Neurosurgeon's Instincts Save Young Man From Rare Brainstem Bleed
Kasey Trent's life has changed in many ways over the last year. Not negatively, however, thanks to lifesaving surgery for a rare brainstem bleed.
Kasey says the experience has driven him to take a bigger bite out of life by visiting new places, meeting as many people as he can and participating in a wide range of activities.
Wakeup Call: Kasey’s Story
In the summer of 2021, after moving from Freeland, Maryland, to San Diego, California, for work, the 27-year-old started noticing some unusual symptoms. First, he took a hard fall snowboarding after losing his balance, which hardly ever happened in the past. Then, one day, while eating a piece of cake, he noticed a tingling sensation in his face, tongue and fingertips.
"I thought I was having an allergic reaction to something," Kasey says. "When you're my age, the idea that there might be an issue with your brain is the last thing you think about."
After that, things snowballed quickly. "I took a trip back to Maryland to be with my family and friends for Thanksgiving," Kasey says. During the trip, he noticed something was off, and it scared him. His mother, Zhanna, also thought that he seemed more tired than usual.
When he visited again in December, only a few weeks later, Zhanna noticed that her son was struggling on his left side. "He was limping, talking funny," she says.
When she had asked Kasey about it, he said he thought he had a pinched nerve. But just a few days later, his symptoms worsened. "He was talking as if something was in his mouth," Zhanna says.
To the Emergency Department
Realizing something was seriously wrong, Zhanna took Kasey to the Emergency Department at the University of Maryland St. Joseph's Medical Center in Towson. She suspected a stroke, which should have been out of the question since her son is so young.
After running some tests, doctors at St. Joseph's confirmed that Kasey had a brainstem bleed. The bleed came from a brainstem cavernous malformation (BSCM) — a group of abnormal, thin-walled blood vessels packed tightly together. The BSCM had grown so big that it compressed many important structures harbored within the brainstem. These structures help coordinate and integrate functions related to consciousness, body and eye movements, heart rate and breathing.
"The brainstem is responsible for your life, basically," says Mohamed A. M. Labib, MD, assistant professor of neurosurgery at the University of Maryland School of Medicine and cerebrovascular neurosurgeon at the University of Maryland Medical Center (UMMC) who specializes in Kasey's condition.
Shortly after doctors admitted Kasey to the emergency department, Zhanna got a phone call from Dr. Labib, urging Zhanna to bring her son to UMMC in downtown Baltimore. "He told me that he would take care of Kasey right now," Zhanna says. She was scared but decided to take him to UMMC to see Dr. Labib.
An Intricate Brain Surgery
The brainstem is located deep within the brain and accessing it is difficult. On top of that, with all the essential functions it controls, one false move can have lasting effects on the patient. "BSCMs are rare, and few surgeons will operate on the brainstem because it comes with risks," Dr. Labib says.
Most surgeons would have looked at Kasey's imaging and concluded that they could do nothing but observe it. But because Kasey is so young and Dr. Labib is trained to operate on these challenging brain structures, Dr. Labib and his team felt confident that the BSCM could be surgically removed with good outcomes.
Kasey underwent his surgery at UMMC in February 2022. The surgical team led by Dr. Labib operated on Kasey while he was in a sitting position, which allowed gravity to displace parts of the brain to gain a better view of the brainstem while minimizing brain injury.
Working under a microscope, Dr. Labib carefully navigated around various blood vessels and nerves. Staining on the brainstem left by the bleed, as well as surgical navigation, confirmed the location of the BSCM. Working with superior knowledge of the anatomy, Dr. Labib identified where the BSCM could be safely accessed. The team detected and then completely removed the BSCM. See a detailed description of the procedure.
Recovery and Relearning Skills
After the surgery, Kasey's symptoms improved significantly. Kasey stayed in the hospital for about a week and went to a rehabilitation facility for therapy to relearn skills he had lost due to the BSCM and the brainstem bleed. His mother stayed by his side every day.
"I don't want to hear anyone tell me that I might not walk again," Kasey says, thinking about his time in the hospital. "Everyone knew what had happened to me, and they didn't want to give me false hope, but Dr. Labib told me he was confident that he could fix me." Kasey decided he would trust his surgeon.
Whenever Kasey got discouraged, Dr. Labib would reassure him that he would be OK, that he was young and healthy, and that it would take some time. But Dr. Labib always maintained it was vital that he keep working emotionally, mentally and physically.
Kasey spent a year recovering his mobility and strength. "I have pins and needles in my left hand like it's fallen asleep, but it's gotten a lot better."
He had lost a lot of muscle mass, but worked hard to regain wrist and hand strength to do things like opening a jar and pouring himself a bowl of cereal.
"I feel a lot more confident now," he says. "I couldn't fill a water bowl for my dog before, and now I do it every day." He relearned how to walk. Now, he can run.
Back to Life
After finishing rehab, Kasey returned to San Diego for work and is back to living an independent life. He continues to see Dr. Labib periodically for follow-up visits. By virtue of Dr. Labib's successful operation, Kasey's cognition abilities are the same, and he can drive, compete in sports and spend time with friends.
"Dr. Labib was amazing," Zhanna says. "He was there for me and my family, reachable and kind, explained everything. He's a very, very good doctor and human being."