September 29, 2022 by Peter B. Laird
‘Worst Headache of Her Life’ Signaled a Ruptured Brain Aneurysm for Miami Mom and Media Entrepreneur
What does it feel like to have a ruptured brain aneurysm? Ask Angela Sustaita-Ruiz, 51, who suffered a ruptured aneurysm earlier this year. “Literally out of nowhere, I got this massive headache, the worst of my life,” says the energetic and outgoing Hispanic entertainment media entrepreneur and mother of four. “It was an intense pain that started at the front of my forehead and traveled back through the rest of the brain with some tingling. The pain radiated so quickly that my back started hurting, too. I told my colleagues who were on the Zoom call with me at the time that my head was about to explode – that is exactly what it felt like.”
Mrs. Sustaita-Ruiz quickly downed some ibuprofen to help relieve the pain but it kept getting more intense. Soon, she started noticing other symptoms, including tightness in her chest and numbness in her right arm and face. Then came severe nausea and vomiting. “I knew I was in trouble at that point,” she recalls. Fortunately, her husband was home and he immediately drove her to the Emergency Department at South Miami Hospital, which is close to the family’s home in South Miami.
(Watch Now: Angela Sustaita-Ruiz credits Dr. Robert Wicks and Miami Neuroscience Institute with saving her life after she suffered a ruptured brain aneurysm this year. Video by George Carvalho.)
When Mrs. Sustaita-Ruiz arrived at South Miami Hospital, emergency medicine physicians sprang into action and did a CAT scan and MRI of her head. “They quickly determined that I had not just one ruptured aneurysm but two,” she says. “I didn’t know if I was going to survive.”
She was told she would need emergency brain surgery and was immediately transferred to Baptist Hospital, where she underwent further evaluation by Robert Wicks, M.D., co-director of cerebrovascular surgery and director of the neurosurgical anatomy laboratory at Baptist Health’s Miami Neuroscience Institute.
Typically, Dr. Wicks says, a patient with a ruptured brain aneurysm has what many have described as the worst headache of their life, as was the case with Mrs. Sustaita-Ruiz. “It is often associated with a seizure or a weakness or nausea and vomiting so if you have any of these symptoms, it’s important that you do what she did and get to the hospital as soon as possible,” he says, adding that calling 911 is safer than relying on a family member to drive you.
Brain aneurysms are actually thought to be quite common in the general population and can happen to people of all ages, according to Dr. Wicks. “Approximately two percent, or roughly one in 50 people, have a brain aneurysm,” he says. “Fortunately, not all aneurysms rupture and many people may live with one their entire lives and not even know it.”
If a brain aneurysm does rupture, however, it can be fatal if not treated quickly, according to Dr. Wicks. Approximately one third of patients don’t even survive the trip to the hospital, he says, while another third develop “longer term deficits.” The rest tend to do quite well, he says, noting that Mrs. Sustaita-Ruiz was fortunate to be one of those who survived a ruptured brain aneurysm with no apparent long-term effects.
Risk factors to be aware of
Typical risk factors for brain aneurysms include smoking and uncontrolled high blood pressure, but some people with polycystic kidney disease and other, more rare disorders have a higher risk of developing brain aneurysms, Dr. Wicks says. “Patients who effectively manage any risk factors have a low risk of developing an additional aneurysm.”
Family history also plays a role, he adds. “For patients with at least two family members who either have a known aneurysm or have had a ruptured aneurysm, they have an increased risk themselves, so we recommend that they undergo screening with an MRI of the head,” Dr. Wicks says. “That way, we can see if there are any aneurysms and determine from their location, size and structure if they need to be treated immediately or if they can simply be monitored over time.”
Repairing the aneurysm from inside the vessel
There are two types of treatment for a ruptured aneurysm, according to Dr. Wicks. “With the endovascular approach, we go through the blood vessel with a micro-catheter and then close the aneurysm from the inside of the vessel, either with a tiny metal-filament coil or some other device that diverts blood flow away from the aneurysm,” he explains. “Or, we approach it from the outside of the vessel through a small incision in the skin and close off the aneurysm with a tiny clip.”
Both approaches generally lead to successful outcomes, Dr. Wicks says, but for Mrs. Sustaita-Ruiz, he thought her ruptured aneurysms would respond best to endovascular surgery. This type of surgery doesn’t come without risks, though, as it requires highly complex procedures and extremely intricate movements on the part of the neurosurgeon. “We have to be able to safely access the aneurysm with the micro-catheter in order to prevent any further bleeding,” Dr. Wicks explains.
