Last month, on a recent family outing, eight-year-old Harel Goldstein suffered a rare, sudden stroke caused by a clot in his brain stem. Rambam Health Care Campus specialists felt that his chances of recovery were small. “We were in shock; we did not believe that Harel would recover without permanent brain damage.”
Eight-year-old Harel Goldstein hovered between life and death after experiencing a severe brain stroke. Although his doctors didn’t believe he would survive, they were very thankful when proven wrong.
The Goldstein family were enjoying a weekend outing recently in northern Israel. On their way home, Harel fell asleep in the car. “When he woke up at home, he was in a panic—stressed out. He told us he was very tired, which was unusual as he has attention deficit disorder (ADHD) and is normally alert and full of energy,” his mother Racheli explains. “He began to cry, but when I asked him why, he didn’t answer. He looked frightened. I thought it was a side effect of his ADHD medication which had recently been changed.”
Since Harel had been diagnosed with a virus the week before, the parent decided to take him to Carmel Hospital’s emergency room (ER). But by the time they arrived, Harel was unresponsive and his pupils were dilated. The staff took a cranial CT scan. Alarmed by the results and that Harel remained unconscious, the ER doctors called Rambam’s unique Invasive Neuroradiology Unit (Brain Catheterization) and told them they were urgently transferring the boy there.
Dr. Haj Ahmed, a pediatric specialist, was one of the doctors treating Harel. After reviewing the CT, he feared that the boy had suffered a stroke. “Strokes are rare in children and are difficult to diagnose.” Dr. Ahmed explains. The next steps involved more tests, which revealed a blockage due to a blood clot in Harel’s brain stem.
In the meantime, Dr. Eytan Abergel, Director of the unit, who had been off duty that day, was called in due to the seriousness of Harel’s condition. “Strokes are extremely rare in children and are therefore, difficult to diagnose,” explained Dr. Abergel. He continued, “The vigilance of Dr. Haj Ahmed, led to accurate interpretation of the data.”
Nevertheless, by the time Dr. Abergel arrived at the hospital, several hours had already passed since the onset of Harel’s first symptoms. “I was pessimistic since some brain damage had already occurred. I told the parents that surgery and brain catheterization were complex and life-threatening procedures.” He explained to Harel’s parents that the next few hours would be critical.
Yaniv and Racheli signed a consent form to proceed with a brain catheterization. “We couldn’t believe that our fun-filled family day had gone so terribly awry. Our lives had been turned upside down. We were now being told that, Harel was in serious danger. It was a message from Hell,” Racheli recalled.
A stroke is a medical emergency caused by a disruption in the blood supply to the brain and can be fatal. Immediate medical treatment is critical to saving lives and preventing permanent disability. One effective treatment is brain catheterization, which Rambam’s multidisciplinary brain catheterization team now set out to do.
The brain catheterization procedure was performed by Dr. Abergel and his team. Harel lay before them, unconscious and on a ventilator. The three-hour procedure was nerve-wracking for the parents as they prepared themselves for the worst.
And then, the best happened. Dr. Abergel was able to remove the arterial blockage – the result of a ruptured artery – an aneurysm. The aneurysm had released small blood clots which, over time, had merged into one large, life-threatening clot.
Despite the success of the procedure, Dr. Abergel explained to the distraught parents that there were still major concerns. “A challenging and complex hurdle was still ahead of us; had Harel suffered brain damage, and if so, to what extent?”
The next day, the amount of anesthetic being given to Harel was reduced gradually. He opened his eyes and was then re-sedated. His blood pressure was high. The following day the anesthetic was further reduced. Harel could now focus his eyes.
“His breathing tube was removed and, after testing his reflexes, we observed that one of his legs was partially responsive while the other was fully responsive,” Dr. Abergel said. “We were amazed when Harel regained consciousness and began communicating with us. When we saw that he could eat on his own, we transferred him to Pediatrics.”
Dr. Abergel concluded, “When I visited him in the ward, less than a week after the catheterization, and saw him playing with a ball, I could not digest the miracle that had happened to this boy!”
Racheli trembled with joy as she summed up the entire experience, “Contrary to all expectations – a miracle happened – I got my son back.”