Reaching Down the Rabbit Hole: Extraordinary Journeys into the Human Brain

by Allan H. Ropper

A subarachnoid hemorrhage, or burst aneurysm, is one of the most treacherous diseases in medicine. Although considered a type of stroke (or to use the Boston vernacular, a “shock”) because it happens suddenly and occurs in the head, it bears no resemblance to the paralysis or speech trouble usually associated with a stroke. An aneurysm is a rounded pouch on one of the blood vessels at the bottom of the brain. If it reaches a critical size and form, it can burst open with the entire force of the body’s blood pressure. Blood then fills the spaces around the brain in a split second and causes a thunderbolt of a headache that no one forgets and many don’t survive. One-third of patients who do survive have a re-rupture in days, and half of those people die. Ruby had dodged the thunderbolt twice. He had had two bleeds, which resolved, although his blood had now mixed with the spinal fluid surrounding his brain—not enough, apparently, to show up on the CT scan (in about 5 percent of patients it does not), but enough for us to confirm it if we could get a lumbar puncture.