{"id":4863,"date":"2016-03-20T00:00:00","date_gmt":"2016-03-20T06:00:00","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/2016\/03\/20\/youth-is-served-in-stroke-save\/"},"modified":"2021-09-07T17:49:27","modified_gmt":"2021-09-07T23:49:27","slug":"youth-is-served-in-stroke-save","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/youth-is-served-in-stroke-save\/","title":{"rendered":"Youth is served in stroke save"},"content":{"rendered":"
<\/div>

It was late afternoon on Feb. 26, and 14-year-old Iram Quezada was doing something unremarkable for a kid his age: playing baseball on an unseasonably warm day. Then something most uncommon happened to the Fort Lupton teenager.<\/p>\n

He had a stroke.<\/p>\n

Sharon Poisson, MD, co-medical director of the Stroke Program at UCH, and neurosurgeon Joshua Seinfeld, MD, played key roles in the rescue of 14-year-old Iram Quezada.
\nNo one knew it at the time, but it was obvious something was wrong. Iram had finished up a batting drill and was walking over to talk to his manager when he suddenly had trouble speaking. He turned to walk away, then stumbled and fell.<\/p>\n

\u201cI got up and fell down again,\u201d Iram said in a phone interview. His left side was also weak.<\/p>\n

One of his coaches set Iram against a fence and called 911. His mother, Maria Arellenes, got a call that something was wrong. She thought initially Iram had suffered one of his periodic asthma attacks, but when she raced to the field and saw him, she knew that wasn\u2019t the case.<\/p>\n

\u201cThe paramedics were there, and I noticed he couldn\u2019t move his left side,\u201d Maria said. \u201cI knew this was not good or right.\u201d The ambulance transported Iram to Platte Valley Hospital in Brighton, where providers in the emergency room examined him.<\/p>\n

The quick action set the tone for a rescue that draws a bright line under the oft-repeated line that in cases of stroke, time is brain.<\/p>\n

Quick catch<\/strong><\/h2>\n

A coordinated effort between emergency medical service providers, Platte Valley Hospital, University of Colorado Hospital, and Children\u2019s Hospital Colorado got Iram from the baseball field to a table in the Interventional Radiology suite at UCH in less than three hours. By the end of the evening, a few seemingly insignificant red splotches \u2013 blood clots in the brain that caused the stroke \u2013 lay on a piece of sterile gauze. Three days later, Iram was home recovering and working toward resuming his pre-stroke life.<\/p>\n

The life-threatening blood clots Seinfeld removed from Iram\u2019s right middle cerebral artery.
\nThe story could have had a much different ending if anyone involved had been slower to recognize the seriousness of the situation, said Meredith Snyder, RN, CCRN, SCRN, manager of the Stroke Program at UCH.<\/p>\n

\u201cA stroke destroys 2 million neurons per minute,\u201d she said. \u201cIf even small pieces of our response go a little bit off, the results can be devastating.\u201d<\/p>\n

In Iram\u2019s case, the response was quick and decisive. Providers in the emergency department at Platte Valley quickly recognized Iram\u2019s left-side problems and other symptoms as signs of stroke and ordered a CT scan and angiogram, said neurologist Sharon Poisson, MD<\/a>, co-medical director of UCH\u2019s Stroke Program. The tests revealed a blockage in the right middle cerebral artery of Iram\u2019s brain.<\/p>\n

Poisson called Platte Valley\u2019s work crucial. \u201cStrokes are much less common in children than they are in adults,\u201d she said. Because of that, they are frequently mistaken for migraines and other problems that mimic the signs of stroke, Poisson added.<\/p>\n

\u201cRecognizing stroke in a patient 14 years old is a big deal,\u201d she said.<\/p>\n

Timothy Bernard, MD<\/a>,<\/a>\u00a0director of the Pediatric Stroke Program at Children\u2019s Colorado, put the prompt recognition in perspective, noting that the stroke rate in children is 2 per 100,000. Only half of those occur in previously healthy kids like Iram. The average time to diagnosis nationally for a child who suffers a stroke is 24 hours, Bernard added.<\/p>\n

Wheels in motion<\/strong><\/h2>\n

Platte Valley\u2019s catch set multiple wheels in motion. After reviewing the brain images, their providers contacted the patient transfer center at Children\u2019s Hospital Colorado. As the neurologist on-call, Poisson consulted with emergency physicians at both hospitals and accepted Iram for transfer and a possible procedure to remove the blood clot.<\/p>\n

\"IramStroke specialists at Children\u2019s Colorado and UCH have worked together closely to establish guidelines for deciding which hospital will accept young stroke patients, Poisson said. Children with blockages of a large blood vessel in their heads who are at least 12 years old and weigh more than 40 kilograms are considered for transfer to UCH for intervention, while other children with stroke transfer directly to Children\u2019s Colorado.<\/p>\n

Iram exceeded all of these requirements, so the decision was made jointly to transfer him to UCH. The hospital\u2019s DocLine pre-admitted him, creating a medical record in Epic and setting a flurry of activity in motion.<\/p>\n

Just 35 minutes after she received the initial call, Poisson called UCH neurosurgeon Joshua Seinfeld, MD<\/a>. He contacted the Interventional Radiology team, which began preparing for a procedure. Orders were put in for an MRI scan. Teams from intensive care, anesthesia, and pediatric neurology were put on alert and got ready for a stroke case.<\/p>\n

