Peter Gammons undergoes emergency brain surgery

While Peter is recuperating:


Gammons had just finished recording a CD, scheduled for release July 4, in which members of the Red Sox, including GM Theo Epstein, contribute, along with many of his friends in the music industry. The CD is entitled, "Never Slow Down, Never Grow Old," and is to be released by Rounder Records.

 

Never met Peter, but get well soon. He's a giant in our industry.

 

Sorry I'm late on this...

A brain aneurysm is a weakening in one of the blood vessels in the brain, causing it to bulge or form a sac, just like a weak spot in a bicycle inner tube. It is a congenital issue and why or when it chooses to leak or rupture is anybody's guess; karma, I suppose.

There often is a warning or sentinel headace that occurs before a true rupture. This is caused by a small amount of blood leaking. The classic textbook example is of somebody having the worst headache of their life, a normal neurologic exam and perhaps a stiff neck, caused by blood in the cerebrospinal blood (CSF) that bathes the brain, irritating the covering of the spinal cord or meninges. The diagnosis is made by clinical suspicion and CT scan of the head. About 5% of the time, the CT is normal and a lumbar puncture needs to be done to look for the blood in the CSF.

Once the diagnosis is made, then planning is made to clip the aneurysm semi - emergently within 1-2 days. An angiogram needs to be performed to map out the anatomy and figure how to approach the aneurysm. Two options include formal neurosurgery, but on occasion and interventional radiologist can use a catheter and thread to wear the aneurysm is in the brain and put a coil in it to prevent rupture. During either procedure, blood vessels in the area can go into spasm and cause stroke symptoms, or the pressure in the brain can spiral out of control and cause brain death.

If, however, there was no warning sign and the aneurysm ruptures or bursts, then blood pours into the brain tissue itself and causes significant problems. Blood damages adjacent brain and it can also push normal brain up against the hard skull and cause it to fail. And finally, blood causes inflammation and swelling when it is not in blood vessels. Think of how much a bruise can hurt and gtranslate that to brain tissue.

As to the anatomy, the aneurym usually occurs in the Circle of Willis, which is the area in the base of the brain where the two carotid arteries (L and R) and the two vertebral arteries (L and R again) join. It is often a weakness at one of these junctions or at the junction where smaller blood vessels leave this circle that is the cause of the aneurysm forming in the first place.

 

I was at a music store in the arty section of town today and saw on the blackboard under "new releases" the names of Johnny Cash and Peter Gammons next to each other. Couldn't be him, I thought.

 

Stupendously explained, Doc.

Can motor function decline be a sign, like the headache you mentioned?

That is what I didn't think would be true.

 

Typically, pre-rupture, there is no neurologic deficit...no problems with movement, speech, vision or anything else. The thunderclap heachache is usually the first sign.

 

Doc - thank you. The contributions that you make to this site are invaluble and always informative.

 

I've mentioned on the board before my sister-in-law who, while relaxing on the beach celebrating her acceptance to med school 20 years ago, suffered a brain aneurysm. She survived, but has no short-term memory and also no immediate pain receptors (she's always burning herself with hot coffee, for instance). She is a real-life version of Drew Barrymore's character in 50 First Dates.

I don't think Peter would want to live like that.