WHILE UNUSUAL, EVEN THE YOUNGEST AMONG US CAN SUFFER THE CONSEQUENCES OF A DANGEROUS 'BRAIN ATTACK'

Da’Quandez Wise is the last person you would expect to suffer a stroke.

He was a perfectly healthy teen-ager, a 13-year-old student at Waterloo (Iowa) Central Middle School.

Yet Wise suffered a stroke earlier this year while running on the school track.

It just didn’t make sense. Teens and children don’t suffer strokes, do they?

“Well, actually, yes, they do, though it’s relatively uncommon,” says Harold Adams, M.D., an internationally recognized stroke expert at University of Iowa Hospitals and Clinics. “Stroke is among the leading causes of death in childhood.” Generally, teens with acute stroke receive the same therapy as adults. These include thrombolytic agents (tPA) administered either intravenously or, in exceptional cases, through an artery.

Wise was initially treated in the emergency room at Covenant Medical Center in Waterloo. There, a computed tomography (C.T.) study performed by emergency medicine specialist Anthony Markham, M.D., (a 1991 University of Iowa Roy J. and Lucille A. Carver College of Medicine graduate) showed that a portion of the boy’s brain had already likely suffered an irreversible injury, referred to as infarction.

The Waterloo teenager had experienced the most common type of adult stroke, ischemic stroke, which results from a clot or other blockage within an artery leading to the brain. Much of his left cerebral hemisphere was deprived of vital blood flow.

Following initial treatment, Wise was airlifted to University of Iowa Children's Hospital at UI Hospitals and Clinics, where he was first evaluated by Charles Jennissen, M.D., a pediatric emergency medicine specialist. He was then seen by an interdisciplinary team of doctors from the Stroke Neurology and Neuro-Interventional Services, which had a limited window to begin life-saving care. Their evaluation indicated that a much larger portion of the left hemisphere was still viable despite the poor blood flow, which if left untreated would likely deteriorate.

Wise was rushed to the neurointerventional catheterization laboratory where John Chaloupka, M.D., and his team performed an emergency angiogram and treatment of the blockage. The left internal carotid artery (I.C.A.) was completely blocked at the base of the brain, and a blood clot had formed downstream in the main trunk of the middle cerebral artery (M.C.A.). Chaloupka crossed the blockage with a tiny microcatheter. After infusing 10 mg of tPA, flow into the left I.C.A. and M.C.A. was partially restored.

The underlying cause of the stroke turned out to be a tear in the artery wall, a relatively common cause of ischemic stroke (particularly in children). Unfortunately, there was evidence of early re-blockage. At this point, Chaloupka navigated a different microcatheter with a tiny balloon on its tip, which was used to break up the remaining clot. This angioplasty procedure improved blood flow into the still-salvageable portion of the brain. However, the risks of attempting any additional repairs were too high at that time.

Although the intra-arterial thrombolysis partially succeeded in restoring blood flow to portions of the left hemisphere, major brain damage had already occurred, leading to emergency surgery to relieve dangerou swelling that had begun to occur.

The 48 hours after surgery were critical. During this time, Wise received care from pediatric intensivist Caroline George, M.D., and other specialists in the University of Iowa Children's Hospital’s Pediatric Intensive Care Unit—the only PICU in eastern Iowa affiliated with a Level I Trauma Center.

To everyone’s delight, the eighth grader showed early signs of recovery. Within two weeks, he was transferred back to Waterloo for intensive rehabilitation. “We still have a long way to go but to see him smile and wave is a blessing,” says Da’Quandez’s mother, Carla Campbell.

For more information about teen stroke, patients and families should call UI Health Access and ask for the Stroke Clinic. For consultation or referral, physicians should call UI Consult.

SYMPTOMS OF STROKE

• Sudden onset of severe headache, dizziness, or lightheadedness
• Vision in one eye becomes fogged or hazy, or double vision
• Numbness or feeling of being heavy or clumsy
• Slurred speech or speech that does not make sense

"You can’t undo a lifetime of paralysis, which can happen if stroke is not treated in time. But if any patient is treated early enough, we can do a lot to prevent permanent paralysis and promote a better outcome.”

—Harold Adams, M.D.

RECOVERING WELL
Teen-age stroke patient Da’Quandez Wise, here being
evaluated by Vincent Traynelis, M.D., is following a slow,
steady path to recovery.

STROKE EXPERTS
The world-class multidisciplinary stroke team at
University of Iowa Hospitals and Clinics includes
neuro-interventional radiologist John Chaloupka,
M.D., and neurologist Harold Adams, M.D.