Rubi Ramirez described it as a strange whooshing noise in one ear, as well as some severe headaches she began experiencing in early 2019. A 40-year-old labor and delivery nurse, Ramirez initially suspected migraines until she learned about a cousin who had experienced similar symptoms and was diagnosed with a brain aneurysm. Her mother, too, had a history of aneurysms.

No Time to Waste
At the time her symptoms developed, Ramirez was pregnant with her third child, and she and her husband had just adopted a baby girl. The couple moved quickly to get a clear understanding of her health, scheduling a magnetic resonance angiography (MRA). The diagnostic scan looks for abnormalities in the blood vessels, and revealed that Ramirez had an arteriovenous malformation or AVM in her brain, essentially a tangle of arteries and veins known as a fistula.

Ramirez’s husband Jamil Abdur-Rahman, MD, a Chicagoland OB/GYN physician, is familiar with NorthShore’s Maternal Fetal Medicine (MFM) program. The Barrington couple scheduled a consultation with Ann Borders, MD, who specializes in high-risk pregnancies. Dr. Borders immediately brought in a neurosurgery colleague, NorthShore Neurological Institute’s Shakeel Chowdhry, MD, to collaborate on a treatment plan to protect both mom and baby.

Nonsurgical Intervention
“I was nervous and overwhelmed, thinking the worst,” Ramirez recalled, “but Dr. Chowdhry was super nice and confident he could repair the AVM.” Following a thorough consultation with the MFM team, Dr. Chowdhry performed a minimally invasive endovascular repair—threading a catheter into a vein from her leg up to the brain to close off the blood supply to the fistula.

“It’s quite rare to diagnose something like this in pregnancy, and naturally Rubi and her husband were very concerned,” explained Dr. Chowdhry, who along with Dr. Borders, holds an academic appointment at the University of Chicago Pritzker School of Medicine.
“It was very frightening given Rubi’s family history,” noted Dr. Borders. “With her symptoms and the early stage of her pregnancy, we wanted to move forward with treatment as soon as possible. We had multiple conversations with Dr. Chowdhry and together worked out ways to shield the baby from radiation exposure during the procedure.”

Successful Outcomes
Ramirez spent just one night in the hospital following the procedure and had virtually no pain and a very swift recovery. “Everyone at NorthShore was awesome, added Ramirez. “I actually felt well enough to go home the same day,” she said.

Ramirez was followed closely by the MFM team throughout her pregnancy and delivered a healthy baby boy named Matias in December of last year. “We monitored Rubi and her baby closely and they both did well, which is what we expected,” said Dr. Borders.
“Everyone went above and beyond,” said Ramirez about her extended care team. As medical professionals, Ramirez and her husband fully understood the risks involved and were grateful for the exceptional care they received.

“They were excellent patients,” said Dr. Chowdhry. “It’s gratifying to be part of such an integrated system where two very specialized departments can work together to provide optimal care and a great outcome.”

Ramirez’s days are beyond full now, caring for her four children, ages 10 to nine months. “I came from a huge family. My house was always the loudest, and now mine is even louder. It’s been a roller coaster,” she said, “but things happen for a reason and we’re so grateful!”