Multidisciplinary Team of Experts Saves Life of Teen With Serious Neurological Problem
Kit with one of the neurological ICU nurses who cared for him.
It was a typical Thursday morning in December. Sixteen-year-old Christopher Sherren, also known as Kit, was lifting weights during a conditioning class at his Howard County school. Since it was ice hockey season, this intense exercise was part of this athlete's routine to keep his body in tip-top shape.
Kit was feeling a bit off that morning. The instructor commented that he looked pale and told him to go to the nurse. Somewhat delirious at this point, Kit ran up two flights of stairs to see the school nurse.
It turned out this nurse had just taken a refresher course on clots, aneurysms, and strokes. After seeing Kit, she suspected almost immediately that his symptoms matched a neurological problem.
While the ambulance was on the way to the school, Kit's parents got a call at home saying their son was injured. They suspected he had pulled a muscle or sprained some body part. Little did they realize, their son was in grave condition and getting worse.
"When I got to the school, he was on a stretcher. He did not appear to be injured, but as I got closer, I realized he was semi-conscious and the EMTs were visibly concerned," remembers Kit's dad.
Kit was transported to a local hospital, where it was determined that he needed much more specialized care. "He was crashing and it did not look good," says Mr. Sherren.
The emergency room physicians at the hospital where Kit was taken made contact with Vinay Vaidya, M.D., the attending physician in the Pediatric Intensive Care Unit (PICU) at the University of Maryland Children's Hospital. Dr. Vaidya was told about an adolescent with an altered mental state. The ball was then set in motion for Kit to be transported via helicopter to the PICU at the University of Maryland.
Before he was loaded into the helicopter, Kit was intubated with a breathing tube and given drugs to reduce the swelling in his brain. He also underwent a CT scan which determined what physicians in the PICU had suspected. Kit had a massive bleed in his head.
"We were completely prepared for Kit's arrival. The room was set. The nurse was assigned. The drugs were ready. The neurosurgery team was there," explains Dr. Vaidya.
Just moments after Kit was wheeled through the double doors to the PICU, Dr. Vaidya started putting in the arterial line to monitor blood pressure. At the same time, the neurosurgeons began to drill a hole in Kit's brain to reduce the pressure.
Though Kit's condition was critical, Dr. Vaidya was optimistic. "This was a bad situation where everything that could have gone right did. The weather was good so the chopper could fly. This happened in the morning at school and not in the middle of the night. The patient had not gone into cardiac arrest. His pupils were not fixed and dilated. There were no signs of cerebral herniation."
The immediate goal was to relieve the pressure in Kit's brain. Once this was achieved, the next step was to precisely diagnose the problem. Just several hours after his arrival at the University of Maryland, Kit was taken to interventional radiology, where it was confirmed that he had what is known as an AVM.
An arteriovenous malformation, or AVM, is an abnormal collection of blood vessels that ruptures in the brain. Most people live with an AVM and never know they have it, unless it leads to headaches, seizures, and in extreme cases like Kit's, bleeding. "An AVM is silent until it decides to rupture," says Dr. Vaidya.
Kit needed surgery, but he needed to be stable enough to go to the operating room. Almost a week after he came to the PICU, he returned to interventional radiology for a therapeutic -- as opposed as to a diagnostic -- procedure. In the simplest terms, Dr. Zoarksi placed a surgical glue in Kit's brain to block the AVM.
This procedure was then followed by a complex microsurgery led by Dr. Francois Aldrich, chief of cerebrovascular surgery. He successfully removed the AVM and blood clot so there would be no chance of it bleeding again.
Before the second surgery, the team came into the room and asked Kit if he was ready. Unable to speak or even open his eyes, Kit held up his arm and gave a thumb's up. "The room went silent for a second. He was heavily sedated, but he was responding the only way he could," recalls his father.
"Kit is extremely competitive and driven. He was dancing with death, but he fought this every step of the way," says his dad. The physicians, nurses and staff at the University of Maryland were also fighting on Kit's behalf. Teams from different divisions were all working together to save a young life.
"I have never seen such dedication or professionalism in any field. The staff was unbelievable. The people constantly impressed us with their commitment and concern for Kit," says Mr. Sherren. "The staff in the PICU, including nurses Jen, Ashley, Nicole and Dana, worked 24/7 for a week until Kit was stable enough for two brain surgeries. Then it was the nurses and staff in the neurological ICU, including Dennis, Stephanie and Russell, who helped transition Kit back to the real world."
Kit has made a remarkable recovery and continues to regain his strength every day. He hopes to be back playing ice hockey soon.