7-Year-Old Experiences Miraculous Recovery from Life-Threatening Stroke
After months of debilitating headaches, 7-year-old lands at Cook Children’s where doctors perform life-saving procedure, diagnose rare condition.
By Heather Duge
Sometimes a mother’s intuition can be the difference between life and death. That was true for 7-year-old Ismael Aguilera whose episodes of debilitating headaches turned out to be a life-threatening condition. Ismael’s mom, Karla, questioned the doctor every time she was told he had migraines.
“I knew it was not normal for him to be feeling like that every few weeks,” Karla said.
Ismael went through eight months of episodes including unsteady walking, vomiting, dizziness, sweating, slurred speech and blurry vision. A couple of trips to the local Emergency Department also left Karla and her husband Isack with more questions than answers. Last July, Ismael had another episode, but this time one side of his face drooped down and one side of his body tingled. They once again rushed Ismael to the Emergency Department and pushed for answers.
Ismael’s condition worsened as his mental status rapidly declined and he experienced weakness on his left side. Doctors in their local Emergency Department contacted Cook Children’s and the Teddy Bear Transport team acted fast. Once in the Intensive Care Unit at Cook Children’s, the team intubated Ismael and quickly began testing which revealed he was in a dire situation. Karla remembers hearing the doctors tell her the severity and urgency of Ismael’s condition, but she was in shock and not able to process everything.
“Even though I couldn’t think through it all, I had this feeling that he was going to be fine, and he would leave the hospital walking,” Karla said. “My faith in God got me through.”
They told her that during these episodes he was having smaller strokes but this one was in a different area affecting the basilar artery which can be fatal if not treated immediately. The area included the brainstem which coordinates breathing and maintains alertness. Only an extremely skilled physician can treat this successfully.
Right Place, Right Team, Right Time
Marcela Torres, M.D., Cook Children’s Hematology and Oncology - Stroke and Thrombosis Program co-director, began treating Ismael with blood thinners to prevent more strokes. She had to strike a delicate balance with the medications – not enough could cause more strokes but too much could cause him to bleed into the vital area of his brain.
“It is very possible he only had a matter of hours before we would not have been able to save him,” Dr. Torres said. “I remember watching the images of Ismael’s MRI in real time and texting Dr. Gerstle because I knew we needed him right away.”
Ronald Gerstle, M.D., pediatric interventional radiologist at Cook Children’s Medical Center, performed a thrombectomy which came with many risks but was the only chance at saving Ismael’s life. He very carefully removed the clot through a tiny catheter that went from Ismael’s leg to his brain.
“It takes an experienced stroke center with all the resources to perform these procedures in kids this young and in a timely manner so we can save their brains,” said Richard Roberts, M.D., pediatric neurosurgeon at Cook Children’s Jane and John Justin Neurosciences Center.
After the procedure, the team anxiously waited for Ismael to show signs of progress.
“There was a chance Ismael wouldn’t wake up after the procedure,” said Rachelle Herring, M.D., one of Cook Children’s pediatric stroke neurologists who treated Ismael in the ICU. “We were all surprised and thankful to watch him slowly wake up and then talk, move and regain function.”
A Miracle in the Making
After five days, Ismael was extubated. Drs. Herring and Torres checked on him frequently to monitor his neurologic status and assess his level of recovery. Ismael continued to improve at a faster pace than anyone expected. He spent one month in rehab learning to walk and eat again – all while wearing a cervical collar since the doctors suspected his strokes were caused by bow hunter’s syndrome. With this condition, turning the neck compresses the artery and causes strokes.
Two months later, Dr. Gerstle performed an angiogram to confirm the diagnosis. Sure enough, every time he turned Ismael’s neck during the procedure, it began to compress the artery.
Road to Recovery
In January, Dr. Roberts performed a rare procedure fusing Ismael’s head and neck to prevent further strokes. Dr. Roberts placed screws in the cervical vertebrae and a head plate on the base of his skull – operating in an area that was one millimeter away from the artery running through Ismael’s neck.
Since then, Ismael has continued to recover well without any vascular events. In April, he was cleared to remove the cervical collar and continues to follow up with Dr. Roberts and Fernando Acosta Jr., M.D., Stroke and Thrombosis Program co-director.
“He now has an excellent prognosis with a low risk of more strokes,” Dr. Herring said. “His recovery has been miraculous considering where the major stroke was located. We are all so amazed.”
‘Thank God They Knew What to do’
“We needed to be at Cook Children’s all along,” Karla said. “Everyone from child life specialist Madi Mayfield who Ismael called his best friend to nurse Tyler Adair who went out of his way to make him happy with special handshakes and talking about his favorite things to the amazing doctors who got Ismael to where he is today. Thank God they knew what to do.”
Because of the fusion, Ismael will not be able to participate in impact sports or jump on trampolines or bounce houses. This could pose a significant risk of extension or hyperextension of the neck and potentially break the hardware or his bone putting Ismael at risk for strokes again.
But other than that, Karla says he is back to being a normal kid who loves animals, riding horses, playing outside and watching the Steelers play football.
“Ismael has such a caring heart,” Karla said. “I really think God put him on this journey to help others. He has a purpose here.”
To spot the signs of stroke, remember the acronym BE FAST:
Balance - Is there a sudden loss of balance or coordination?
Eyes - Is there blurred or lost vision?
Face - Is one side of the face drooping or numb?
Arm - Is there weakness, numbness or loss of movement in the arms, legs or one side of the body?
Speech - Is speech slurred?
Time - If you or someone you know is experiencing any of these symptoms, call 911 immediately.
The most important thing to know is that strokes happen in children. If something is different or off about your child, seek emergency care.
Pediatric Hematologist Vital when Treating Strokes
When Marcela Torres, M.D., began her career as a pediatric hematologist, strokes in children often were under recognized, but she has been treating pediatric strokes for years.
“Now we are noticing a lot of adult centers trying to treat pediatric strokes, but children are not little adults,” Dr. Torres said. “They need a multidisciplinary team with pediatric training.”
At Cook Children’s, patients are fortunate to have a hematologist managing the blood thinners and knowing exactly what level to give every step of the way. There are very few pediatric hematologists who do this day in and day out. Dr. Torres is part of an International Stroke Group and has seen so much in 12 years that her expertise is vital to a pediatric stroke patient’s outcome.
The Stroke and Thrombosis Program at Cook Children’s is comprised of a multidisciplinary team including a pediatric hematologist, two pediatric neurologists, a pediatric neurosurgeon, a pediatric neuroradiologist and a neuroInterventional radiologist with expertise in pediatric care.