A Bomb in the Brain

This is a story of beating the odds. It’s not so much a story of luck as it is a story of teamwork, expertise and clockwork precision. It’s the story of Ashley White and the cadre of medical professionals, family and friends who changed her life when an aneurysm ruptured in her brain—the kind that most people don’t survive. She did.

At 35, Ashley is a petite, delicate-boned woman with a soft voice and gentle manners. Originally from North Carolina, she still carries traces of that state’s gracious intonation when she speaks. Her husband, Mike, 37, is a hard-working national account manager and sales associate for the Robson Corporation, a national sign manufacturer based in Sarasota. They have two sons, Joey, who’s eight, and four-year-old Michael. Their lives are filled with family, work and church.

One Saturday morning in August 2009, Ashley experienced a skull-splitting migraine. The Whites didn’t wait to see if the migraine would go away. They’d been through this scenario four years earlier, when Ashley, pregnant at the time with Michael, experienced the worst headache she had ever had. When the pain became too much for her to bear, they had taken her to the emergency room, where she was diagnosed and treated for a ruptured aneurysm on the left side of her brain.

It was a miracle she survived—and another miracle she survived without serious neurological damage. But they always knew there was a chance that the aneurysm could re-rupture where it had been treated, or worse, that she could develop another one. Aneurysms often run in families; both Ashley’s grandmother and great-aunt had died of ruptured aneurysms.

Ashley and Mike were well aware of the grim statistics: The National Institute of Neurological Disorders and Stroke estimates that 40 percent of people with a ruptured aneurysm die within 24 hours. Another 25 percent die within six months. Of those who survive, many are left with severe paralysis and worse. They knew they had to get Ashley to Sarasota Memorial Hospital’s emergency room.

But let’s pause the movie for a moment. What is an aneurysm?

Our expert and a key player in this story is Dr. Robert Knego, Ashley’s neurosurgeon. “Imagine a blood-engorged blister or bulge on an artery,” he says. “In the case of a cerebral aneurysm, it usually occurs on an artery at the base of the brain.” Knego explains that as long as the aneurysm doesn’t rupture, it’s not a problem. “But,” he says, “if the size of the aneurysm increases and it eventually ruptures, it causes a cascade of complications and even death.” When an aneurysm bursts, the bleeding is referred to as a subarachnoid hemorrhage (SAH).

According to Knego, the worst effect of a burst aneurysm in the brain is pressure—like a sudden break in a high-pressure fire hose. The rush of blood can damage or kill surrounding brain cells. The flow of blood can cut off oxygen to the brain and result in significant neurological damage and death.

Back to the story. When Ashley arrived at Sarasota Memorial Hospital (SMH), Dr. Michael Schremmer, a board-certified emergency room physician and 19-year veteran of SMH’s ER department, was waiting. Aware of Ashley’s medical history, he knew exactly what to do. He ordered a CT scan of Ashley’s brain, which indicated that there was mild cranial bleeding. When he saw the bleeding, Schremmer called Knego, who was enjoying a Saturday off with his wife and five children (they now have six).

Knego jumped in his car and sped to the hospital. He knew the clock was ticking.

At the hospital, Knego reviewed Ashley’s CT scan and suspected that it was another aneurysm, this time on the right side of Ashley’s brain. The scan showed that mild bleeding had occurred. Knego was relieved to see that the bleeding was mild, which meant that there was a window of a few hours to work with. A cerebral angiogram, which would more accurately pinpoint the location of the aneurysm, was the next step.

Again—let’s hit that pause button.