In January 2008, 7-year-old James T. Syring got violently ill while on a family vacation. "He was nauseous, vomiting, and had severe headache and dizziness," says his father, also James Syring.
When the family returned home to Portland, Ore., emergency room physicians there ran standard tests and sent the boy home, prescribing rest for his flulike symptoms.
Doctors put James T. on a blood thinner, monitored him closely in the ICU — and suggested the Syrings contact UCSF. A week later, the family met with UCSF pediatric neurologist Heather Fullerton, M.D..
Dr. Heather Fullerton and James
One of the world's leading experts on pediatric stroke, Fullerton ordered imaging of the head and the neck — the neck had not been part of the previous imaging. "We found a cerebellar stroke that was attributable to a vertebral artery dissection," she says.
After a comprehensive exam, she sent James T. home on an aspirin a day and prescribed regular follow-ups.
"Over time, we noticed that the vessel didn't heal as we expected," says Fullerton. Still, James T. seemed fine, with no recurrent strokes, so Fullerton continued him on aspirin therapy.
Then, nearly four years to the day after his first stroke, James T. collapsed at school, landing him back in the Portland hospital. There, a consulting neurologist ordered an immediate MRI, which confirmed another stroke.
The neurologist phoned Fullerton, who suggested a rotational neck CT scan, a special study that examines the vertebral artery in different positions as the head rotates. A phone collaboration between the Portland radiologists and a UCSF neuroradiologist led to the missing link: when James T. turned his head 60 degrees to the left, there was 100 percent closure of the vertebral artery.
This rare condition — compression of the vertebral artery with head turning — likely was the cause of the chronic injury to the vertebral artery that increased the risk of stroke-causing clots. As soon as they could, the Syrings rushed back to UCSF to meet with a team that included Fullerton, pediatric neurosurgeon Nalin Gupta, M.D., Ph.D., vascular neurosurgeon Michael Lawton, M.D., and interventional neuroradiologist Randall Higashida, M.D..
Higashida's angiogram precisely identified the causes of the compression; the surgery to alleviate the problem would take almost the entire next day.
"We knew it was risky, cutting around that artery, but we trusted them," says Syring, who was impressed with the surgical team's experience.
"To ease the external compression, we drilled away the bone adjacent to the artery and removed soft tissue at the level of cervical vertebrae C1 and C2," Gupta says. "Imaging immediately afterwards showed some improvement in the occlusion."
Dr. Nalin Gupta
But only time would tell if the surgery had truly diminished the risk of another stroke.
In the ensuing weeks, James T. returned to normal activities. His headaches went away.
The week of March 25, 2012, he returned to UCSF for testing, which revealed the surgery was a success.
There was no more occlusion of the vertebral artery when James T. turned his head.
"We are very appreciative of UCSF's expertise and the way the two hospitals worked together," says Syring. "People need to know that kids really do have strokes."
For more information, contact Dr. Heather Fullerton at (415) 353-3681 or Dr. Nalin Gupta at (415) 353-7500.
How Selective Hearing Works
The longstanding mystery of how selective hearing works — how people can tune in to a single speaker while tuning out their crowded, noisy environs — was solved by two scientists from UCSF, and others at hospitals in the U.S., Canada and Europe. UCSF neurosurgeon Dr. Edward Chang and postdoctoral fellow Nima Mesgarani worked with three patients who were undergoing brain surgery for severe epilepsy.
Donors Support Neurosciences Research and Patient Care
UCSF received a challenge gift of $20 million from the Sandler Foundation that will support for the university's groundbreaking research and clinical care in neurological diseases. In honor of Herbert and Marion Sandler and the Sandler Foundation, the new neurosciences building at the UCSF Mission Bay campus will be named the Sandler Neurosciences Center.