Let’s Ask ChatGPT Medical Questions!

So a while back, having finished up the final season of The Umbrella Academy* and the first season of 3 Body Problem**, I had canceled our Netflix subscription while we watched some other stuff on Britbox, Starz, and elsewhere. But then the Jamie Foxx special What Had Happened Was … came along, and I wanted to see it, so I signed back up. The special is being billed (sort of) as standup comedy, but that’s not really what it is. It’s more or less Jamie Foxx speaking about a very serious incident and cracking the occasional joke, kind of not unlike somebody else we know.

Now, it’s been a while, but you may recall that back in April of 2023, Jamie Foxx suffered an unspecified medical emergency. At the time, details were in short supply, but the information that was available led me (not to mention the rest of the Internet) to believe that he had probably suffered a stroke, and I, at least, suspected that it was of the hemorrhagic variety. Fast forward to now, and that turns out to be true.*** As Jamie Foxx describes it, the incident started with a sudden and severe headache. As he puts it, “April 11, I was having a bad headache and I asked my boy for an aspirin. And I realized quickly that when you’re in a medical emergency, your boys don’t know what the fuck to do.”**** He ended up going to a hospital, getting a shot, and being sent back to his hotel*****, at which point his family decided he needed to go to a different hospital, where he was diagnosed and treated.

This special has spurred a little bit of debate in one of the aneurysm groups I belong to about what we as survivors owe other people, with some members being disappointed that it took this long for the details to be revealed, and others arguing that it’s none of anyone’s business. Both of these opinions are valid, of course, as are the shades of opinion in between. My own position is:

• Yes, it would have been good for the information to be shared earlier, since it has the potential to save lives and he has a massive audience to hear it (see also Emilia Clarke); but,
• There’s no actual obligation to share this information in a timely fashion, or, indeed at all; and, finally,
• He’s sharing it now, which is not nothing.

I mean, obviously I come down in favor of sharing information, since I was already plotting my series of posts about The Event while I was lying in ICU for a couple of weeks; I tried very hard to remember everything I could, since I knew I would be writing about it.

From what I can gather, in Jamie Foxx’s case, they never found the source of the bleeding. It’s not entirely clear to me exactly where his bleed occurred, but if it was into the subarachnoid space, this would make it a “subarachnoid hemorrhage of unknown etiology” AKA a “non-aneurysmal subarachnoid hemorrhage”, or naSAH******. The interesting thing about these is that they tend to have less severe consequences and better outcomes than aneurysmal SAHs (aSAH) such as mine. Granted, humans usually like to know exactly why something bad happened, but this is one of those rare cases where if you can’t identify the root of the problem, you’re actually better off. I was explaining this to my wife, and she found it hard to believe. It does seem counter-intuitive, doesn’t it? As she said, if you don’t know why it happened, how do you know it won’t happen again? And this is where ChatGPT comes in.

Now, I do like to give the LLMs a hard time, but one thing they are very good at is summarizing a lot of documentation on specifically-tailored subjects, such as medical papers and articles. Does this mean that, in an emergency, we should ask ChatGPT what to do? No. Does it mean that we should use ChatGPT to diagnose ourselves? Also no. But it does mean we can ask ChatGPT why a naSAH often has a better outcome than an aSAH and get a reasonably clear answer:

A brain bleed of unknown etiology, often referred to as a non-aneurysmal subarachnoid hemorrhage (NASAH), can be less severe and have better outcomes compared to an aneurysmal subarachnoid hemorrhage (ASAH). Here’s a breakdown of why this is the case:

Key Differences Between NASAH and ASAH

1. Source of the Bleeding:
   • NASAH: The bleed usually arises from small, fragile vessels in the subarachnoid space without structural abnormalities like aneurysms. It can be caused by trauma, venous rupture, or spontaneous bleeding with no detectable source.
   • ASAH: Caused by the rupture of an aneurysm, which is a weakened and ballooned-out area of an artery under high pressure.
2. Hemodynamic Stress:
   • In ASAH, the rupture of an arterial aneurysm releases blood under high pressure, leading to significant damage to surrounding brain tissues, blood vessels, and cerebrospinal fluid (CSF) pathways.
   • NASAH bleeds are often venous or involve less high-pressure arterial bleeding, so the volume and impact on brain structures may be less severe.
3. Rebleeding Risk:
   • Aneurysmal bleeds carry a significant risk of rebleeding, which is often catastrophic. The risk is highest in the first 24 hours without treatment (e.g., coiling or clipping).
   • In NASAH, the risk of rebleeding is much lower, as there is no underlying aneurysm or structural defect to cause recurrent hemorrhage.
4. Vasospasm and Delayed Cerebral Ischemia:
   • Blood from a ruptured aneurysm can irritate and inflame blood vessels, leading to vasospasm (narrowing of blood vessels), which reduces blood flow and causes delayed ischemic strokes.
   • While vasospasm can still occur in NASAH, it is generally less severe because the volume of blood and its distribution are more localized.
5. Hydrocephalus Risk:
   • Aneurysmal ruptures often release large volumes of blood that can block CSF pathways, causing hydrocephalus (excess fluid in the brain) and requiring interventions like ventricular drainage.
   • NASAH usually involves smaller volumes of blood, reducing the risk of hydrocephalus.

