It was two weeks after Thanksgiving and 17-year-old Joshuah Sanchez had just come home from wrestling practice at Liberty Ranch High School in Galt. He was winding down for the evening when he began to feel dizzy. He assumed it was the beginning of another epileptic seizure, like the ones he'd had before, but seconds later he felt the worst headache of his life.
"That's when I knew something was off, and so I called to my mom to call 9-1-1," Sanchez recalls. "After that it was all kind of a blur, but I remember being transported to a hospital."
Paramedics administered morphine for the headache with no results. Upon arrival at Lodi Memorial Hospital, the attending physician suspected something abnormal and ordered a CT scan. The scan confirmed bad news: a subarachnoid hemorrhage, also known as bleeding in the brain due to a ruptured brain aneurysm.
He was quickly transferred to UC Davis Medical Center, a destination hospital for stroke patients from 33 counties.
Strokes in teenagers are relatively rare but can have devastating consequences. Doctors realized Sanchez had a ruptured terminal left internal carotid artery. The situation was critical and could lead to tragic outcomes, such as severe disability — or worse — if another aneurysm occurred.
"This aneurysm needed to be treated because it can rupture again," recalled Ben Waldau, a neurologist who oversaw Sanchez's care at the medical center. "Typically, the second time such an aneurysm ruptures is fatal."
This needed to be treated because it can rupture again. Typically, the second time such an aneurysm ruptures is fatal." -Ben Waldau
An aneurysm is the bulging of an artery that begins as a weak spot that balloons out then may rupture. When it bursts, it bleeds into the space between the brain and the cranium. While a ruptured aneurysm in a survivor may have only bled for a few seconds and then closed off again, the aneurysm still poses a high risk of bleeding again and causing fatal damage.
There are two common ways to treat an aneurysm.
The most common, known as coiling, is the least invasive. With coiling, providers insert a light, flexible coil through the blood vessels of the arm or groin and allow it to coil inside the ballooned portion of the affected artery. This helps a blood clot form inside the ballooned portion, thereby preventing another bleed. With coiling, patients need to be screened every year with imaging. There may also be a need for re-treatment as approximately 20% of aneurysms come back after being treated with coiling.
The other treatment requires surgery to open the head and skull to expose the aneurysm. Surgeons then close off the ballooned area with a small metal clip which is about 2 to 20 mm long.
Waldau decided to clip the aneurism because it would be the least disruptive to Sanchez's lifestyle in the long term. The procedure is more common for pediatric patients, due to their longer life expectancy.
"The advantage of clipping is that the treatment is more durable, especially because he is only 17 years old," continued Waldau, professor and neurological surgeon for the Department of Neurosurgery. "Clipping lasts longer than coiling. In my experience, aneurysms, especially pediatric aneurysms, come back after coiling, perhaps because their aneurysmal walls are more unstable than in adults. This is where the value of microsurgical clipping as definitive therapy comes in. With clipping, the aneurysm almost never comes back, and I only screen every 10 years."
Sanchez emerged from the surgery groggy but responsive. Despite waking up with slight weakness on his right side, he was able to follow easy commands.
Twenty-one days after surgery, he walked out of the hospital and went home to Galt.
By January, Sanchez had begun attending classes again.
Despite some challenges with short-term memory, he continued the school year as normal, crediting support from his mom, teachers, and peers. He attended prom in April and will be graduating from Liberty Ranch High School this Friday.
