A medical mystery: York County woman's headaches lead to brain surgery

Tina Locurto
York Dispatch

Tabitha Pacheco suffered from headaches and sinus infections for two years.

No matter how many pills she swallowed nor how many tests she took, Pacheco's doctors were stumped at what could be wrong. 

Little did Pacheco know, she had a gumball-sized aneurysm — a section of weakened artery that ballooned outward — growing in her brain the entire time.

Tabitha Pacheco, from Dover, in one of the angiogram units at WellSpan York Hospital on Tuesday, Aug. 30, 2022.

"I got myself a will and called my mom and dad," the Dover resident said after learning her diagnosis. "I have two kids, so I was like 'You need to make sure they're OK.' I was super scared."

Enter Dr. Michael Casey — a neurosurgeon with WellSpan York Hospital. 

After previous doctors suspected a tumor was growing inside Pacheco's brain, she was referred to him for further treatment. In her case, Casey was faced with a couple of avenues for approaching the medical mystery. 

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"The hardest part of my job is to tell people really — what is the risk in this thing rupturing?" Casey said. "What we say is when the risk of rupture is higher than the risk of the procedure, that's when we should pull the trigger."

Dr. Michael Casey, a neurosurgeon at WellSpan York Hospital, showing previous scans of the aneurysm Tabitha Pacheco,  from Dover, had in one of the angiogram units at WellSpan York Hospital on Tuesday, Aug. 30, 2022.

Aneurysms don't cause headaches — or at least, they typically aren't supposed to, Casey explained.

Pacheco proved to be a unique case, experiencing up to 19 headaches in one month. In her first meeting with Casey, Pacheco was presented with several options for the procedure. Traditionally, doctors would physically slice the head open and insert a clip to cut off the aneurysm's blood supply.

Casey, however, didn't think that was the safest option for 37-year-old Pacheco.

Dr. Michael Casey, a neurosurgeon at WellSpan York Hospital, on left, and Tabitha Pacheco, from Dover, on right, in one of the angiogram units at WellSpan York Hospital on Tuesday, Aug. 30, 2022.

Instead, Casey performed surgery using a newer technique involving a flow-diversion stent.

"We put a flow diverter and made the blood go past (the aneurysm)," Casey explained. "It let the artery heal and clot off the injury from it — so the weak point is now gone."

Pacheco officially underwent the surgery in 2021 — and is now walking fine a year later.

"It's a little delayed gratification because we had to wait three months to see (results)," Casey said. "Even though I do the surgery, it's anxiety producing. If one of my loved ones had to have surgery like this, I understand the anxiety that is produced with not knowing the unknown."

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The stent will stay in Pacheco's head for the rest of her life. She now carries a medical card with her everywhere that gives information about the surgery.

"When I looked up the top hospitals, this wasn't on the list," Pacheco said. "But then I met (Casey) and I knew this was who I was going to see." 

After Pacheco's surgery, WellSpan staffers all signed a card for her. And even though her procedure happened a year ago, Pacheco is still welcomed at York Hospital with friendly faces.

"Nice to see you standing up," one nurse called to Pacheco as she and Casey walked through the hospital's hallways.

Dr. Michael Casey, a neurosurgeon at WellSpan York Hospital, on left, and Tabitha Pacheco, from Dover, on right, in one of the angiogram units at WellSpan York Hospital on Tuesday, Aug. 30, 2022.

Anybody can develop an aneurysm — though there is a hereditary component, too, Casey said.

High blood pressure, smoking and drugs also can contribute to the formation and rupture of aneurysms.

"We do high level, high acuity neurosurgery in York, Pennsylvania," Casey said. "When I was looking at places to work, I was really surprised at what they're doing here."

— Reach Tina Locurto at tlocurto@yorkdispatch.com or on Twitter at @tina_locurto.