Prognosis Differences

• NASAH: Outcomes are often excellent, with many patients recovering fully or with minor long-term effects, especially if the bleeding is localized (e.g., perimesencephalic NASAH, a subtype that occurs around the midbrain and brainstem).
• ASAH: The mortality rate for untreated ruptured aneurysms is about 50%, with significant risks of severe disability even after treatment.

Summary

The key factors for better outcomes in non-aneurysmal brain bleeds are:

1. Lower initial pressure and volume of bleeding.
2. Reduced risk of rebleeding and complications like vasospasm or hydrocephalus.
3. Localized nature of the bleed, sparing critical brain structures.

However, both types of hemorrhages require immediate medical evaluation to rule out serious causes and manage potential complications.

Now of course, as we are all well aware, ChatGPT can be wrong and it can even make up lies, but I know from my own reading that in this case it is not doing that. It just did a better (or at least, faster) job of summarizing all the information that I could (or at least, felt like).

Incidentally, after this I decided it would be interesting to ask ChatGPT about the specific kind of experience that I had, i.e., the rupture of a small (2-3mm) aneurysm at the terminus of the right ICA adjacent to the clivus near the Circle of Willis. Here is what ChatGPT had to say about that:

An aneurysm at the terminus of the internal carotid artery (ICA) near the Circle of Willis, especially in the clival region, is considered exceptionally dangerous for several reasons:

Key Risks:

1. Proximity to Critical Structures:
   • The ICA supplies blood to vital areas of the brain, including regions involved in cognition, sensory processing, and motor control.
   • Its terminus near the Circle of Willis connects to major arteries (e.g., anterior and middle cerebral arteries), increasing the potential for widespread damage if rupture occurs.
2. High Pressure:
   • The ICA is a major blood vessel, so aneurysms here are under significant hemodynamic stress, making them more prone to rupture.
3. Location Challenges:
   • The clival region is near the brainstem, cranial nerves, and other critical structures, making surgical or endovascular interventions more complex.
4. Rupture Consequences:
   • A ruptured aneurysm here often leads to a subarachnoid hemorrhage (SAH), which can cause rapid and severe neurological deterioration, including loss of consciousness or death.
   • The location’s proximity to cerebrospinal fluid pathways increases the risk of widespread blood distribution, leading to elevated intracranial pressure.

Other Considerations:

• Clival Position:
  • The clivus is adjacent to the skull base and critical brainstem structures, which heightens the difficulty of surgical access and elevates risks for complications.
• Size & Morphology:
  • Even a small aneurysm in this location can be life-threatening because of the critical nature of the surrounding anatomy.

Prognosis:

Survival and outcomes after rupture depend on rapid diagnosis and treatment. Treatments such as endovascular coiling or surgical clipping have advanced, improving outcomes significantly, but the location still makes it a high-risk scenario.

I asked Gemini to check ChatGPT’s work and it told me the same thing. So, um, yikes, I guess? No wonder they couldn’t clip it. Honestly, I’m kind of glad they didn’t tell me all that ahead of time.

I definitely should have bought a few lottery tickets, though.

* Mediocre.
** Quite good.
*** The incident keeps getting described as “a brain bleed that led to a stroke”, which isn’t as bad as when they kept reporting that Tom Sizemore had suffered “a stroke that caused an aneurysm”, but still, repeat after me, kids: A brain bleed is a stroke.
**** One thing not to do: Don’t bother getting dressed before you call 911.
***** This happens all the time with hemorrhagic strokes. They are zebras in the herd of horses that are migraines, dehydration, stress, and other forms of headache.
****** Not to be confused with the folks who used to shoot rockets into space of course.