The Helmsley Brain Center at Shaare Zedek Medical Center in Jerusalem recently successfully treated an extremely rare case of a four-year old girl who had experienced repeated strokes and deteriorating mobility and brain function. Cared for in the Interventional Neuroradiology Unit under the direction of Dr. Yaakov (Koby) Amsalem, she underwent a complex procedure to address a life-threatening bleed in her brain.
Ayla, a resident of Qalqilya, came to Shaare Zedek after other medical hospitals were unable to diagnose her condition which had been ongoing for more than a year as her condition deteriorated. One recent morning, while walking to her nursery near her home, she collapsed. Her parents immediately took her to the local medical clinic where she was referred to a hospital in Nablus where the doctors informed Ayla’s parents that the likely cause was a condition in her legs. She was sent home but her condition continued to deteriorate. Her father Mahmud recalled, “We had no idea why she was getting worse so fast and all of a sudden the entire right side of her body became paralyzed.”
Ayla and her parents returned to their local clinic who referred them to the government hospital in Ramallah. “The doctors there diagnosed a tumor in her head and she was continuing to get worse and her kidneys began to fail. At that point we decided to refer her to an Israel hospital where they detected the life-threatening bleeding in her brain.”
Dr. Amsalem, a senior neuroradiologist, has considerable experience in treating cases of this nature including in children and infants. He explains that Ayla had been suffering from bleeding in the left side of her brain for an entire year before coming to Shaare Zedek which was resulting in ongoing strokes. Upon admission to Shaare Zedek she was diagnosed as suffering from a brain aneurysm and the doctors worked to resolve the blockage using a specific stent and coil approach.
Dr. Amsalem explains, “The insertion of the stent required administering blood thinners to prevent clotting. Since the artery in question was extremely narrow, about just a millimeter and a half, the strokes continued even after our intervention to the point where the patient stopped speaking and began to experience paralysis in her right extremities.”
“After continued monitoring of her condition, we determined that the stent was almost completely blocked which together with the aneurysm blocked blood flow to the left cerebral hemisphere which controls the right side of the body and speaking and comprehension. This is obviously a very dangerous situation which can lead to serious disability and death.
We were then confronted with two possibilities. We could could perform a bypass procedure which comes with many potential complications, or a brain catheterization which requires considerable experience to navigate the tiny arteries which in Ayla’s case could easily rupture. After considerable deliberation we decided to proceed with the catheterization where we could use a special balloon combined with a material to close up the aneurysm that had been successfully advanced in other cases without resulting side effects.
We were extremely encouraged when we were able to see that the procedure successfully stopped the bleeding and within a period of just hours Ayla’s condition began to improve. Together with our hematologists we designed a drug protocol designed for the patients age and weight.”
Dr. Amsalem stresses that, “Strokes in children is an extremely rare condition and repeated strokes like this is even rarer. We’re talking about a case that occurs in about one in 500,000 children. We are very happy that our intervention prevented further damage. Caring for children with neurological conditions requires a very specific and individualized approach to address the size of their arteries while also taking into account how their bodies and organs will continue to grow and we are very proud to be able to offer these children some of the best possible care available in the country.”
Ayla was released from the hospital within days of the procedure and able to return to a full level of functioning.
Alya’s father added, “We never thought something like this could happen to Ayla. She is generally a happy and healthy girl who loves to run and play. But after a year of sickness where we almost lost her, the doctors at Shaare Zedek were able to save her and allow her to return to be with all the other children. We want to thank all the medical staff and in particular Dr. Amsalem.”