrhage, endovascular neurosurgery at Mount Sinai saved her life

In January 2010, Brunilda Ayala, a police officer at a busy hospital in Harlem, experienced a series of increasingly severe headaches. A vibrant mother of three, Brunilda was found slumped over in her car in the hospital parking lot. Paramedics rushed to stabilize her breathing and take her to the emergency room. A CT scan of her brain showed a subarachnoid hemorrhage — diffuse bleeding into the membranes (layers) surrounding the brain.

Emergency room physicians contacted Mount Sinai neurosurgeons, who helped orchestrate rapid transfer of Brunilda to the Mount Sinai Neuro Intensive Care Unit. There, a team led by Aman Patel, MD, and Jennifer Frontera, MD, worked quickly to stabilize an increasingly critical situation. They used medicated infusions to prevent additional bleeding and placed drains in her head to relieve pressure in Brunilda’s now swollen brain.

Endovascular Neurosurgery Saves Brunilda’s Life

Dr. Patel, Director of Endovascular Neurosurgery and Interventional Neuroradiology at Mount Sinai, performed an emergency angiogram on Brunilda, revealing an aneurysm in the blood vessel behind Brunilda’s left eye. The aneurysm, a sac-like collection of blood that formed at a weak point in the arterial wall, had ruptured into the surrounding brain tissue.

Using X-ray guidance to provide a roadmap of the blood vessels in Brunilda’s brain, Dr. Patel and his team first placed a stent across the bottom of the aneurysm. Next, they placed delicate coils within the aneurysm. Stabilized by the stent, the platinum coils were packed into the aneurysm and clotted the blood flow. In less than two hours, the aneurysm had been stabilized, preventing another bleed.

As Brunilda’s family and fellow police officers kept vigil, Dr. Patel and his team worked hard to combat new problems that arose. Although the aneurysm had been secured, the initial subarachnoid hemorrhage continued to have a devastating effect. Arteries in Brunilda’s brain constricted, leading to stroke-like symptoms. To reopen the constricted arteries, Dr. Patel and his team treated Brunilda every day with balloon angioplasty and verapamil, a medication infused directly into the brain’s constricted vessels. The initial hemorrhage also led to hydrocephalus, which required additional surgery.

Recovery Slow But Steady

During Brunilda’s stay in the Neuro ICU, family and friends remained optimistic. Despite multiple setbacks Brunilda became increasingly responsive, made eye contact, and began to speak and move. As each tube was removed, her children experienced renewed hope.

Brunilda entered Mount Sinai’s rehabilitation center, where she worked daily with physical, occupational, and speech therapists. On April 5, after more than two months’ of hospitalization, Brunilda went home.

Rapid Treatment Leads to Successful Interventions

Brunilda remembers nothing of her initial subarachnoid hemorrhage or her lengthy intensive care stay. But her immediate transfer to Mount Sinai’s highly experienced team of surgeons, physicians, and nurses made all the difference.

“In the U.S., there are about 30,000 to 40,000 ruptured aneurysms a year,” Dr. Patel notes. “15 percent to 25 percent of patients die before they get to the hospital. That’s why it’s so important to get to the hospital immediately upon experiencing symptoms of a brain hemorrhage.”

These symptoms include an unbearable headache — often described as the worst headache of your life — as well as light sensitivity, nausea, vomiting, neck stiffness, and changes in consciousness. Early intervention for a ruptured aneurysm can make the difference between life and death.

An endovascular neurosurgeon, Dr. Patel specializes in the treatment of brain aneurysms, including minimally invasive procedures performed within blood vessels. Along with Drs. Joshua Bederson and Henry Moyle, he treats aneurysms in order to prevent rupture and performs emergency interventions once an aneurysm has hemorrhaged, as in Brunilda ‘s case.

Brunilda still has a challenging road ahead. Regaining her memory, energy, and strength are her immediate goals. But this resilient woman, once comatose on a ventilator, is walking, talking, and laughing again. And as for the future, Brunilda says she looks forward to resuming her passion for dancing, cooking, and serving on her hospital’s police force.

We Can Help

If you or someone you love has been diagnosed with an aneurysm, please call our office at 212-241-3457 to schedule an appointment and to learn more about how our neuroendovascular techniques can help.