The stroke struck in the middle of math class.
Zosia Wasylewski sat on the floor with her classmates for a geometry lesson. But when the students rose to return to their seats, 14-year-old Zosia struggled to stand.
Her left leg didn’t seem to work. Or her left arm.
“People were trying to help me, but I just couldn’t (stand),” she said. “When they finally got me into my chair, I said that I felt like I was having a stroke.”
Talking became difficult.
“I was emotional, but I was also starting to stumble over some words,” she said.
Two classmates formed a chair with their arms and carried her to the school office as someone called for an ambulance.
No one expects to suffer a stroke. But when it happens to an active teenager—who plays a half-dozen sports—it’s especially shocking.
“She’s as healthy as they get,” said Zosia’s mother, Anna Wasylewski.
Fortunately for Zosia, prompt medical attention, expertise in stroke care, and the removal of the blood clot in her brain led to a quick comeback. Zosia returned to school just five days later.
“She looks great,” said Justin Singer, MD, the director of vascular neurosurgery for Spectrum Health Medical Group. “She really didn’t have any discernible impact evident on her physical exam.”
Her impressive recovery stands out especially because strokes in children do not always receive prompt, effective treatment. Zosia is the youngest patient at Spectrum Health to undergo a mechanical thrombectomy—a procedure to remove the blood clot from her brain.
“Pediatric stroke affects maybe 25 kids in 100,000. It is very uncommon,” Dr. Singer said. “It often ends up being a missed opportunity to help. Here, everything came together for her.”
Zosia, a freshman at Boyne Falls Public School, is the youngest of Anna and Frank Wasylewski’s four children.
She loves math and language arts. She dreams of starting her own business someday—and has already run several money-making ventures. At age 11, she pocketed $200 from sales of handmade decorations at a local craft show.
You can track the seasons by the sports she plays: softball in the spring, swimming in the summer, cross country and volleyball in the fall and basketball in the winter.
And growing up with Boyne Mountain Resort down the road, she has skied all her life.
When Zosia suffered her stroke, school officials called for an ambulance.
At a local hospital, she underwent a CT scan and an MRI. The staff contacted the pediatric neurology specialists at Spectrum Health Helen DeVos Children’s Hospital for guidance in evaluating the results.
Use FAST as an easy way to identify the most common symptoms of a stroke. Get help immediately if you observe any of these symptoms:
F – Face drooping
A – Arm weakness
S – Speech problems
T – Time to call 911
Source: The American Heart Association
As she underwent testing, Zosia’s left side began to come back to life. She could again move her arm and leg.
Doctors considered whether a migraine caused her symptoms.
But when a scan showed a blockage in a brain artery, they made arrangements for Zosia to go to Helen DeVos Children’s Hospital. There, young stroke patients receive care from a team that includes pediatric neurologists, intensivists and hematologists, as well as neurosurgeons.
Because dense fog kept Spectrum Health Aero Med grounded, Zosia made the 180-mile trip by ambulance.
Dr. Singer studied the scans while awaiting her arrival.
“The clot was in the right middle cerebral artery. That’s a large artery that supplies blood to the majority of the right side of her brain,” he said.
He suspected Zosia’s symptoms subsided because of collateral circulation. The left middle cerebral artery likely pumped blood across the top of the brain to keep the right side of the brain supplied with blood, restoring some function.
But the clot in the right middle cerebral artery still had to be removed for her long-term health, Dr. Singer said.
“If we didn’t get the artery opened, it’s possible nothing would have happened,” he said.
But another possibility loomed.
“If she became dehydrated or her blood pressure dropped, the collateral blood flow would not support things indefinitely,” he said. “She could go on to have a much larger stroke.”
After Zosia arrived at the hospital, her medical team quickly transported her to the neurointerventional radiology department in Spectrum Health Butterworth Hospital.
Dr. Singer performed a minimally invasive procedure, called a mechanical thrombectomy. He inserted a catheter in a leg artery to reach her brain and used a wire mesh device to pull out a clot that measured almost 3 centimeters long.
‘This is real’
Two days later, Zosia sat in her hospital bed, tired but in good spirits. She joked about how she managed to skip the end of her math class.
She noticed no difference in her ability to move or talk.
“I just have an IV now,” she said, holding up her left arm.
Dr. Singer showed Zosia and her parents a brain scan of the clot in her artery, followed by a scan taken after he removed the clot.
“Oh my gosh, this is real,” Anna said.
Zosia’s youth aided her recovery, he said.
“Young brains are better than old brains at finding new ways to work around the areas of injury,” Dr. Singer said.
Four days after the stroke, Zosia returned home—and went to a basketball game that night to watch her friends play.
The next day, she went back to school.
Two weeks after her stroke, Zosia visited the pediatric neurology clinic for a follow-up visit, with hopes that her parents would ease some restrictions on her activities.
“We don’t let her ski or go to practice for basketball or play in games,” her mother said.
And she admitted watching Zosia as she slept, to make sure she was still breathing, which made Zosia laugh.
Her parents’ protectiveness was understandable, said nurse practitioner Caroline Rich, PNP-AC.
“You have to remember you are a 14-year-old who had a large stroke,” Rich said. “Because everything went so well, from the outside hospital getting you here and getting you to Dr. Singer, you have had a complete recovery.
“It’s amazing how well you’ve done.”
With Zosia on blood thinners, Rich said she should still avoid some activities. But she cleared her to return to basketball practice and to begin driver’s training.
A heart connection
For Zosia and her parents, two questions loomed large: Why did she have a stroke? Could it happen again?
The search for answers led to a visit with Yasser Al-Khatib, MD, an interventional pediatric cardiologist with the Congenital Heart Center at Helen DeVos Children’s Hospital.
On the morning of her stroke, Zosia complained about pain in her calf. As an athlete, she may just have strained a muscle.
But her doctors, consulting the team of experts who make up the neurovascular board, said the pain may have been a sign of a deep vein thrombosis, a blood clot that forms in a vein deep in the body.
Her doctors suspect the clot may have broken off and gone into her bloodstream. An ultrasound of her leg —taken two days after the stroke—revealed only a small, superficial clot.
A small hole in Zosia’s heart may have enabled a larger clot to reach her brain.
An unborn baby has a natural opening in the upper chambers of the heart, called a patent foramen ovale, which allows blood to bypass the lungs. It typically closes in infancy.
But in about 25% of the population—including Zosia—the opening never closes.
“Millions of people have (this) and it’s open and they have no clue,” Dr. Al-Khatib said. “They live a long and healthy life, can be athletic, have grandkids, a job—everything.”
In Zosia’s case, her doctors suspect that opening may have allowed a blood clot to pass from her veins to her arteries. Her pumping heart may have sent it to her brain artery.
The next step for Zosia involved closing the opening through a minimally invasive procedure.
“You’re not going to feel any different afterward,” Dr. Al-Khatib said. “It doesn’t cause symptoms to close or not to close it, but you will be more protected.”
‘Time is brain’
Zosia’s stroke and remarkable recovery serves as a reminder of the importance of recognizing stroke symptoms and receiving expert treatment promptly, said Daniel Fain, MD, the section chief for pediatric neurology at Helen DeVos Children’s Hospital.
“Stroke is pretty rare for the pediatric population, but you have to be on the lookout for it because it can always happen,” he said. “Just like for adults, time is brain.”
Among children, stroke is most common in newborns. In older children, a stroke caused by a blood clot in the artery occurs in only 5-10 children per 100,000.
He admires Zosia’s ability, at such a young age, to recognize her stroke symptoms.
“That is very insightful,” Dr. Fain said. “She’s a wonderful young lady.”