Saturday, June 26, 1999

Felled by stroke, young swimmer fights to recover

College completed, therapy continues

The Cincinnati Enquirer

        In his last year at Cleveland's John Carroll University, Patrick Carey, a 5-foot 9-inch, 130-pound senior, was all wiry muscle. The 21-year-old Westwood man swam more than a thousand yards a day in the hope of helping his swim team retain its championship ranking.

        But that all changed Sept. 7, 1998, when a small tear in the lining of the carotid artery, which supplies blood to the brain, sent blood tunneling through the interior wall of the vesseland formed a clot that reached his brain.

        “I remember swimming that morning and I remember sitting in my dorm room doing my computer science homework,” he says. “Next, I remember waking up in the intensive care unit.”

        The captain of a college swim team with several winning titles was left with limited use of his right side. His ability to speak was severely hindered.

        Though doctors say Mr. Carey's disorder and subsequent stroke are rare, what triggered them could be as common as a cough.

        Called a spontaneous carotid artery dissection, this puzzling affliction is considered an uncommon cause of stroke.

        “This is a rough guess ... but, there are about one or two cases per 100,000 strokes that occur in people under age 50 per year,” said Dr. Joseph Broderick, Mr. Carey's neurologist and director of the Greater Cincinnati/Northern Kentucky Stroke Team at University Hospital.

        The American Heart Association estimates that about 600,000 new or recurrent strokes occur every year.

        Overt trauma, such as being struck or cut in the neck area, is an obvious cause of some arterial dissections. However, spontaneous dissection is exactly what its name suggests.

        “Any kind of sports, chiropractic manipulation, house painting, a sneeze, a cough — just turning your head quickly can lead to a dissection,” said Dr. Dewitte Cross III, director of Interventional Neuroradiology at Washington University's Barnes Jewish Hospital in St. Louis.

        But dissections do not always lead to stroke. Medical experts think it is possible that a person can have a dissection and not suffer any negative affects.

        “It may be more common than we think because we think we don't see all of the people who may have them,” Dr. Cross said, adding that a tear may heal itself. “People don't catch them unless they suffer a stroke or some other neurological problem.

        “In the old days we used to directly puncture the carotid artery when inserting a catheter. These caused dissections, but most of the times they did not result in a stroke or any neurologic system deficits. It is reasonable to conclude that people have spontaneous dissections that may never come to their symptoms,” Dr. Cross said.

        Symptoms could include neck pain, headache, dizziness, weakness or possible neurologic damage.

        Exactly who is susceptible to a dissection and the outcome it may have on one's body is not predictable.

        “Some people's blood vessels may be more fragile or elongated ... containing more turns and curves,” Dr. Cross said. “It's hard to avoid all the things that might place you at risk for illness and injury, but in this particular case it's best not to make any sudden neck movements.”

        What ultimately caused Mr. Carey's dissection is unknown. It could be attributed to the repeated head turning swimmers do to breathe, but medical experts say there are no indications that swimmers are more susceptible to the disorder than anyone else.

        A 1995 graduate of Roger Bacon High School, Mr. Carey felt no pain, weakness, dizziness or headache and did not suffer any of the common signs, such as high blood pressure, that may make someone a stroke candidate.

        When Mr. Carey's father, Bill, was finally able to visit his son the day after the stroke, he could see the fear in the younger man's eyes.

        To soothe his son, all the elder Mr. Carey could do was “hold him, touch him, let him know that his mother was coming,” he said.

        Though initially unable to talk or move his right side, Patrick Carey has come a long way in the nine months since the stroke.

        Dr. Thomas Watanabe, medical director of the Neurorehabilitation Unit at Hartwell's Drake Center, where Mr. Carey receives outpatient therapy, calls his recovery “remarkable.”

        The stroke affected a major portion of the left side of Mr. Carey's brain in the area governing speech and his right side mobility. In older patients, such a debilitating episode would take years of recovery to get to the point where they can communicate and regain some movement, Dr. Watanabe said, adding that the stroke did not affect Mr. Carey's intelligence.

        “I'm basically the same person I was before this,” he said. said. “There have been a number of obstacles, but I draw from inside to overcome them.”

        Mr. Carey graduated with honors from John Carroll, is working a summer internship as a data programmer and plans to pursue his master's degree in the fall.

        He has regained some use of his right side and though he sometimes gets frustrated, he has relearned to speak.

        Although his recovery can mainly be attributed to Mr. Carey's own strength and drive, he credits the help of friends and strangers, among them the University of Cincinnati's National Student Speech Language Hearing Association, an organization of students that raised about $1,200 toward his therapy.

        “He's the one who has been so determined and he has never given up and that inspires me,” said Mr. Carey's mother, Shannon. “But so many things have been done for us ... and without that support ... the prayer — they certainly helped lighten the load. We don't take anything for granted anymore.”

        Carotid artery dissection is a tear in the interior lining of one of the main vessels in the neck that carries blood to the brain. Blood may make its way through the tear and channel into the lining of the artery. It may act like a tourniquet or cause a clot that breaks off and travels to the brain, resulting in a stroke.

        Trauma-related dissection, caused by a blow or a cut to the neck, is more common than spontaneous dissection, which might be caused by a sudden turn of the neck.

        Its symptoms may include headache, neck pain, weakness, dizziness, drooping of an eyelid and small pupils.

        It can be detected via angiography or magnetic resonance imaging, in which a substance is injected into the body and followed through the bloodstream. Source: HealthAnswers Medical Reference Library


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