Mumbai: What began as a routine headache turned into a life-threatening emergency for 57-year-old Tushar Mehta (name changed on request), a resident of Ranchi who suffered a sudden and massive brain haemorrhage in the first week of May, losing consciousness within hours.
In a rare, high-stakes intercity transfer, Mehta was immediately placed on ventilator support and airlifted to Sir HN Reliance Foundation Hospital in Mumbai, 1,700 km away, fighting time and odds. A doctor was on board the air ambulance to take care of Mehta, including managing the ventilator and maintaining blood pressure.
Upon arrival in Mumbai, doctors at the Reliance hospital found dangerously high pressure in the patient’s brain and swiftly inserted drainage tubes to relieve the fluid and stabilise him.
A multidisciplinary team led by Dr Vipul Gupta, director of neurointerventional surgery at the hospital, then carried out a digital subtraction angiography (DSA) to determine the source of the bleed. The scan revealed an arteriovenous malformation (AVM), an abnormal, high-flow connection between arteries and veins in the brain, which had ruptured and caused the haemorrhage.
“Stroke has become quite common and is the third most common cause of death and disability,” said Dr Gupta. “Around 20%-30% of strokes are due to brain bleeding. The arteriovenous malformation was there for a very long time. Since it did not cause any symptoms, it remained undetected until it caused bleeding at this age.”
The doctors introduced a tube into Mehta’s neck blood vessels through the leg artery. From there, a very thin tube was taken over a very fine wire and guided into his brain using 3D image guidance. Thereafter, a liquid material was injected into this abnormal blood vessel, which solidifies on contact with blood. In this way, the abnormal connections were blocked off. The procedure is called arteriovenous malformation embolisation.
“The major risk during this procedure was bleeding due to potential damage to the blood vessels. To minimise this, we use advanced 3D image guidance. It’s also critical to ensure that no normal vessels are blocked, as that could lead to a stroke. We could precisely close the abnormal vessels while preserving the healthy ones,” added Dr Gupta.
Mehta gradually regained consciousness. After weeks of intensive neurorehabilitation and physiotherapy, he was able to walk with support. Once stable, he was discharged in 15 days and returned home to Ranchi, where his recovery continued remotely.
Nearly two months later, with significant recovery achieved, Tushar returned to Mumbai for definitive treatment of the AVM that had triggered the initial bleed in multiple stages. “The patient is doing very well now. He is almost asymptomatic and is carrying on with almost all day-to-day activities,” said Dr Gupta.
What helped the doctors was a biplane lab in which they could conduct X-rays from two angles at the same time. “This helps us understand exactly what is happening inside the brain with the material that we have introduced,” Dr Gupta added.