Despite spending the summer in and out of hospitals, 14-year-old Perry Lampman and his family are counting their blessings. The Beaverton, Ore. teen who played catcher in the Little League Word Series just a year ago, suffered a series of rare pediatric strokes that could have been debilitating. But thanks to vigilant parents and UCSF Medical Center's pediatric stroke team, he's back home tackling a new, gentler sport — golf.
Doctors diagnosed Perry with an acute confusional migraine in 2003 after he developed a headache and became disoriented and confused while at school. Four years later without any episodes, Perry was on a school field trip when he again felt excruciating head pain and dizziness, and had trouble walking.
"He was confused and he didn't understand what was going one," his father Scott recalls. "He couldn't read his mother's reply to his text message and couldn't put names to the faces of his fellow students."
Perry took his first of many trips to the emergency room. Doctors at the local hospital prescribed him migraine medication and sent him home.
In the next month while playing sports, Perry had several more episodes in which he felt tingling and weakness on one side of his body. At the end of a long day at the beach Perry was struck with a severe headache and nausea, and couldn't grasp objects with his left hand. It got so bad, doctors thought he might have meningitis, and he was back in the hospital for another battery of tests, including an MRI and an angiogram, a test that uses x-rays and a special dye to see inside the arteries.
"They saw several strokes when they did the MRI, but they said the angiogram came out clear," Scott said. "When we walked out of that hospital and they told us they couldn't determine the cause of the strokes, we said — we're going someplace else."
Fortunately, Perry has an aunt who works at UCSF Medical Center, who put them in touch with pediatric neurovascular specialist Dr. Heather Fullerton who also serves as the director of UCSF's Pediatric Stroke and Cerebrovascular Center. Perry's family immediately flew to San Francisco to see Fullerton, who helped solve the mystery of Perry's illness.
In the next week, Fullerton and a team including interventional neuroradiologist Dr. Chris Dowd, interventional neuroradiologist Dr. Randy Higashida and neurologist Dr. Kyle Steinman, determined Perry had a vertebral artery dissection, a tear leading to the brain that causes strokes.
"A dissection can cause a stroke in two ways," Fullerton says. First, a blood clot can form at the site of the tear (like a scab), break off, travel up to the brain, and block off an artery in the brain, thereby causing a stroke. Or, it can lead to closing of the blood vessel at the tear if the blood tracking through the vessel's layers is enough to close off the inner space of the artery, she says.
Pediatric strokes, notoriously difficult to diagnose without specialized expertise, are rare, but more common than experts once believed with advances in technology and better non-invasive imaging tools. Ischemic strokes occur in about four per 100,000 kids per year, and dissections account for about 10 percent of those, according to Fullerton.
Perry must now inject blood thinners twice a day, which help prevent the blood clots from forming at the site of the tear while the vessel is naturally healing. Unfortunately, the avid athlete can no longer play many of his favorite sports, including baseball, because of the location of the tear near the back of his neck. But that hasn't stopped the motivated teenager.
"When he heard no baseball, but he could golf, he immediately started planning how he would work on his golfing. He is really a remarkable kid," Fullerton says.
And in order to golf, a sport that can take all day, Perry must inject himself with the blood thinners right out on the course.
"He's not showing much disappointment. He's trying to make the best of what he's got," his father Scott says.
The Lampmans continue to stay in touch with Fullerton as Perry's heals and they learn more about what might have caused the tear. They'll be back at UCSF for follow-up treatment this winter.
"Right now, we're just trying to get through this healing time," Scott says. "We've certainly gotten a lot more answers now then we had."
Story written in September 2007.
Erica Holt is a freelance writer in San Francisco.