Just hours after complaining of a headache during a July 2014 car trip with her parents, 13-year-old Christina Blumstein was comatose, in an ambulance, and on her way to Robert Wood Johnson University Hospital (RWJUH)—her life in grave danger. Until that night, nobody knew Christina had been born with a rare clump of small, abnormal blood vessels in her brain called an arteriovenous malformation, or AVM. Most AVMs cause no harm, but a few—like Christina’s—rupture and cause bleeding inside the brain. Christina had suffered a stroke and only immediate measures would save her life.
The first step for physicians at the hospital was sealing the blood vessel shut, with what Sudipta Roychowdhury—clinical assistant professor of radiology at Rutgers Robert Wood Johnson Medical School, part of Rutgers Health—calls “brain glue.” Roychowdhury, who is also director, interventional neuroradiology, at RWJUH, the principal teaching hospital for the medical school, and neurosurgeon Gaurav Gupta, assistant professor of surgery at the medical school, inserted a catheter through an artery in Christina’s leg, guided it past her heart and through the carotid artery in her neck, and with a microcatheter injected the glue to stop the bleeding.
Pediatric neurosurgeon Rachana Tyagi, assistant professor of surgery and director, pediatric neurosurgery, then led a team that removed part of Christina’s skull to relieve swelling that can cause secondary damage to the brain. “We gave her brain space,” says Dr. Tyagi.
Christina emerged from surgery still in a coma, which would last for nine days. When Christina awoke in the pediatric intensive care unit, her mother says, “It was ‘Oh my God—she recognizes me and she can speak.’ One of the first things she asked for was her phone, so I knew things were happening in that brain, that this is my child and I’m getting her back.”
Able to walk again, and with the situation looking up, Christina set two deadlines: one was to leave the hospital before her birthday in August—she did—and the second was to have her major treatments done before Christmas.
Completing Christina’s treatment meant reattaching the piece of skull and performing a delicate procedure to eliminate all vestiges of the AVM, so it could never rupture again. For that procedure, Dr. Tyagi enlisted Atif Khan, associate professor of radiation oncology, whose specialty is using a device called a Gamma Knife, a noninvasive tool that uses radiation instead of surgical cutting to treat many brain conditions. It was Dr. Khan’s job to demolish Christina’s abnormal blood vessels. Guided by imaging technology, Dr. Tyagi showed Dr. Khan which delicate structures of the brain he needed to avoid, and Dr. Khan did the rest.
As recently as 10 years ago, says Dr. Tyagi, trying to eliminate the abnormal vessels would have produced significant complications, because the risk of damaging brain tissue was too high. Now, she says, “it’s a one-day process and it’s much more precise, only possible because we have a great team of subspecialists, and the latest technology.”
Christina got her Christmas wish. She was finished with the procedures by mid-December, and since then she has progressed even more, picking up where she left off at a dance studio and giving a stirring recital almost a year after the stroke.
One lingering vestige of her stroke appears to be her memory. Christina feels she needs to work harder to retain what she learns at school. With cognitive therapy, however, that, too, is getting better. “I’m feeling great,” Christina says. “I think I’ve recovered really well.” That means everything to her physician. “It makes staying up at night, phone calls at 3 in the morning, all worth it,” says Dr. Tyagi. “It’s the best reward you could ever ask for.”