Rare U.S. case highlights brain’s amazing ability to ‘reshape’ itself
A newly published study of a rare case shows the brain’s extraordinary potential for self-remodeling, especially early in life. This is a diagram of the brain.
A newly published rare case study shows a boy in the United States who did not know he was missing a part of his brain until he was 13 years old and is still living a normal life today at age 22. His treatment team believes that this bizarre case highlights the brain’s extraordinary potential for self-reinvention, especially early in life.
Daniel Carr’s physical abnormality was first noticed at a baseball game in seventh grade. The coach noticed that Daniel’s defensive strategy in the outfield was effective, but unusual. Daniel wore a glove on his right hand, but when a baseball was coming at him, he would always take off his glove, grab the ball with both hands, throw the ball with his left hand, and then put the glove back on with his right hand.
Daniel catches and throws the ball faster than most kids who do it the traditional way,” the coach told Kellie Carr, Daniel’s mother. But I’ve never seen a left-hander like that, it’s incredible.”
After the coach said so, Kellie also realized that Daniel did have a lot of physical “quirks”. For example, he was often clumsy when using his right hand; when he was about a year old, he walked unsteadily and always leaned to the left, but this phenomenon was very short-lived; and Daniel had always been left-handed, which had been obvious when he was an infant.
In search of answers, Kelly took her son to the doctor several times, seeing pediatricians, orthopedic surgeons, and physical therapists, but all to no avail.
It wasn’t until the fall of 2012, when Daniel was 13 years old, that they received a shocking initial diagnosis when they found Nico Dosenbach, an associate professor of neurology at the University of Washington School of Medicine. Dr. Nico told them, “We still need to do more tests, but I think Daniel’s stroke as an infant is the cause of these phenomena.”
As a mother, Kelly never knew her son had also had a stroke.
In reviewing Daniel’s medical history in detail, the team noted that he had experienced a three-week-long viral infection as a newborn. Although the source of the infection was unknown, Daniel was having difficulty breathing, eating poorly, vomiting, diarrhea and constant lethargy, and spent about a week in the NICU receiving intravenous fluids and blood transfusions. However diagnostic tests did not show signs of a stroke. He eventually recovered and was discharged from the hospital with no other serious health problems.
Strokes are known to occur when the flow of blood to the brain stops, depriving tissues of essential oxygen and nutrients. Niko explained that a minor stroke in an infant usually goes unnoticed. However, to confirm the stroke diagnosis, the treatment team performed a more extensive physical exam on Daniel, including neuroimaging.
Says Nico, “This was the most severe stroke I have ever seen in a child who did not die or who did not suffer severe physical and mental disabilities.”
However, Daniel, now 22, led a very normal life. This rare case of his reveals the amazing resilience of brain remodeling, especially early in life.
Daniel’s MRI scan revealed that a severe stroke as an infant damaged both sides of his brain. There was significant tissue loss in areas of the brain associated with thinking, emotion, memory and higher functions, but Daniel did not appear to have cognitive, memory or emotional problems.
There was asymmetric damage to the motor cortex in both hemispheres of his brain, which can affect skills such as movement and balance. Typically, most strokes damage one side of the brain, and the consequences of bilateral damage can be more severe.
After establishing a stroke diagnosis, Dr. Niko, with the consent of Daniel and his family, conducted a series of motor and neurobehavioral tests and imaging studies over a six-year period.
Daniel underwent a structural MRI to examine brain anatomy and pathology, and Nico also used precise functional MRI to understand how Daniel’s brain was reorganizing itself. The results revealed that some of his brain structures were missing, with almost a quarter of the cerebral cortex (cortex) missing.
Current neurobehavioral testing showed that Daniel’s scores were generally within the normal range. Motor skill assessments, however, showed that Daniel’s right upper extremity was weaker in strength, speed and agility relative to his left upper extremity.
Imaging also showed that in Daniel’s brain, the spaces created by necrotic tissue were filled with cerebrospinal fluid, which cushions and protects the brain from injury, while also delivering nutrients to the tissues and removing metabolic waste. Neurons also “reconnected” to preserve brain function, starting near the healthy tissue and gradually restoring interconnections between the “remaining” tissues after the injury.
Our findings illustrate the brain’s resilience in reorganizing and restoring function,” said Dr. Nico. Future studies of the functions corresponding to the lost tissues may provide additional insights.”
This particular case also highlights the difficulty of making accurate predictions about early stroke. In the medical team’s view, if Daniel’s brain injury had been detected as an infant, his family might have been told that he would face severe developmental and cognitive delays. He may not have had the opportunity to attend school and participate in sports normally.
Despite his lack of dexterity in his right hand, everything in Daniel’s life was normal. He goes to school on the block and plays baseball, soccer and soccer with his friends. He also earned an associate’s degree from a technical college and is now working as an automotive repair technician.
The findings were published in the latest issue of The Lancet-Neurology (April 2021).
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