Jeffrey Thomas, M.D., F.A.C.S.
Cerebrovascular and Neurointerventional Neurosurgery
Diplomate, American Board of Neurological Surgery
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Tubbs Jones memorial a reminder of Biden's aneurysms

Published in, 9/5/08

CLEVELAND - A memorial service here for Rep. Stephanie Tubbs Jones on Saturday comes as a stark reminder of a condition that nearly took vice presidential candidate Joe Biden's life 20 years ago. Tubbs Jones, 58, the first black female representative from Ohio, died on Aug. 20 from a brain hemorrhage caused by a ruptured aneurysm.

Biden, who attended the church service with Democratic nominee Sen. Barack Obama, underwent two surgeries to correct near-fatal brain aneurysms in 1988. A Biden spokesman said the Delaware senator, 65, works out regularly and is healthy today. "Senator Biden is in terrific health, leads a vigorous lifestyle, and looks forward to an extremely busy campaign schedule as we sprint into the fall campaign," spokesman, David Wade said.

Vice presidential contenders submitted themselves to a "very invasive" vetting process, according to Eric Holder, one of two people in charge of the process for Obama. Those who hadn't had a physical in the last 12 months were asked to have one and some were asked to see specialists, Holder said, without identifying names. Wade said Biden's medical records would be released to the media at a later time.

One in 15 Americans develop a brain aneurysm, a weakening of the walls of an artery or vessel. When the artery ruptures, it causes bleeding into the brain, causing a hemorrhage, which can lead to stroke, brain damage and death. The goals of treatment are to stop the bleeding and potential permanent damage to the brain and reduce the risk of recurrence. Neurosurgeons also treat unruptured brain aneurysms preventatively.

In his book Promises to Keep, Biden described having headaches and passing out for five hours in a hotel room after a foreign policy speech before discovering his aneurysms. A priest read him his last rites at a Wilmington hospital where doctors told him an artery in his brain was leaking blood, he wrote. Tests at Walter Reed Army Medical Center near Washington, D.C., showed he had two aneurysms -- one below the left side of his brain and another on the right side. Doctors recommended surgery to remove both. "As I heard it, my chances of surviving the surgery were certainly better than fifty-fifty," he wrote. "But the chances of waking up with serious deficits to my mental faculties were more significant."

The first surgery, performed on Feb. 12, 1988, lasted four and a half hours. The second surgery came on May 4. Recovery kept him out of the Senate for seven months.

The reasons for the vast majority of ruptured aneurysms are still a mystery. Less than 11% of them are due to genetics, said Dr. Jeffrey E. Thomas of the American Association of Neurological Surgeons.

People who have aneurysms have arterial walls in their blood vessels that are missing a layer, said Thomas, also a neurosurgeon with California Pacific Medical Center in San Francisco. The weak area bulges out with every beat of the patient's heart. Eventually, the area ruptures. Once an aneurysm is treated, it's unlikely to occur again. "If there was any reason that the surgery was less than perfect, then sometimes there can be small remnants of the aneurysm," Thomas said.

A common screening technique is called the "cerebral angiography," a procedure that involves the injection of contrast dye into the femoral artery. Doctors take images using X-rays that show the dye flowing through the blood vessels. "If we find an aneurysm before it bursts we can cure you," Thomas said. "Unfortunately, most are discovered only after they burst."

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