Bump on Shoulder Leads to Surprise Diagnosis

It was 2016 and Humberto de Lara and his family were looking forward to celebrating the upcoming Thanksgiving holiday at their home in Pinecrest. While shaving one morning, Mr. de Lara noticed a bump between his shoulder and his neck and decided to see his doctor, who recommended a CT scan. The bump, it turns out, was nothing. But the scan revealed something far more serious: two unruptured brain aneurysms, one of which was large and potentially fatal.

Mr. de Lara, 62, consulted with Italo Linfante, M.D., medical director of Interventional Neuroradiology and Endovascular Neurosurgery at Miami Neuroscience Institute and Miami Cardiac & Vascular Institute – both a part of Baptist Health South Florida. Dr. Linfante has been successfully treating aneurysms like Mr. de Lara’s with endovascular surgery, which involves accessing the femoral artery in the patient’s groin, navigating a small catheter into brain vessels and securing the aneurysm by occluding it with platinum coils to prevent it from rupturing.

“If Mr. de Lara’s large brain aneurysm had ruptured and bled, it could have taken his life,” Dr. Linfante says. “Besides endovascular surgery, the traditional procedure to secure a brain aneurysm is called microsurgical clipping, a type of ‘open surgery’ that requires a craniotomy – opening the skull – and surgically repairing the aneurysm. Clinical experience and scientific literature shows better outcomes with endovascular surgery compared to traditional “open” surgery – particularly at high-volume centers like Baptist Hospital.”

Dr. Linfante says that endovascular surgery has become the preferred approach for treating both ruptured and unruptured brain aneurysms at Miami Neuroscience Institute, accounting for 90 percent of all cases treated there.

“The advantage of repairing unruptured brain aneurysms endovascularly is that it’s a minimally invasive procedure. Therefore, the patient can go home and resume normal activities the very next day,” Dr. Linfante says. “Open surgery is far more invasive, the risks are higher, and it requires a longer recovery time,” he adds.

Mr. de Lara remembers feeling scared during his initial consultation with Dr. Linfante. “I was very nervous, and my family was so worried,” he recalls. “I’m an active person, I run a business, I love to travel, and my daughter was going to be getting married. I was worried I might not get to walk her down the aisle. But Dr. Linfante told me, ‘Don’t worry. You’re going to do well,’ and I believed him. I knew right then that I was going to be okay.” Dr. Linfante said the second, smaller aneurysm was not an imminent risk but would have to be monitored.

Mr. de Lara went home the next day and was back at work the following day. He felt great and was relieved he no longer had to live with the fear of an aneurysm suddenly rupturing and causing a fatal brain hemorrhage. Life was good. In fact, a follow-up angiogram with Dr. Linfante in January 2018 revealed that the repaired aneurysm was stably occluded. But during that visit, Mr. de Lara received another surprise diagnosis – one that that shook him to his core.

“When I examined Mr. de Lara’s latest angiograms, I was surprised to see that the small unruptured aneurysm had tripled in size in just six months,” Dr. Linfante says. “We know from scientific literature and clinical experience that size growth of an unruptured brain aneurysm is a strong risk factor for rupture. In addition, the second aneurysm was in the posterior circulation – a location known to be associated with higher rates of death when they bleed compared to brain aneurysms in other locations.”

Mr. de Lara was stunned. “I couldn’t believe this was happening to me again,” he recalls. But Dr. Linfante was confident that this second aneurysm could be treated with the same endovascular procedure as before. The surgery was a success, the aneurysm was occluded and, once again, Mr. De Lara was able to go home and return to work the next day.

With National Brain Aneurysm Awareness Month in September, Mr. de Lara says people shouldn’t be afraid to see their doctor if they notice anything unusual. “You never know what they might find,” he says.

Mr. de Lara is extremely grateful to Dr. Linfante and his team at Miami Neuroscience Institute for saving his life. “He gave me the opportunity to experience so many of life’s important milestones that I would have missed,” says Mr. de Lara, who got to walk his daughter down the aisle at her wedding and is now enjoying his new role as an abuelo. He calls Dr. Linfante his angel. “Because of Dr. Linfante, I won the lottery – not once, but twice!”

What’s next for Mr. de Lara? Hoping to retire in the next year, he and his business partner have been grooming their sons to take over the freight forwarding and logistics company they started in 1989. After that, he plans to spend half the year in Spain and half here in Miami. He also hopes to travel more, including a trip to one of the few countries he hasn’t seen – Russia – to explore Moscow and St. Petersburg.