Iram and Maria arrived by ambulance to UCH\u2019s ED, where he was whisked to Radiology to start an MRI scan in just eight minutes, Snyder said. The scan confirmed the right middle cerebral artery occlusion. While Maria waited, providers explained the treatment they recommended for Iram: a catheter-based procedure to remove the clot and open the blood vessel. Maria consented, and only about 45 minutes after he arrived to the hospital, Iram was on a table in an IR room that had been hurriedly readied.<\/p>\n

Seinfeld threaded a catheter through Iram\u2019s femoral artery and aorta to the carotid artery. He then put a smaller catheter bearing a wire mesh device called a stent retriever into the larger catheter. Seinfeld snared the roughly 5-millimeter clot with the stent retriever and pulled it out of Iram\u2019s head, into the larger catheter, and out of his body.<\/p>\n

Iram Quezada and mom Maria Arellanes speak with Channel 4 reporter Kathy Walsh in the AIP lobby at UCH March 14.
\n\u201cWe got it in one try,\u201d Seinfeld said. \u201cIt was average size, and it came out in pieces.\u201d He estimated the entire procedure was over in about a half an hour.<\/p>\n

Bernard said strong ties between Children\u2019s Colorado and UCH, built over time, were a major key to the success.<\/p>\n

\u201cWithin a couple of minutes, providers at Platte Valley were talking to specialists adept at taking care of kids with stroke,\u201d he said. \u201cNot many places have that kind of access, and without our collaboration, they wouldn\u2019t have that ability.\u201d<\/p>\n

On to the next<\/strong><\/h2>\n

I\"Iramram stayed in the hospital\u2019s Neuro Intensive Care Unit through the weekend and was discharged Feb. 29 with significant improvement in his functioning. He\u2019ll have physical, occupational, and speech therapy and follow-up care with Bernard at a multidisciplinary stroke clinic jointly staffed by specialists from Children\u2019s Colorado and UCH. Poisson and Seinfeld said his prospects for recovery are good, but it\u2019s impossible to make firm predictions.<\/p>\n

\u201cHe had a stroke,\u201d Poisson said. \u201cIt could have been much worse, but he still had damage to his brain.\u201d<\/p>\n

Two weeks after the procedure, Iram was back in school. He said he was feeling better, but was weaker and more tired than he was before the stroke.<\/p>\n

\u201cI have a hard time focusing sometimes,\u201d he said.<\/p>\n

\u201cWhen we say something to him, it takes him a little bit of time to figure out what we\u2019re saying,\u201d Maria said. \u201cHe has to think a little bit. It\u2019s harder for him to understand.\u201d<\/p>\n

Fort Lupton teenager Iram Quezada hopes to be back on the basketball court after he recovers from a blood clot in his brain that was removed at UCH. Photo courtesy Maria Arelleanes.
\nThat\u2019s to be expected, Bernard said. The first post-stroke year is typically the hardest for a recovering patient, with physical and cognitive fatigue often presenting especially difficult challenges, he noted.<\/p>\n

\"ram\u201cEven as function returns, young stroke patients often feel very fatigued and have trouble focusing,\u201d he said. \u201cThat\u2019s very typical.\u201d<\/p>\n

As for why such a young, generally healthy kid suffered a stroke, there are no clear answers, Poisson said. \u201cWe don\u2019t have an answer for that,\u201d she said, noting that there is no identified cause in about one-third of pediatric stroke cases.<\/p>\n

What is known is that the quicker a patient of any age gets treatment for stroke, the better the prospects for a good recovery become. In Iram\u2019s case, everything fell into place. \u201cThe stars aligned,\u201d as Seinfeld put it.<\/p>\n

The key to success lies in creating a solid system built by committed individuals who quickly recognize the signs of stroke and act on them with a sense of urgency, Snyder said.<\/p>\n

\u201cWhen the process is clear and in place, this kind of outcome is expected. Things go well,\u201d she said. \u201cThis was what we want to have happen every time.\u201d<\/p>\n

Strokes in previously healthy, active kids like Iram are extremely rare, said Timothy Bernard, director of the Pediatric Stroke Program at Children\u2019s Hospital Colorado. Photo courtesy Maria Arellanes.<\/p>\n","protected":false},"excerpt":{"rendered":"

It was late afternoon on Feb. 26, and 14-year-old Iram Quezada was doing something unremarkable for a kid his age: playing baseball on an unseasonably warm day. Then something most uncommon happened to the Fort Lupton teenager. He had a stroke. Sharon Poisson, MD, co-medical director of the Stroke Program at UCH, and neurosurgeon Joshua […]<\/p>\n","protected":false},"author":2143,"featured_media":2371,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[7],"tags":[270,869,263],"class_list":["post-4863","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-stories","tag-childrens-hospital-colorado","tag-stroke-care","tag-university-of-colorado-hospital"],"acf":[],"yoast_head":"\nYouth is served in stroke save - UCHealth Today<\/title>\n<meta name=\"description\" content=\"It was late afternoon on Feb. 26, and 14-year-old Iram Quezada was doing something unremarkable for a kid his age: playing baseball on an unseasonably warm day. 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