As terrified as she was by what had quickly blown up into a life-threatening medical emergency, Mrs. Sustaita-Ruiz was calmed by Dr. Wicks’ extensive knowledge, calm manner and thoughtful approach. “He took his time to really explain to me and my husband what my treatment options were,” she says. “I could tell that he really wanted to make the best decision for me.”
During surgery, catheters were introduced into the blood vessels within Mrs. Sustaita-Ruiz’s neck and then smaller catheters were threaded from there into her brain where the aneurysm was located. A small balloon was then placed inside the blood vessel to protect the main portion of the artery, and coils were placed into the aneurysm itself to fully close it, says Dr. Wicks.
“Once we deploy the coil, we have to monitor how the coil forms and closes the aneurysm, because you don’t want to place too much pressure on the aneurysm itself or that could cause additional bleeding,” Dr. Wicks explains. “We also have to ensure that the coil remains in the aneurysm and doesn’t enter the main blood vessel that supplies the brain, which could cause a stroke.”
Slowly getting back to normal
Seeing her daughters for the first time following her surgery was an especially memorable moment for Mrs. Sustaita-Ruiz. “I wasn’t really sure that I was ever going to see them again and seeing their little faces light up when they saw me was everything,” she recalls.Following her surgery, she remained in the hospital for several weeks, allowing Dr. Wicks and the care team at Miami Neuroscience Institute to closely monitor her progress before she could continue her recovery at home.
Recovering from a ruptured brain aneurysm can be “quite complex,” Dr. Wicks says, because blood that has leaked into the base of the brain causes inflammation that can persist from three days to as long as three weeks. “During that period, we have to monitor the patient very closely with daily ultrasounds to ensure that the inflammation doesn’t trigger a vessel spasm or a clamping down of the blood vessels at the base of the brain, which could cause a stroke,” he explains.
Getting back to normal following a ruptured aneurysm requires therapy, focus and motivation, says Dr. Wicks. “Once the patient gets home, they’ll typically need about one month as they slowly get back to their normal daily activities,” he says. “Even patients who recover well tend to experience fatigue and find that they often have difficulty focusing.” He also says it’s important to monitor the patient over time to ensure that an aneurysm doesn’t recur or that they don’t develop any new aneurysms.
Increasing awareness of brain aneurysms
Mrs. Sustaita-Ruiz says she feels very good now and life for her has returned to normal. “I’m back to my regular routine now, staying busy with my kids, my work and traveling,” she says.
“I’m looking forward to getting back into running half marathons again, including the upcoming Miami Half Marathon next January, if all goes well.”
In the meantime, Mrs. Sustaita-Ruiz has become a vocal proponent of brain aneurysm awareness. “Having a brain aneurysm is a very scary experience and I want to make sure people understand what the potential risk factors are and what the symptoms of a ruptured aneurysm are,” she says, adding that you need to pay attention to the signs your body is sending you. “I never realized that the pain I had behind my right eye for many, many months was actually a symptom. I thought it was from working too much.”
Mrs. Sustaita-Ruiz is grateful for the care she received at Baptist Health and credits her recovery to Dr. Wicks and the team at Miami Neuroscience Institute. “The level of treatment I received at Miami Neuroscience Institute was impeccable – everyone there has such professionalism and patience,” she says. “Dr. Wicks has been amazing. His knowledge of modern technology and how to use it to treat ruptured brain aneurysms is very much what helped me have the positive outcome that I did.”
The most advanced technology in Florida
Dr. Wicks says Mrs. Sustaita-Ruiz was fortunate to end up at Miami Neuroscience Institute where, in conjunction with Miami Cardiac and Vascular Institute, she had access to the most advanced technology in the state of Florida for treating and managing aneurysms.
“This is especially the case with ruptured aneurysms, which may necessitate some more complex treatments,” says Dr. Wicks. “We have some of the more advanced technology in terms of coiling and the placement of flow diversion devices to treat ruptured aneurysms. Together with Miami Cardiac & Vascular Institute, Miami Neuroscience Institute has helped bring many of these devices to South Florida.”
If you or someone you know is diagnosed with a brain aneurysm, Dr. Wicks says it’s important to seek care from either a neuro-interventionalist or neurosurgeon. “They can best determine the most appropriate course of treatment – even if that means no treatment at all but simply monitoring the aneurysm,” he says.