Recently, foreign media reported a rare case in the U.S. For 13 years, the boy Daniel Carr (Daniel Carr) was unaware that he was missing a part of his brain.
One of the earliest clues emerged on a seventh-grade baseball field, where the coach noticed that Daniel’s defensive strategy in the outfield was different from others, but effective. The coach told Daniel’s mom, Kelly Carr, that Daniel caught and threw the ball faster than most kids using traditional methods, and that he had the most incredible left hand and had never seen anything like it.
After the coach said that, Kelly also remembered some of her son’s quirks, such as getting clumsy when using his right hand; walking unsteadily at age 1, leaning to his left side, but ignoring it because it was temporary. Also, Daniel had always been left-handed, evident as an infant, and for most children, hand dominance does not appear until age 2 to 3.
In search of answers, Kelly took her son to pediatricians, orthopedic surgeons and physical therapists, but no one knew why. It wasn’t until the fall of 2012 that Kelly took Daniel to Washington University School of Medicine in St. Louis. Nico Dosenbach, M.D., made a startling, heart-pounding initial diagnosis, “I need to do more tests, but I think the problem is that Daniel had a stroke when he was a baby.”
A stroke as a baby, but not discovered until age 13, during which time life was normal and he even played baseball, that’s incredible! Strokes occur when the flow of blood to the brain stops, depriving tissues of essential oxygen and nutrients. Dossenbach, an associate professor of neurology who treats patients at St. Louis Children’s Hospital, explained that a minor stroke in an infant usually goes unnoticed. However, to confirm the diagnosis, he performs a more extensive physical examination, including neuroimaging.
Dossenbach, who is also an associate professor of occupational therapy, pediatrics, radiology and biomedical engineering, said, “This was the most severe stroke I have ever seen in a child who did not die or who did not suffer extreme physical and mental disability.” However, Daniel, now 22, led a remarkably normal life. This rare case of his reveals the brain’s amazing resilience to self-restructuring, especially early in life. I know Daniel’s brain deserves further study.”
The study culminated in a case study published March 17 in The Lancet – Neurology. Daniel’s MRI scan revealed that a severe stroke damaged both sides of his brain when he was an infant. In addition, dark spaces span parts of the cerebral cortex. The cerebral cortex is the outermost layer of the brain and is the center of thought, emotion, memory and higher functions. These dark spots indicate apparent damage to brain tissue, but Daniel does not appear to have cognitive, memory or emotional problems.
A bird’s eye view of Daniel’s brain shows asymmetric damage to the motor cortex in both hemispheres of his brain, which affects skills such as movement and balance. The right side of a person’s brain controls the movement of the left side of the brain and vice versa. Most strokes are specific to one side. But because bilateral strokes damage both sides, the effects can be more severe.
Dossenbach says: “Daniel’s injuries may have been on the verge of being life-sustaining.” After the stroke was diagnosed, and with his mother’s consent, Dossenbach recruited Daniel, then 13, for a study that included a series of motor and neurobehavioral tests and other neuroimaging over a six-year period.
Doctors noted that Daniel had contracted a disease at birth that lasted three weeks. Doctors believed he had contracted some kind of virus. Daniel went through periods of breathing difficulties, poor feeding, vomiting, diarrhea and constant lethargy.
Daniel spent about a week in the neonatal intensive care unit, receiving intravenous fluids and blood transfusions. However, diagnostic tests did not show signs of a stroke. Eventually, Daniel recovered and returned home with seemingly no other serious problems.
Daniel underwent a structural MRI to examine brain anatomy and pathology, and Dossenbach also used a precise functional MRI to understand how Daniel’s brain was reorganizing itself. The results revealed that part of Daniel’s brain structure was missing, with almost a quarter of the cerebral cortex missing.
Necrotic tissue in Daniel’s brain formed cavities filled with cerebrospinal fluid, a fluid that acts as a buffer for the brain, protecting it from damage while also circulating nutrients into the tissue and removing waste products. Neurons reconnect to preserve brain function. Connections emerge along islands of unactivated tissue, restoring motor and cognitive function. Connections restart in nearby healthy tissues.
Daniel’s case also highlights the difficulty of making accurate predictions about early stroke. “If brain damage had been detected when Daniel was an infant, the family might have been told that he would have developed severe developmental and cognitive delays. He might not have been able to attend regular school, and he might not have been able to participate in sports.”
Blessed by the disaster, Daniel grew up and went to school like a normal kid, playing baseball and soccer with his friends. He even earned an associate’s degree from a technical college and now works five days a week rebuilding diesel pumps for trucks.
Daniel’s bizarre stroke case also appeared in The Lancet Neurology.
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