One evening, 9-year-old Fabian Vasquez competed in a wrestling match, pinning an opponent to the mat.
Just an hour later, at home, he suffered a headache that hurt so much it made him cry.
He got dizzy. He threw up. As his parents prepared to bring him to an emergency room, he dropped to the floor, paralyzed on the right side of his body.
A tangle of blood vessels in Fabian’s brain had suddenly begun to bleed. The results could have been catastrophic.
But two months later, Fabian walked into the neurosurgeon’s office at Spectrum Health, wearing sweats and sneakers, moving with the quick step of a boy eager to get the appointment over, so he could return home to play.
It was almost like there was an angel sitting on our shoulders.
He showed off the surgery scar on the top of his skull, now partially covered with hair.
“They call me the million-dollar head,” he said with a grin.
“He’s doing really good. He’s pretty much got his whole right side back,” said his mother, Stacy Vasquez. “It was almost like there was an angel sitting on our shoulders.”
Seeing Fabian’s dramatic comeback is just as gratifying for Justin Singer, MD, the vascular neurosurgeon who operated on Fabian.
“For him to be back at school only two months afterward, and to be able to ride his bike and do his activities—things like that are why we go to medical school,” he said.
A bleed in his brain
Fabian, now 10 years old, is the youngest of four children, from from Hart, Michigan. An outdoors kid, he loves helping his dad, Heraldo Vasquez, who manages a large fruit and asparagus farm.
“Fabian is not a sit-down kind of kid,” Heraldo said. “He likes to work. He likes to ride snowmobiles. He likes to do anything active.”
And he loves wrestling. He started the sport at age 4.
Neither he or his parents knew that in his brain lay a tangle of arteries and veins called an arteriovenous malformation—or AVM. An AVM can exist for years without issue. But sometimes the area where the arteries and veins come together becomes weakened and it begins to bleed.
That’s what happened with Fabian. There was no sign of a problem until after his wrestling match on Jan. 13, 2018.
But the Aero Med helicopter could not make the trip on that snowy, winter day, so Fabian went by ambulance.
Artur Szymczak, MD, a pediatric neurosurgeon, determined he was stable when he arrived, but could not move the right side of his body. He ordered a CT scan, which identified a large hemorrhage on the left side of the brain, in an area that affects sensation and movement.
An angiogram showed there might be an AVM, but there was so much pressure and blood that the results were not definitive, said Dr. Singer, director of vascular neurosurgery for Spectrum Health Medical Group.
Fabian’s parents struggled to see their son sedated, on a ventilator. Their little wrestler could not move his right arm or leg.
“We didn’t know if he was ever going to breathe on his own,” Stacy said. “He was such an active child. To see him like that was hard.”
Five days later, they performed another angiogram and identified the AVM. The next day, Dr. Singer performed surgery.
Almost immediately after surgery, he actually was able to move better.
Before surgery, Fabian was alert and able to talk to his parents. He told them he was terrified of dying. He begged his mom and dad to accompany him to the operating room.
His mom, a nurse, tried to explain why they could not go with him. “We said, ‘It’s a clean place. Only the doctors can go in there.’ He said, ‘Then take a shower.’”
As Fabian went into the operating room, his family prayed.
In surgery, Dr. Singer removed the AVM, as well as the blood that had pooled in his brain.
“Almost immediately after surgery, he actually was able to move better,” he said. “And part of that was related to the fact that the motor fibers weren’t under so much pressure from the hemorrhage that was there.”
A 10th birthday party
Fabian quickly improved. Two days after surgery, he transferred to Mary Free Bed Rehabilitation Hospital for rehab.
And he met his goal to return home by his 10th birthday—Feb. 21. His dad threw a surprise party for him at the VFW Hall in Hart. More than 300 family and friends joined the celebration.
“We are happy to have him home,” Heraldo said.
On March 13―two months to the day of his brain bleed—Fabian arrived for his follow-up visit with Dr. Singer and physician assistant Olivia Rivera, PA-C.
He had already graduated from a wheelchair, walker and brace. He was back in school. He could ride his BMX bike again.
“It’s amazing,” his mom said. “I will feel forever grateful to Dr. Singer.”
He climbed on the exam table and lay face-down, propping his head on his arms, so Rivera could remove stitches from the incision.
“This better not hurt,” he said.
Fabian and his mother talked about a few signs of his illness that remain. Sometimes, he has trouble finding the word he wants to say. And his right foot drops a bit.
“I’m not as strong as I was,” Fabian said. “My right leg is not as strong.”
But he has already come a long way in a short period of time. The brain can continue to heal for a year after an injury from a hemorrhage, Dr. Singer said.
“He still has much time to heal and improve,” he said. “Kids are much more resilient than we are as adults.”
The location of Fabian’s AVM helped in his recovery. If it had occurred a little farther forward in the brain, it might have permanently injured parts of the body that control movement.
“He was potentially in a place where he could have been neurologically devastated the rest of his life and be paralyzed on that right side,” Dr. Singer said.
Fast action also helped. He praised Fabian’s parents for quickly seeking medical care when his symptoms occurred. He hopes it will set an example for others to follow.
“If something really unusual occurs for a loved one, or for you, people should get help quickly,” he said. “That’s when we can do something about it.”