ER Visit Reveals Something More — a Life-Threatening Brain Aneurysm

Martha Hernandez didn’t come to the hospital because of a brain aneurysm. She came because of hives. The rash had started on a Sunday and spread from her thighs to her chest and face. Then came headaches and dangerously high blood pressure, prompting a trip to the emergency department at Baptist Health Baptist Hospital.

What began as a search for one problem uncovered another, far more serious one: a small brain aneurysm. And what happened next would save her life.

(Watch now: Suffering from hives, high blood pressure and headaches, Martha Hernandez sought emergency care at Baptist Health Baptist Hospital. What began as a search for one problem uncovered another, far more serious one: a brain aneurysm. And what happened next would save her life. Video by Alcyene de Almeida Rodrigues.)

A Hardworking, Always-Busy Woman

Ms. Hernandez, now 40, helps run her family’s carpentry and retail display manufacturing business in Doral. She is a wife, a mother and a daughter. She also leads Amor y Fuerza, a nonprofit that supports children and vulnerable communities in Miami and her native Honduras. In the hours left over, she creates and sells floral arrangements, a craft that later became part of her healing.

“I’m a hardworking person. I’m a great mother, a great friend,” Ms. Hernandez says when asked to describe herself. “I never say no. If I can help and if I can say yes, then why say no?”

An Incidental Finding

Ms. Hernandez had never had hives before but has had problems with high blood pressure. When the hives kept returning and she also started experiencing headaches, she went to the emergency department at Baptist Hospital. Imaging revealed a small brain aneurysm.

“The brain aneurysm was an incidental finding,” she says. “It’s crazy how I came in for one thing and they found another. If it wasn’t for having the hives, I would never have known I had an aneurysm that could rupture at any minute. Coming into the emergency department saved my life.”

Angiogram Reveals Troubling News

Ms. Hernandez followed up with specialists and was referred to Guilherme Dabus, M.D., an interventional neuroradiologist and co-director of the Interventional Neuroradiology Program at Baptist Health Miami Neuroscience Institute.

At first, the aneurysm appeared small on magnetic resonance angiography (MRA). But Dr. Dabus knew that more precise imaging was needed.

“MRA is a good screening tool but lacks a lot of definition,” he says. “For that, we recommended that she have a minimally invasive catheter procedure called cerebral angiography, which is the gold standard test for evaluating the intracranial vessels—intracranial aneurysms in particular.”

The angiography revealed troubling news. The aneurysm was larger than expected—and far more dangerous.

“To my surprise, when she came in and had the test done, her aneurysm was larger than we initially thought and we could see it was not a typical aneurysm,” Dr. Dabus recalls. “It was something that we call a dissecting aneurysm.”

A Dangerous Diagnosis

Dissecting aneurysms are rarer than the more common saccular type. They also carry a greater risk. In Ms. Hernandez’s case, the aneurysm was located in the basilar artery, a major blood vessel that supplies the back of the brain.

“A dissecting aneurysm is not common at all. In fact, it’s very rare,” Dr. Dabus says. “If left untreated, the consequences could have been catastrophic.”

What made it especially dangerous, he adds, was the fragility of the vessel wall. “If that aneurysm ruptures, that is usually devastating to the patient,” Dr. Dabus states. “Most patients will either be dead or severely disabled.”

Facing Complex Brain Surgery

After the angiography, Dr. Dabus went to Ms. Hernandez while she was in recovery and urged immediate treatment. She had expected to go home that day. Instead, she learned she would be admitted to the hospital and undergo highly complex brain surgery the very next morning.

“When he said the diagnosis, I didn’t have any words,” Ms. Hernandez says. “I felt that my life was coming to an end.”

She was alone at the time. Her daughter had dropped her off, expecting a routine outpatient visit. Her mother was supposed to pick her up later.

“I was crying, but at the same time, I couldn’t believe it,” she recalls. “I wasn’t even 40 years old. For me to have a brain aneurysm at the age of 39, it was just a shocker.”

