It's not common, but it is often deadly. When tangled blood vessels in the brain rupture and cause a stroke, time is of the essence.
One little boy's survival is a miracle.
One year ago, the Christie family gathered around the dinner table when 10-year-old Neal started acting strangely.
"Neal goes, 'Mom, I don't want to eat, I don't feel good,'" recalled Amish Christie, Neal's father.
"Now it's slurred speech is kicking in, we can't figure out what he's saying, but he kept on saying 'I'm numb, I'm numb,'" added Twinkal Christie, Neal's mother.
They couldn't believe what the 911 operator was telling them.
"She said to us that your son is having a stroke," Twinkal Christie said.
Neal had an arteriovenous fistula, similar to brain arteriovenous malformation but without the tangle of abnormal blood vessels connecting arteries and veins in the brain.
"We were able to stabilize Neal and get him to the operating room quickly, to do a craniotomy, evacuate hemorrhage and stop the bleeding," Dr. Christopher Gegg said.
After being kept in a coma, 10 days in the intensive care unit and rehab, Neal was finally sent home after two months and two surgeries.
"I don't need any more canes, I don't need any assistance with walking, so that's one thing that's already improved. Another thing is putting on my brace by myself," he said.
Neal has even learned to play video games one-handed with his older sister and is improving every day.
Gegg wants other parents to know the symptoms to watch for: sudden headaches, numbness, vision loss or slurred speech.
Neal's mom urges parents to be vigilant.
"Ask further questions, to asses, do they need to be seen by a doctor?" she said.
IS THERE DANGER HIDING IN YOUR CHILD'S BRAIN? WHAT PARENTS NEED TO KNOW REPORT #2687
BACKGROUND: Stroke is a type of blood vessel disorder. It can be categorized as ischemic (caused by insufficient blood flow) or hemorrhagic (caused by bleeding into the brain). When a blood vessel in the brain is injured, the brain tissue around it loses blood supply. Pediatric stroke can cause neurologic disability, with a risk of permanent long-term cognitive and motor impairment. Stroke is among the top ten causes of death in childhood with the highest mortality in the first 12 months of life. The number of new cases per year is around 2 per 100,000 population. Stroke affects between 1 in 2,300-5,000 newborns. Fifty to eighty-five percent of survivors of stroke will be left with problems which may include seizures, physical disability, speech or learning difficulties and twenty to forty percent of children have recurrent strokes. The burden of stroke in children is likely to be greater than in adults because children surviving stroke will have more years living with functional limitations and disability. (Source: https://www.hopkinsmedicine.org/health/conditions-and-diseases/stroke/pediatric-stroke and https://strokefoundation.org.au)
AVM'S AND AV FISTULAS: Abnormal tangles of arteries and veins is known as arteriovenous malformations (AVMs). While many AVMs remain asyptomatic for life, they can cause serious problems when they occur inside the brain as a cerebral AVM, in the brain's covering as a dural AVM, or in the spinal cord as a spinal AVM. AV fistulas are an abnormal connection between arteries and veins. This condition can occur in the brain, the covering of the brain and the spinal cord as well. They can cause symptoms by affecting the surrounding brain or spinal cord, and in some cases from bleeding. In both conditions, the capillaries that normally exchange blood between the arteries and the veins don't develop in a certain area, and as a result, the arteries dump blood directly into the veins. Christopher Gegg, MD, Nemours Children's Hospital said, "After Neal had his emergent brain surgery, he was kept in a coma and required another operation to replace his skull flap which was left out during the surgery to control brain swelling; this second surgery was done after he was stable and approaching rehab." (Source: https://med.nyu.edu/neurosurgery/physicians/a-z-technologies-guide/arteriovenous-malformations-avms-and-av-fistulas)
NEW STROKE TREATMENT: An international group of researchers, including physician scientists at University Hospitals, recently concluded a 31-month clinical trial that studied clot removal, called mechanical thrombectomy. This study was for stroke patients who presented for treatment more than six hours after onset of their stroke symptoms. In the DAWN trial, patients treated with mechanical thrombectomy within 24 hours after stroke onset had a significantly better rate of functional independence without an increased risk of bleeding into the brain. "Almost half of the patients (49 percent) receiving the thrombectomy therapy had an independent recovery at 90 days after treatment, as opposed to only 13 percent of the patients treated medically," says Cathy Sila, MD, Director of UH's Comprehensive Stroke Center and principal investigator of the DAWN study at the UH site. (Source: https://www.uhhospitals.org/Healthy-at-UH/articles/2018/10/clinical-trial-leads-to-breakthrough-treatment-for-stroke)