Deven had a typical day on Sunday, August 28th. In the morning, he went with Steve to FlyWheel where he did a 20+ mile indoor cycling ride. In the afternoon, the Sawyers all volunteered at the Ronald McDonald house. On Monday, August 29th Deven woke up around 4am and generally did not feel well. He started walking to get a drink and go to the bathroom when his left leg suddenly buckled causing him to fall. Steve was downstairs feeding their dog, Yoda and heard the loud noise upstairs. When he came up he found Deven on the floor in his room. He wanted to rest more so he got back in bed and Smita stayed with him to be sure he was ok. He woke again around 9am and noticed his left arm and leg were weak and tingling. Smita looked at him and noticed the left side of his mouth was drooping and called an ambulance. He was taken to Levine Children's Hospital where he was evaluated in the emergency room.
Deven had a CT scan of the head which did not show any abnormalities. There was no bleeding on the brain, no brain masses/tumors. Next he had a CT Angiogram of the blood vessels in his head and neck which showed a small amount of narrowing and irregularity in the right posterior cerebral artery (PCA) and that there was less blood flowing to the back right side of the brain which is supplied by the right PCA. There were no aneurysms, abnormal collections of blood vessels or complete blockages of any blood vessels. Deven did not have a fever or any abnormalities on his blood tests. He was admitted to the hospital where a pediatric neurologist evaluated him. This examination confirmed left face, arm, and leg weakness and tingling. These findings were concerning for an ischemic stroke in the right side of the brain affecting the left side of the body. An ischemic stroke is where you do not get enough blood to a part of the brain as opposed to a hemorrhagic stroke where there is bleeding on the brain. In general, the right side of the brain controls the left side of the body. An MRI scan of the brain the evening of 8/29 confirmed that Deven had a small ischemic stroke.
Strokes in children are rare. Even more rare in health children with no concerning family history such as Deven. In the hospital, he has had other tests to try to figure out the cause of his stroke.
Deven had an ultrasound of his heart (echocardiogram) which was normal except for a variant found in about 30% of the general population called a patent foramen ovale (PFO). This "hole in the heart" allows blood and other material to cross from the right side of the heart to the left side of the heart without being filtered by the lungs. In Deven, this cross over of material was very small and only allowed blood to cross over when he would bear down w/ breath holding or coughing during the test. He was seen by a pediatric cardiologist who did not think this was a likely cause of his stroke. There is a lot of recent information about if these PFOs should be closed with devices. At this time it does not seem like this will be necessary or indicated for Deven. Again, this is considered a normal variant that can be seen in up to 30% of the general population. His heart rate and rhythm have been normal throughout his hospitalization.
Multiple blood tests have been sent to rule out any blood abnormalities that would make Deven's blood more like to form clots. These labs will hopefully come back by Friday 9/2.
To help prevent any further strokes he is taking Aspirin to "thin his blood" just a little bit. At this time there is no reason to put him on a more powerful blood thinner such as coumadin (warfarin).
At this time, the focus in on stroke rehabilitation. He was seen by the Speech therapist. His swallowing is intact with both liquids and solid foods. He scored 100% on a cognitive test called the Montreal Cognitive Assessment. He continues to work with physical therapy and occupational therapy to strengthen his left face, arm and leg. He has a list of exercises that he has to complete on his own multiple times throughout the day in addition to his daily therapy sessions. He spoke with the Physical Medicine and Rehab doctor who was very optimistic about his prognosis in terms of regaining his strength.
Today, 8/31 he was able to walk from his bed to the door with the the help of the physical therapist. The goal is for Deven to go from the hospital to acute inpatient rehab where he will participate in 3-6 hours of therapy per day. Typically, patients will stay from 1-3 weeks at inpatient rehab depending on how fast they improve.