'I could have died': Winnipeg senior says her struggle to get aneurysm diagnosis is a cautionary tale
A Winnipeg senior is sharing the story of her quest to get two cerebral aneurysms diagnosed and treated in hopes of helping others advocate for themselves in the emergency department.
"I could have died," said Karen Marklinger, 73.
"I could've been shovelling snow or doing any of number of things that could've put enough pressure on those aneurysms that they could've blown."
The otherwise healthy woman first knew something was wrong on Nov. 12, 2017, when she bent over to pick something up outside.
"I felt like a curling rock fell in my face, from the inside," she said. "I'd already had a headache for a month."
She went to the St. Boniface Hospital emergency department on Nov. 16, because she'd woken up that morning with her right eyelid half-closed and the headache hadn't gone away.
"I told them that I was afraid that I'd either had … am having or will have a stroke, and I was quite surprised when they let me sit there for three hours," she said.
She said doctors assessed her and found she also had some double vision. She went for two CT scans — including one with dye — she said, but was told everything appeared normal and sent home.
'Knocked me over with a feather'
Four days later, her right eye closed completely, so she called her family doctor, who advised her to go to the Misericordia Hospital. The physician there reviewed her CT scans from St. Boniface, she said.
"By then I was seeing double everywhere," she said. "[My eye] was looking down and to the right when they opened it up."
An aneurysm happens when part of an artery wall weakens, causing it to widen or balloon out. While most are small and can exist without causing symptoms, the Brain Aneurysm Foundation lists symptoms for which medical help should be sought immediately.
If a brain aneurysm ruptures, it can be fatal or cause permanent brain damage.
Marklinger returned to the St. Boniface Hospital emergency department that day and underwent two more CT scans — one with and without dye, and says the doctor sent her home with a neurology consultation booked at the Health Sciences Centre a week later.
The next morning, her eye was still completely closed, so she called her family doctor, who told her to go to the HSC emergency immediately.
She took a cab there, waited three hours and finally met with a neurologist who looked at her CT images and saw her symptoms.
I'm grateful to [the doctors] who listened to what I had to say and did something about it, instead of just sending me home.- Karen Marklinger
"This is serious," the doctor told her, Marklinger said. "It should not have been ignored."
That night, she went for a craniotomy surgery — a procedure involving removal of part of the skull to expose the brain — and metal clips were placed on both of her posterior and anterior communicating arteries. She said since then, she's been headache free and her vision has returned to normal.
But not all aneurysms need to be treated, said Dr. Timo Krings, a neuroradiologist at the Toronto Western Hospital.
"Not every single aneurysm ruptures," he said.
When a patient has symptoms like Marklinger's, it may indicate that the aneurysm is so large it's compressing the nerves, but is not necessarily about to rupture, Krings said.
"On average we say that the rupture rate, depending on the size and location of the aneurysm is below one per cent per year. If you now compare this to the risk that we impose on the patient, that even in the best hands is somewhere in the range of two to four per cent per intervention, then we can see that not every single aneurysm needs to be treated."
Hospital apologizes
Marklinger met with St. Boniface patient relations and the head of the emergency department at St. Boniface Hospital last week. She said the physician apologized for the Nov. 16 visit and told her a resident had interpreted her CT scan, and that other doctors should have also reviewed it, but inexplicably hadn't.
She said he told her that on her visit on Nov. 20, a St. Boniface physician tried to get her into the HSC immediately, but the HSC would only take her the next week.
In a statement, a spokesperson for St. Boniface Hospital said, "We have expressed our apologies to Ms. Marklinger for her experience and we thank her for the opportunity to review her experience as it provides opportunities to improve our service."
Marklinger is cutting back on strenuous activity, like shovelling, and wants to share her story to help others.
