Medical Expertise and Timing Count
Olivia Grace Call is a happy, energetic six-year-old who loves animals, especially horses. She is also a Girl Scout, takes swimming lessons, and plays sports.
In many ways, she’s just like hundreds of other first-graders in Roanoke.
When she was 5 1/2 months old, Olivia began bleeding in her brain and suffered a stroke.
She underwent emergency surgery and was found to have a large arteriovenous malformation (AVM) in her brain—a tangle of blood vessels that don’t perform properly. They are a sort of “short circuit” in the system.
AVMs are very rare, occurring in less than 1 percent of the population, and may appear in different areas in the body. They are usually present from birth, but until symptoms develop, they go unnoticed.
In the hours before her stroke, Olivia had been fussy, according to her mother, Kristy Call of Roanoke. She’d also vomited while being fed. Then she seemed tired and fell asleep several hours earlier than usual, and her sleep was fitful. Her father, Brian, slept with her in a recliner for several hours during the night.
Early in the morning, Olivia seemed to be resting peacefully, but Brian noticed that her arms and legs were stiff. He tried to wake her, but she was unresponsive.
“I tried to rouse her, too, but she wouldn’t wake up,” says Kristy. “Her left pupil was dilated. We knew that something was terribly wrong, so we dialed 9-1-1.”
When the Call family arrived in the Emergency Room, they were shocked to learn that their infant daughter was bleeding on the left side of her brain. Later, they learned she had suffered a stroke.
“I was on call when Olivia was brought to the ER,” says Lisa Apfel, M.D., the Carilion Clinic pediatric neurosurgeon who performed her surgery. “Her condition was very serious. Just minutes longer, and it is possible that she would not have survived.”
During the surgery at Carilion Roanoke Community Hospital to relieve the pressure on Olivia’s brain and remove excess blood, Dr. Apfel identified the cause of Olivia’s bleeding as an AVM.
“Unfortunately, there are often no clear prior warning signs for AVMs,” she says. “When the symptoms develop, they may be serious, and the condition becomes an emergency.”
When a child has bleeding in the brain not related to an injury, neurosurgeons have a high suspicion for some type of vascular malformation. “In Olivia’s case, we were able to remove the AVM and repair the blood vessels,” Dr. Apfel says.
As a result of the bleeding, though, Olivia did suffer some brain damage.
Over the next five years, Olivia underwent three more surgeries at Carilion Clinic Children’s Hospital to fully repair her skull. And with speech, physical, and occupational therapy, she has made tremendous strides.
“Carilion linked us up with Easter Seals and their early intervention program and also Brain Injury Services of Southwest Virginia—both of which proved to be invaluable resources,” says Kristy.
Olivia is also benefiting from an aquatics program at Aquatic Adventures and therapeutic horse riding through Healing Strides of VA. In addition, she is active in Awana, a church group in which she sings, does arts and crafts, and goes to the gym.
Advances in the Field
“Every day, pediatric neurosurgery is evolving and changing,” says Dr. Apfel. “We are seeing advances now that make a real difference for children and families.
“Treating neurosurgical emergencies successfully is also about timing. Olivia’s situation was dire, but our entire medical team, working together, made the difference.”
Olivia is proof that a life-threatening condition like hers can be overcome. “Her right side is still weaker than her left,” says Kristy. “But as more time passes, she gets stronger, and her limitations seem to be less noticeable.”
“Dr. Apfel and the team at Carilion Clinic saved our daughter,” Kristy says. “How can you measure the value of a miracle? We find the answer every day in Olivia’s smile. It’s priceless.”
Dr. Lisa Apfel joined Carilion Clinic in September 2006, just one month before Olivia’s stroke. One of six Carilion neurosurgeons, Dr. Apfel specializes in pediatrics and trauma. For more information on pediatric neurosurgery in the region, call 540-266-6000 or 800-422-8482.
Erica Stacy is a writer whose articles have appeared in regional and national health publications. She also works with nonprofit groups in Virginia and the Carolinas to promote health and education. She lives in Pulaski.