I had a ruptured aneurysm clipped in Oct. 2005 and I am still not feeling like myself. I will try to make this as brief as possible:

Since the surgery I now suffer from extremely painful migraines (worse than the headache I had the day my aneurysm was found). My neurologist states that it is common to get migraines after an aneurysm, but is it really necessary for me to have to try and “live” with these headaches? (I had a CT scan in Dec. 2005 at the onset of these headaches to ensure there were no problems from the surgery and everything was ok at that time.) I was taking depakote at night as a preventative and this seemed to help some of the headaches, but not the really bad ones. I had to stop using the depakote due to fatigue (I’ll get into that more in a minute). I also take Relpac for the migraines when they come on - this works pretty good, but makes me tired and kind of loopy - which means I can not go to work when I take this. Would it be a good idea to have another scan?

I was starting to feel a little stronger and then about 5-6 weeks ago I started suffering from severe fatigue - I am physically drained! I feel like I could fall asleep almost anytime. My family doctor had me participate in a sleep study about a week ago, but I am still awaiting the results. *Due to the fatigue I had to stop some of my meds to be sure they weren’t the cause of the fatigue - apparently they weren’t because I am still feeling tired.

I have also suffered some cognitive problems - memory loss, word finding problems, etc.

During one of my follow-up visits to the neurosurgeon after my surgery the doctor was showing me some of the CT scans and when he held up one of them he said “Oh, and this is when you had your stroke.” My husband and I both had no idea I had a stroke - this was the first time the doctor had mentioned it. I am confused on the difference between a stroke and aneurysm. My doctor was not a very patient man and he provided me with no further explanation and I was too out of it to really be persistent and/or ask the correct questions, so I am now left guessing about this part.

I also suffered from depression prior to the aneurysm. I now have a lot of anxiety and was taking zoloft until the fatigue started. I now see a Psychiatrist and Psychologist.

Last, the worst problem has been knowing which doctor I should be visiting. It seems there is no real “coordination” of my care with the doctors I see. Is this normal? I feel like I have all these things going on, but noone to help guide me through it all and put the pieces together. My family doctor is very nice, but he knows little about the aneurysm stuff and seems to blame everything on the depression. The neurologist I have seen really isn’t very informative or maybe I am not asking the right questions. I feel like maybe it is time to change doctors, but I just don’t know….

I am starting to feel like I am hypochondriac or something - but I know my problems are very real. I am only 38 and much too young to feel this horrible everyday. I am also going to loose my job on top of all of this because my FMLA runs out and I am still only able to work part-time and miss many days due to the migraines.

I hope this is all making sense! Any thoughts you could provide would be much appreciated. Thank you for taking time out of your busy schedule to answer questions.

Dr. Joshua’s Answer

First of all I’m happy to hear that you have survived and recovered from the subarachnoid hemorrhage (SAH), which is a very serious illness and fatal in nearly 50% of cases. Subarachnoid hemorrhage is what occurs when an aneurysm ruptures.

Headaches and neuropsychologic sequelae such as memory loss, word finding problems, fatigue and depression are quite common after an SAH due to ruptured aneurysm.

It has been 8 months since the SAH — you can take comfort in the fact that 8 months is a short time for the brain to fully recover from such an illness. You will get better with time, but sometimes it takes years.

As for the difference between stroke and aneurysm: An aneurysm is a weakness in a blood vessel, the rupture of which was the cause of the bleeding. A stroke means damage to brain tissue as a result of loss of blood flow and oxygen. After a subarachnoid hemorrhage, a stroke can occur by two possible mechanisms: 1) Cerebral artery spasm, which means that the vessels in the brain are irritated and constricted, resulting in a stroke. 2) Direct occlusion of an artery due to the clipping (surgery). The fact that you have had a stroke that is visible on a CT increases your risk of developing long-term problems significantly. In this light, I am not surprised that you are still suffering from these problems.

What you need is a thorough review of your situation. If possible, an examination by a neuropsychologist is recommended to pinpoint the problems and help plan the rehabilitation. A rehabilitation plan to get you back working should be made, and in any case a multidisciplinary approach is needed to evaluate your situation physically (symptoms, neurologic problems) and socially (work etc). A neurologist with experience in treating headaches can help with the persistent migraines. I’m happy that you are seeing a psychiatrist and a psychologist. Antidepressant medication is important and you should talk to your psychiatrist about that. Remember to exercise, get fresh air, do not smoke, and drink alcohol only in moderation if at all.

In summary, there is no magic trick that would make all your symptoms disappear, but with proper treatment and time, you will make a good recovery. Time is your friend - your brain needs lots of time to recover. You have survived a life-threatening illness, and you are just on your path to recovery, much patience is needed.

Good luck!

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