The Case Studies Series highlights Dr. Javahery’s hands-on experience as a practicing surgeon over the last 10 years and his most extraordinary cases, from patient diagnosis and treatment to their recovery and current condition.
This patient was a 32 year-old with a history of multiple prior back surgeries. I met her in early 2017 when she presented with severe lower back pain and bilateral leg pain. Her pain was basically preventing her from a normal life. Walking any distance caused a rapid increase in her pain. Her leg pain went down the back of both legs and resulted in numbness in the feet.
This patient was the first case I ever did after completing my training. He was a 14 year-old high-school student on the local wrestling team. He was horsing around with a friend and the friend picked him up and dropped him on his head.
He was instantly unable to move his arms or legs.
He was brought in by the paramedics to the emergency room as a complete C4 quadriplegic. Complete means that he had no function (either motor or sensory) below the level of injury and being at the C4 level meant he had no muscle control in his arms or legs. He could only breathe spontaneously and move the muscles of his face and head.
This child is a 6 year-old who presented with progressive right-sided weakness. The weakness was initially subtle with some dragging of the right foot but it progressed to the point that he was falling and eventually could not walk
The weakness affected his face, arm, and leg. He was sent for an MRI and based on the results of the MRI, sent to me for an evaluation.
The MRI, unfortunately, showed a large tumor in the left side of his brain stem. The tumor extended from the midbrain (superiorly) to the pons (inferiorly).
Brain stem tumors in this age group can run the spectrum from very benign tumors to very malignant tumors. Some of these malignant brain stem tumors are so aggressive that they are invariably fatal.
This patient is a 19 year-old young woman who was involved in a high-speed motor vehicle crash. She suffered multiple fractures, including her leg and and her cervical spine (neck).
Fortunately, the fractures of her neck did not result in any neurological injury. The fracture pattern, however, was complex.
This patient was a 48-year-old woman who presented with a sudden transient loss of consciousness. When she regained consciousness, she had a severe headache. Fortunately, she was neurologically intact.
Her CT scan showed that she had an extensive subarachnoid hemorrhage (SAH). A SAH is bleeding inside the head into the subarachnoid space where cerebrospinal fluid circulates. This type of SAH is usually related to a cerebral aneurysm.
This patient was a 66 year-old women at the time of her initial presentation with Stage IV breast cancer and a new metastatic lesion in the 2nd lumbar vertebrae (L2).
She presented with new onset back pain about three months before I met her. She had radiation therapy for the lesion in L2 per the recommendation of her oncologist and another spine surgeon.
This case involves a previously normal child who, at 15 months old, presented with nystagmus, or abnormal eye movements. Her neurologist recommended she have an MRI, and the results showed large tumor in the posterior fossa compressing her brain stem.
This was one of the largest tumors I have ever seen. We initially did a biopsy since the lesion was so large and she was so young to see if there was a role for chemotherapy prior to surgery.
Another interesting case is this 18-month old child who presented with recurrent hemorrhages related to a cavernous malformation of her brain stem. Her parents discovered something was wrong when they noticed their child experiencing weakness on the left side of her body. They brought her into the emergency room for further evaluation.
This patient is a 66 year-old gentleman who previously had an L5-S1 instrumented fusion in 2007 (by me) for severe back pain and bilateral lower extremity pain. This pain was caused by an isthmic spondylolisthesis, a spinal condition in which one vertebra slips forward over the vertebra below, at L5/S1.
His symptoms were resolved after surgery but then in 2016 he developed recurrent back pain, leg pain, and foot numbness. His imaging showed that he had progressive spondylosis (degenerative changes) of the lumbar spine and adjacent level disease (from the prior fusion). He had significant spondylolisthesis at L4/5 and scoliosis in the lumbar spine.
This case is a 32 year-old woman who had persistent right sided headaches. She had a work-up done including an MRI of the brain. The MRI revealed that she had an arteriovenous malformation (AVM) of the right posterior temporal lobe going into the deep white matter. An arteriovenous malformation is an abnormal connection between arteries and veins, bypassing the capillary system.
Arteriovenous malformation can be found anywhere arteries and veins operate but occur most often in the brain or spine. In general, brain AVMs are rare and affect less than 1 percent of the population.
They usually cause intense pain or bleeding and can lead to other serious medical problems like brain damage or stroke.
This case was a 6-year old boy who was found to have multiple hormonal abnormalities when he was brought in including deficiencies of growth hormone, thyroid hormone, and the hormone that controls water balance (vasopressin).
These imbalances are fairly common in patients with these tumors and the deficiencies can be corrected with the use of medication.
However, his imaging revealed a much more serious problem. A cystic tumor was found at the base of the brain with calcification that could be seen on the CT scan.
This patient was a 10-year-old boy with partial paralysis in his left eye. He technically had sixth nerve palsy, or abducens nerve palsy, which is a disorder associated with dysfunction of cranial nerve VI (the abducens nerve). It makes it nearly impossible to turn out the affected eye and commonly leads to double-vision.
This was an acute event and when he was brought into the hospital, his imaging showed a very large mass compressing his brain stem.
Another remarkable patient I’ve treated was a five year-old who came into the emergency room experiencing acute hemiparesis on his right side. It was an unusual condition for a child of his age, and what we discovered at diagnosis required immediate action!
Acute hemiparesis causes patients to experience weakness or loss of motor functions on an entire side of their body. It happens often after trauma, tumors or even stroke. This young child experienced acute hemiparesis on the right side of his body after falling off the jungle gym at his school.
One of the most amazing patients I’ve treated was an incredibly brave 7-year old girl, who came in to the emergency room with her parents having extreme difficulties walking.
In addition to feeling numb in both of her legs, she had been experiencing chest pains at night for the past month. In search of answers, we ran emergency imaging and found a lesion on her T6 vertebrae with severe spinal cord compression.