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PPH article details need for speed in brain trauma

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Editor's note: This is one of a series of stories produced by The Lebanon Voice highlighting the need for faster medical response times in West Lebanon and the need for better recognition of aneurysms by rescue personnel nationwide

PORTLAND - Dr. Robert Ecker, a neurosurgeon at Maine Medical Center who operated twice on Martha Soto-Galicia after she suffered an aneurysm in February, is quoted in a Portland Press Herald story today saying about 60 percent of stroke victims can live independently 90 days after the event if surgery can occur within 4 ½ hours of the stroke's onset.

Ecker's assertion underscores the need for speed in ambulance transport and the quick recognition by EMTs and paramedics that the patient is having a stroke.

While a stroke is a condition that occurs when blood flow is cut off from the brain, a brain aneurysm is different, in that it occurs when a blood-filled balloon bursts.

Ecker, in the Portland Press Herald article written by Joe Lawlor, did not describe the event-to-surgery time constraints for aneurysm, however.

Ecker performed a surgery to coil the aneurysm on Soto-Galicia on Feb. 13, and inserted a shunt to expedite the drainage of blood from the brain about a week later.

The sooner a stroke patient can make it to the hospital, the better chance doctors have to limit the damage caused by a clot, Ecker said in the article. If patients arrive at the hospital within three hours after having the stroke, and begin surgery within 4 ½ hours, their chances of recovery are greatly improved. Even if it's several hours later, the surgery can sometimes be helpful, depending on how much damage has been done to a patient's brain.

Ecker said awareness is key - both for potential patients and doctors in far-flung areas.

Early recognition is critical for aneurysms, too, according to the Brain Aneurysm Foundation.

"Early diagnosis is critical, as the initial hemorrhage may be fatal, may result in devastating neurologic outcomes, or may produce minor symptoms," according to their web site. "Despite widespread neuroimaging availability, misdiagnosis or delays in diagnosis occurs in up to 25% of patients with subarachnoid hemorrhage (SAH) when initially presenting for medical treatment. Failure to do a scan results in 73% of these misdiagnoses. This makes SAH a low-frequency, high-risk disease."

Meanwhile, stroke is the fifth-leading cause of death in the United States, strokes claim 130,000 lives a year, according to the U.S. Centers for Disease Control and Prevention.

Much of the PPH story focused on clot-busting tools that Ecker uses to remove clots in stroke victims that is considered ground-breaking.

A story in Tuesday's Lebanon Voice detailed the need for mutual aid in parts of Lebanon that are far closer to Milton Rescue than Lebanon Rescue.

To read today's full Portland Press Herald story click here.

Below are some other facts and figures about brain aneurysms, according to the foundation.

  • An estimated 6 million people in the United States have an unruptured brain aneurysm, or 1 in 50 people.
  • The annual rate of rupture is approximately 8 - 10 per 100,000 people or about 30,000 people in the United States suffer a brain aneurysm rupture. There is a brain aneurysm rupturing every 18 minutes. Ruptured brain aneurysms are fatal in about 40% of cases. Of those who survive, about 66% suffer some permanent neurological deficit.
  • Approximately 15% of patients with aneurysmal subarachnoid hemorrhage (SAH) die before reaching the hospital. Most of the deaths from subarachnoid hemorrhage are due to rapid and massive brain injury from the initial bleeding which is not correctable by medical and surgical interventions.
  • 4 out of 7 people who recover from a ruptured brain aneurysm will have disabilities.
  • Brain aneurysms are most prevalent in people ages 35 - 60, but can occur in children as well. The median age when aneurysmal hemorrhagic stroke occurs is 50 years old and there are typically no warning signs. Most aneurysms develop after the age of 40.
  • Most aneurysms are small, about 1/8 inch to nearly one inch, and an estimated 50 to 80 percent of all aneurysms do not rupture during the course of a person's lifetime. Aneurysms larger than one inch are referred to as "giant" aneurysms and can pose a particularly high risk and can be difficult to treat.
  • Women, more than men, suffer from brain aneurysms at a ratio of 3:2.
  • Ruptured brain aneurysms account for 3 - 5% of all new strokes.
  • Subarachnoid hemorrhage (SAH) is one of the most feared causes of acute headache upon presentation to the emergency department. Headache accounts for 1 - 2% of the emergency room visits and up to 4% of visits to the primary care offices. Among all the patients who present to the emergency room with headaches, approximately 1% has subarachnoid hemorrhage. One study put the figure at 4%.
  • There are almost 500,000 deaths worldwide each year caused by brain aneurysms and half the victims are younger than 50.
  • The cost of a brain aneurysm treated by clipping via open brain surgery more than doubles in cost after the aneurysm has ruptured. The cost of a brain aneurysm treated by coiling, which is less invasive and is done through a catheter increases by about 70% after the aneurysm has ruptured.
  • 10 - 15% of patients diagnosed with a brain aneurysm will harbor more than one aneurysm

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