Still, she made what would be a life-saving decision to have Dr. Dabus proceed with her surgery.

“I told him, ‘OK, I trust you, and if we need to do this, then we’ll do it,’” she says. “Realistically speaking, there was no other choice.”

Precision, Teamwork and Advanced Care

At Miami Neuroscience Institute, Ms. Hernandez had access to a team built for exactly this kind of high-stakes case.

“Here, we have all the specialties working together to provide the very best treatment plan for the patients,” Dr. Dabus says. “Our physicians are highly skilled and are able to execute that plan very well — and that’s what gives the patients the best chance of a great outcome.”

The treatment itself was done from inside the blood vessel, using a minimally invasive endovascular approach which Dr. Dabus explains in simple terms.

“We enter the blood vessel either through the groin or through the wrist, and then we navigate the catheters all the way to the patient’s neck to the vessel that harbors the aneurysm in the brain,” he says.

“From there, after we map things up with X-rays and contrast, we navigate tiny tubes that we call microcatheters. They go inside where the aneurysm is and then we fill the aneurysm with little platinum wires that we call coils.”

In Ms. Hernandez’s case, he also placed a stent, a tiny mesh tube that helped support the blood vessel and seal off the aneurysm.

“The stent covers the neck of the aneurysm, reconstructs the damaged vessel and helps to shut the aneurysm down,” he says.

Planning for any Eventuality

Even with careful planning, the procedure carried real risk. Dr. Dabus says surgeons always prepare for several possibilities before a case begins. “We have plan A, plan B, plan C,” he says.

And, he adds, dissecting aneurysms, because of their nature, are believed to have a higher risk of rupture.

“The wall of it is very thin so when you’re doing the treatment, there’s a higher risk that the aneurysm—or even the whole vessel—can just rupture and cause a massive hemorrhage,” says Dr. Dabus.

Thankfully, Ms. Hernandez’s procedure went exactly as hoped.

“Her case was complex and it was difficult but we were able to execute the plan that we had made for her, and everything went perfectly,” Dr. Dabus says.

A Life Returned, With New Purpose

When Ms. Hernandez woke up after surgery, her mother was by her side.

“I actually thought that I was going into the procedure,” she says. “She clarified to me, ‘No, it’s done. You’re good.’”

Ms. Hernandez spent a few days recovering in the Intensive Care Unit (ICU), then returned home for a few days of strict rest and no lifting. For a woman used to constant motion, that stillness was its own challenge.

“I’m a very active person. I’m always doing something,” she says. “In this case, I couldn’t do anything.”

Over time, she recovered. Follow-up imaging showed complete closure of the aneurysm and repair of the damaged vessel.

“Martha’s doing great and her prognosis is excellent,” Dr. Dabus says. “As long as she continues her follow-up appointments and takes her blood pressure medication, she should have a totally normal life.”

Green, no links or images. Description: “It’s crazy how I came in for one thing and they found another. If it wasn’t for having the hives, I would never have known I had an aneurysm that could rupture at any minute. Coming into the emergency department saved my life.” Attribution: Martha Hernandez, brain aneurysm patient, Baptist Health Miami Neuroscience Institute

Thankful to Be Alive

For Ms. Hernandez, that normal life is anything but small.

She continues to help lead the family business. Through Amor y Fuerza, she and her family organize fundraisers; support Title I schools; provide food, uniforms and school supplies, and help vulnerable communities in Honduras and South Florida. She has also embraced floral design, a creative outlet that helped steady her after surgery.

“Right after, what kept me grounded was the flowers,” she says. “I started making these flower arrangements, and that was like my therapy.”

Her perspective has changed, but her purpose has only deepened.

“I’m thankful to be alive,” she says. “I know that I’m here for a purpose to continue with the nonprofit and to continue helping people.”

Click here for more information about the services and specialists available at Baptist Health Miami Neuroscience Institute.