Battling Brain Infection
By Loretta Coureas
When 6-year-old Cidney Graham didn’t want to go out and play in the new-fallen snow last winter, her mother, Tamika Havard of Virginia Beach, began to worry.
The kindergartner had missed some days from school before the holidays, complaining of tummy aches and headaches. But when the first snow fell in December and Cidney didn’t play outside, Tamika worried that it was more than the bug that had been going around in her family.
“She was just so tired all the time and not acting like herself,” her mom said.
Especially worried about Cidney’s headaches, Tamika took her to her pediatrician,
Dr. Ruth Vogel, who knows that headaches in children under 7 years of age can signify something far more serious than a flu bug. So she scheduled a CT scan for Cidney at CHKD’s radiology department in Norfolk.
But the night before the appointment, Tamika went into her daughter’s room and found her having a seizure. “She was curled up in a fetal position, sweating and shaking, her eyes rolling back,” her mother said. “It was awful. She didn’t even know me.”
A frantic 911 call brought an ambulance to take Cidney and Tamika to nearby Bayside Hospital. After an emergency CT scan there, doctors called CHKD’s special intensive care transport to take Cidney and her mom to CHKD.
Critical care physician
Santa Johnston says that when Cidney arrived at CHKD’s pediatric intensive care unit, her brain was so swollen that it had begun to compress against the boney ridge on the inside of her skull.
“It’s a very grave sign of impending death from brain swelling,” Dr. Johnston said. “We gave her medications and special IV fluids to curtail further brain swelling. But we knew she needed surgery right away.”
CHKD pediatric neurosurgeon
John Birknes says Cidney’s CT scans showed a large, dark mass deep within her brain. “There was no time to lose,” he said. “This was a very extreme case.”
Dr. Birknes took Cidney directly to the operating room, where he removed a portion of her skull in order to access the center-most area deep within her brain. He installed a catheter, called a shunt, which would provide a way for excess fluid to drain away from her brain. He then examined the mass in order to drain it and learn what type of infection it was.
“I found that the covering of the mass was very tough but had obviously ruptured,” he said. The rupture dumped infection into the brain’s ventricles. These are cavities in the center of the brain where cerebral (spinal) fluid is normally generated. That was bad news because it meant the infectious material now had the potential to travel throughout her brain and nervous system.
Dr. Birknes put in a second shunt to allow excessive fluid from the infected ventricles to flow to a collection bag outside of her body. The emergency surgery went well, but he knew an additional surgery would be necessary if swelling didn’t go down.
The battle now would be against the specific bacterium – hemophilus aphrophilus – causing the infection in Cidney’s brain.
Pediatric infectious disease specialist
Randall Fisher explains: “This particular bacterium is commonly found in the mouth, though sometimes the infection can originate in the heart. But Cidney was negative for both mouth and heart problems. We couldn’t tell where the infection started. So we used three broad-spectrum antibiotics to fight the infection.”
Because Cidney’s condition was so grave when she arrived at CHKD, her improvement was very slow. Over the weeks ahead, Dr. Birknes took her back to the operating room three times -– first to carefully reconnect the clogged ventricles and then to add more shunts to fight fluid build-up around her brain.
Dr. Fisher adjusted her antibiotics to combat reactions. All the while, her mom and family stood vigil in the PICU, praying and worrying. Because Cidney was often combative when she awoke briefly, her mom feared she would never regain her sweet nature.
“The nurses really helped me,” Tamika said. “We struggled every day, but I always had faith everything would work out. Everybody who took care of her was top-notch.”
After two months in the PICU, several returns to the OR and weeks of antibiotics, Cidney awoke gradually and regained her cognition slowly.
Everybody was amazed – and relieved.
“At first she was confused a lot and she couldn’t walk,” her mother says. “We thought she would never be the same, but she proved us wrong.”
Once Cidney was out of danger and improving, she moved to CHKD’s Inpatient Rehabilitation Unit where pediatric physiatrists,
Drs. Jean Shelton and
Christine Thorogood, and rehab nurses assessed her potential and established a plan for restoring her ability to stand, walk, talk and carry out normal activities. She was basically starting over.
Her mom and favorite aunt, Felisha Havard, visited every day to cheer her on. They brought her favorite meals and frequently had lunch with her in the family area near her hospital room.
Physical and occupational therapists worked with her daily to strengthen her muscles and improve her coordination. A speech therapist helped her regain language skills.
Cidney cried with joy when her physicians and therapists told her she was ready to go home and continue recuperating, surrounded by her five brothers and sisters.
Her mom cried as well. “I wish I had a billion dollars to give this hospital for giving my child back to me,” Tamika said. “Cidney is like a celebrity around here. I can’t tell you how much it has meant to us to have everyone here helping to make her well.”
After two months of touch-and-go, with Cidney wavering between life and death, all the physicians, surgeons, nurses and therapists who had worked so hard to save her breathed a collective sigh of relief. On April 14, after more than 10 weeks, she was finally going home – no longer sick and returning to normal day by day.
“In many ways she is a very lucky little girl,” Dr. Birknes said. “She was seriously ill.” He explained that physicians at CHKD may see three or four brain abscesses a year, most of which can be treated with antibiotics when they are caught early. “Hers was far more serious because the mass formed deep within the middle of her brain and wasn’t detected for a long while,” Dr. Fisher added.
The four shunts Dr. Birknes surgically implanted in her brain will remain forever, draining any fluid build-up directly into her abdominal cavity, where it dissipates normally. The mass that initially appeared as a large ink blob on her CT scans is now a small gray shadow that may eventually disappear. As she returns to normal, Cidney continues her outpatient therapy at CHKD and will return to school next fall.
Cidney Graham has little memory of her race to CHKD and the weeks that followed in the PICU. But the incredible team of specialists that helped pave the way for her journey home will never forget the miracle of her recovery and her incredible comeback.
Drs. Fisher and
Johnston practice with Children’s Specialty Group PLLC at CHKD.
Dr. Birknes practices with CHKD Surgical Group’s neurosurgery practice, and
Drs. Thorogood and
Shelton practice with EVMS physical medicine division at CHKD.
This story was featured in the third quarter 2010 issue of KidStuff, a publication of Children's Hospital of The King's Daughters.
Click to read more patients' stories.