For as long as she could remember, Marbella Ramirez lived with migraines. Certain smells, bright reflections and everyday triggers could spark intense headaches. Like many young people living with chronic migraines, she learned to push through the pain.
"It was just something that I learned to deal with," Ramirez said. But in 2022, during her senior year at California State University San Marcos, the headaches became more frequent and severe. Then one night, everything changed. "I remember that night, I just couldn't sleep because the headache was unbearable. Unlike the prior migraines that I'd had, this one just didn't go away."
The pain persisted for days. Ramirez missed classes on Monday and Tuesday. By Wednesday, she was in the hospital. There, physicians discovered the source of her symptoms: a ruptured brain arteriovenous malformation, or AVM.
AVMs are abnormal connections between arteries and veins that disrupt normal blood flow and oxygen to the brain. Although some remain undetected for years, they can sometimes lead to headaches, seizures, hemorrhagic stroke and neurological symptoms. In Ramirez's case, worsening migraines and a visual aura in her right eye became warning signs that led to her diagnosis and treatment.
Diagnosed with a Ruptured Brain AVM
Marbella Ramirez celebrates her birthday at Macy's Herald Square in New York City in 2024. Photo credit: Marbella Ramirez
After her diagnosis, Ramirez was referred to UC San Diego Health, which has one of the nation's leading neurovascular programs. The health system has two Comprehensive Stroke Centers and serves as a referral destination for patients seeking advanced treatment options.
Ramirez's case was particularly challenging. The AVM was located in the left occipital lobe, an area of the brain responsible for processing visual information. Any treatment would need to eliminate the risk posed by the AVM while preserving critical brain function.
"The treatment of Marbella's AVM was uniquely challenging because it was a high-grade AVM. It was large and positioned in a very eloquent region of the brain," said David Santiago-Dieppa, MD, a neurosurgeon specializing in cerebrovascular and endovascular neurosurgery at UC San Diego Health.
Ramirez's care involved a team of specialists working together to develop a treatment plan tailored to her specific condition, including neurosurgeons, endovascular specialists, stroke neurologists, neuro-anesthesiologists and critical care experts to guide her through a series of procedures.
David Santiago-Dieppa, MD
- Neurosurgeon
- Chief of Regional Neurosurgery
- Associate Professor, Neurological Surgery and Materials Science and Engineering
Embolization and Surgery for a Complex Brain AVM
Her treatment began with a series of endovascular embolization procedures. During embolization, physicians use minimally invasive catheter-based techniques to reduce blood flow to the AVM and make subsequent treatment more effective.
Following several embolization procedures, the surgical team performed microsurgical resection, a type of brain AVM surgery, to remove the AVM. They succeeded in their goal of treating the rupture and eliminating future bleeding risks.
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Continuing College through AVM Treatment
Maintaining momentum in school was important to Ramirez. Santiago-Dieppa listened to her goals and coordinated treatment in a way that fit as seamlessly as possible into her academic schedule. With procedures planned around breaks in the school year, Ramirez was able to continue her studies. Six months after her operation, she graduated from college.
"This was a young person whose entire career depended on the proper and complete function of the brain," he said. "To be able to resect and treat this high-grade complex AVM so that she could have the rest of her life was really a privilege."
Life After Brain AVM Surgery
Marbella Ramirez graduates from NYU's Magazine and Digital Storytelling program at Carnegie Hall in New York City. Photo credit: Marbella Ramirez
Now, Ramirez is in her mid-20s and thriving both personally and professionally. She continues routine follow-up care, including periodic imaging. On rare occasions, she experiences mild visual symptoms, but they have significantly improved.
She said her recovery after brain AVM surgery has gone so well that she sometimes forgets she ever underwent the procedure. Ramirez said she remains connected to Santiago-Dieppa, who has continued to provide support long after her treatment ended.
Looking back, Ramirez said she has a fondness for the people who cared for her.
"I think about my time at UC San Diego Health a lot," she said. "As difficult as the diagnosis was, I'm so grateful for the many incredible nurses and health care professionals who helped and supported me."
Since then, Ramirez has graduated from New York University with a master's degree. She returned to living in San Marcos, is working as a research assistant, and has plans to pursue a PhD.
Brain Arteriovenous Malformation (AVM) Treatment Neurological Institute at UC San Diego Health
Brain Arteriovenous Malformation (AVM) Treatment Neurological Institute at UC San Diego Health
