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For 24-year-old Ashly Hunt, trips to the beach are filled with sun, sand, and good times with friends. But during a recent trip to Ocean City, Maryland to celebrate the Fourth of July, Ashly knew something wasn’t right.
While relaxing on the beach, Ashly started to feel dehydrated, and quickly developed a severe headache. Hoping it would pass, she tried to ignore the pain. Within hours, her symptoms worsened. She could barely speak or see and had trouble moving her arms and hands. Ashly was quickly life-flighted to a hospital in Baltimore where she was diagnosed with a hemorrhage in her brain stem, which is the central core of the brain. The pooling of blood from the hemorrhage destroyed a critical part of her brain that is responsible for the movement of the right side of her body. The neurosurgeons treating Ashly felt that it was too risky to treat the hemorrhage surgically, given the location of the bleeding.
Soon after the diagnosis, Ashly entered a rehabilitation program in her hometown of Johnstown, PA to help her regain movement of the extremities that were affected by the hemorrhage. Her swallowing, speech, eyesight, movement of her eyes, and balance also were severely affected. However, after several weeks in rehabilitation, Ashly’s condition began to worsen. Her family doctor consulted with a neurosurgeon at the Johns Hopkins University, who recommended the Chairman of Neurological Surgery at UPMC, Dr. Robert Friedlander, as the person who should manage this complex situation. Within one day, a consultation was arranged.
Ashly’s hemorrhage was caused by an underlying condition called a cavernous malformation, which is an abnormal, berry-like patch of blood vessels located inside her brain stem. Because the brain stem is deeply situated within the base of the brain and controls important functions such as movement, sensation, breathing, and instructing the heart to beat, surgery to remove the malformation was extremely risky. However, if left untreated, the malformed vessels could again bleed and result in additional critical neurologic damage or even death.
The neurosurgeons at UPMC faced the challenging task of removing the malformation of blood vessels inside Ashly’s brain stem without causing further complications. Using advanced brain imaging technology known as High Definition Fiber Tracking – pioneered at the University of Pittsburgh – Ashly’s neurosurgeons were able to view the detailed wiring of her brain fibers to determine the best way to execute the surgery, while causing as little damage to her brain as possible. The availability of this technology allowed Dr. Friedlander to delineate the best possible treatment plan for Ashly. In order to obtain appropriate access to the brain stem, Dr. Friedlander turned to Dr. Barry Hirsch, a skull base ENT surgeon at UPMC. Using a special microscope and image guidance device, Dr. Friedlander approached the brain stem and was able to completely remove the cavernous malformation.
Soon after the surgery, Ashly’s neurosurgeons noticed that her vision and speech had significantly improved. She was now able to move her eyes, and also was able to move her right hand, which had been paralyzed. As Ashly began to recover, she noticed daily improvements with her balance, speech, movements, and other functions that were affected by the hemorrhage. She now lives at home with her parents in Johnstown, PA and attends an extensive rehabilitation program. Although she faces a long road to recovery, a return to her once active lifestyle is her strongest motivation.
“I’m hoping to be able to run again and to work full-time,” says Ashly. “I can drive now, I make dinner every night, and can do a lot of things on my own, which has been great. I think back to where I could barely move my head and arms and think that where I am today is just a miracle.”
Our patient stories profile a number of patients who have had minimally invasive brain surgery at UPMC. Although everyone's care experience is unique, we hope that sharing these stories will help other prospective patients and their families better understand these procedures and their potential benefits.
Ashly's treatment and results may not be representative of all similar cases.
Arteriovenous Malformations: Management and Treatment
UPMC offers three treatment options for AVMs, giving patients the best chance for a cure.