Taking one step at a time
Young boy relearns to walk and talk after fluke accident causes hematoma
In May 2017, Victor Lévéillé was finally allowed to stay home alone after school. Like every young boy, he got excited when he saw his friends playing outside and ran towards the front door to join them, but he tripped over his schoolbag and hit his head on a wall. When his parents, Isabelle Chamberland and Hugo Lévéillé, got home a few minutes later, Victor was sitting on the couch icing his head. “He seemed okay, he just had a minor headache,” recalls Isabelle, and within an hour, he was back playing outside with his sister, Laura.
Every second counts
When his headache hadn’t subsided by 10:00 p.m., Isabelle decided to bring him to their local emergency department. “We thought he had a minor concussion,” she says. After being examined by a triage nurse, Victor was sent home because he showed no signs of a head injury, but a few hours later they were back at the hospital. Victor had started to vomit. “At this point, they decided to do a CT scan and they discovered something horrible,” recalls his mother. A blood vessel had ruptured during his fall and blood was collecting between his dura, the tough outer membrane covering the brain, and his skull. Victor was suffering from an epidural hematoma.
An epidural hematoma is often identified by the loss of consciousness after an accident, followed by a period of alertness. The hematoma can put pressure on the brain and cause it to swell and shift. “Never in a million years did we think that his brain was being filled with blood,” says Isabelle. “He just had a little bump on the left side of his head.” The hospital immediately contacted the Montreal Children’s Hospital and prepared Victor for transport. He was intubated and put into an artificial coma. “Everything felt so surreal. I wasn’t sure if I’d ever see my son again,” she says.
At the Children’s, emergency department physician Dr. Sasha Dubrovsky got the call and mobilized the trauma team. “Every second counts when dealing with the brain so we knew we had to work fast,” he says. Dr. Brett Burstein was the trauma team leader that night. Once the “10/10” was called—a code used to identify the most severe type of trauma case—Dr. Burstein immediately jumped into action and coordinated the nursing team and made sure the OR was able to get neurosurgeon Dr. Jean-Pierre Farmer on site as quickly as possible. But while Victor was en route, things went from bad to worse. “He went from being a sick kid to a completely unstable one,” says Dr. Burstein.
One of Victor’s pupils had “blown,” a term used when a person’s pupil becomes very dilated and unreactive to light stimulus; it’s a sign that surgery is required immediately. “Victor’s blood was pushing his brain down into his neck, basically suffocating his brain,” says Dr. Dubrovsky. When Victor arrived at the Children’s he was 10 to 15 minutes away from dying. “Every additional minute we would have waited around would have led to more and more brain damage,” he says. Upon his arrival, the team quickly gave him medication to decrease the swelling in his brain and he was immediately transported to the OR. “If the emergency department wasn’t so well prepared, my son wouldn’t be here today,” says Isabelle.
Relearning to walk, talk and eat
Once in the OR, Dr. Farmer had to perform an emergency craniotomy on Victor. “With this type of surgery, timing is everything, especially since both of his pupils were dilated by then,” he says. Dr. Farmer’s team quickly removed part of Victor’s skull to stop the pressure on his brain, and searched for the bleeding blood vessels. He then performed an ultrasound to make sure the deeper structures were not injured. “After the surgery we looked at his eyes and we knew his nerves weren’t damaged, because his pupils were no longer dilated,” he says. “But it takes several days for the brain to return to its normal position.”
After his surgery, Victor was in a coma for 10 days, but when he finally woke up, he could only move one eye. “He learned to communicate with his eyes by opening and closing them for yes and no,” says his mother. He started to move little by little every day. He spent 17 days in the Pediatric Intensive Care Unit (PICU) at the Children’s and by the time he left the hospital he was able to say yes or no, make different noises, and smile. For the next couple of months, he lived at Centre de réadaptation Marie Enfant where he underwent intense rehabilitation. Victor had to relearn how to walk, talk and feed himself.
A major milestone happened in June when he woke up one day and could talk. “It was the best phone call ever,” says Isabelle. “He basically went from grunting different noises to talking in full sentences overnight.” Doctors explained to her that Victor’s brain was no longer swollen and he had regained his ability to speak. “His speech neurons were stunned, but not dead,” explains Dr. Farmer. Eventually he also began to feed himself and drink again, but it was a challenging process because his parents had to watch him closely to make sure he didn’t choke. But through it all, Victor remained patient and determined to get better.
Dealing with spasticity
Upper and lower limb spasticity was another side effect of Victor’s brain injury that led to difficulties after his accident. Spasticity can cause muscles to tighten uncontrollably because of disrupted signals from the brain. The muscles contract and are not able to relax or stretch properly, making it difficult to walk. In Victor’s case, he was able to overcome the spasticity in his hands and eventually began to write again, but he was still having problems walking.
To help with his spasticity, Victor had Botox injected into his leg muscles, a known treatment to help muscle stiffness in people suffering from upper and lower limb spasticity. “It looked promising at first, but stopped working after a couple of tries,” says his mother. The next step was to surgically implant a baclofen pump, a programmable pump and catheter used to help people with severe spasticity by sending a type of medication, called baclofen, directly to the spinal cord. “We are the only pediatric hospital in Quebec to implant these types of pumps,” explains Dr. Farmer. “It’s important for us to not only save lives, but to improve children’s quality of life.”
The baclofen pump needs to be refilled every five months and the dosage and pump rate can easily be reprogrammed at every hospital visit. “Victor will likely have this pump for life,” says his mom. “He was upset about it at first, but I told him that if this accident had happened to him 30 years ago, he probably wouldn’t be here today. Who knows what kind of technology they’ll have another 30 years from now?”
On April 19, Victor had the pump implanted at the Children’s by Dr. Farmer; his family noticed big changes almost immediately. “On most days, he is able to walk with a walker or crutches,” says Isabelle. “He sometimes has to use a wheelchair, because of the tendonitis in his knees or when he gets tired. The energy it takes him to take one step is the same amount of energy we use to take 15 steps.” Victor’s goal is to be able to walk unassisted by next year, and he would love to be able to play soccer again. “He most definitely has the potential to walk again,” says Dr. Farmer. “A young boy like Victor has all his life ahead of him. The more independence we can help him achieve, the better.”
Dr. Burstein also finds Victor’s recovery remarkable. “It’s a testament of every person involved in his care; from his parents recognizing that something just wasn’t right, to the emergency and trauma teams, the surgeons and anesthetists, the intensivists and nurses, the physiatrists and physiotherapists, and of course, Victor himself,” he says.
Remarkably, Victor did not lose any cognitive function and he is scheduled to graduate from elementary school this year. His family knows how lucky they are to have him alive and healthy. “It’s hard not to see him run in the streets with his friends, but at least we still have him with us,” says his mom. “We’re climbing a mountain, all of us, one day at a time.”