Joe Biden’s Aneurysm Rupture: A Stroke of Fortune

By Michael Brant-Zawadzki, M.D., F.A.C.R.

Categories: Articles

As Joe Biden declares his candidacy for the presidency, his being a part of a fortunate minority – old white guys – will likely come up. But he is part of another fortunate minority: Survivors of a ruptured brain aneurysm. This is an uncommon form of stroke (defined as a sudden loss of neurologic function). The majority of those whose aneurysms rupture die, and many of those that do survive suffer some type of residual impairment. Joe Biden is one of the lucky few who have escaped that fate.

Most strokes are caused by a clot blocking blood supply flowing in an artery to the brain. Yet approximately 10 percent of strokes are caused by a rupture of an artery from high blood pressure, or, less commonly, because a weak bubble in the artery – an aneurysm – bursts. Biden describes his 1988 rupture in his book: A sudden piercing headache, followed by loss of consciousness. The lucky part is he was able to regain consciousness, fly home, and get checked out, which is when blood was discovered in his spinal fluid, and a brain scan found the aneurysm: In fact, two (about one in five aneurysm carriers have more than one). Biden’s aneurysm event was more of a leak than a burst. Brain surgery where a small clip obliterates the aneurysm and saves the parent artery led to his full recovery. Most aren’t as lucky.

Approximately 30 percent of those with an aneurysmal rupture die on the spot, another 30 percent from complications in the first six months after. Complications arise from the irritation of the brain lining, a type of chemical meningitis caused by the blood. The arteries that course in the inflamed membranes lining the brain go into spasm, killing brain tissue from loss of blood supply. The blood from the rupture also can gum up the membranes covering the brain and lead to a blockage in the circulation of the cerebrospinal fluid within them causing hydrocephalus, or extra water accumulation inside the brain’s spinal fluid reservoirs, elevating intracranial pressure, strangling brain cells unless a shunt is placed diverting spinal fluid outside the brain. Needless to say, Biden was a lucky Joe.

Another celebrity treated for a brain aneurysm is Neil Young. His did not rupture, but the bubble on his artery grew large enough before rupture to cause pressure on the nerves supplying his eyeball leading to double vision and headaches. A brain scan found the aneurysm. By 2000, when his aneurysm was discovered, a new minimally invasive treatment was available, sparing the risks of brain surgery. Much like placing a stent in a coronary artery, by snaking a thin tube under real time X-ray guidance from the groin artery through the arterial system up to the brain artery where the bubble lives, the aneurysm can be obliterated by packing it tight with filamentous titanium coils. Such high tech plumbing now treats 90 percent of aneurysms at Hoag’s Pickup Family Neurosciences Institute, and other comprehensive stroke centers.

Such modern aneurysm treatment improves outcomes and lowers cost of treatment: Something politicians and heath policy experts see as the holy grail. About one out of every 100 people have a brain aneurysm, too few to allow insurance companies to cover the costs for screening with brain MRI. Maybe something Joe Biden would favor.