My toughest case

I am a consultant neurologist and stroke physician. My toughest case comes from the difficulties of using what is relatively untested, potentially dangerous intervention for the first time. The case involved a gentleman in his early 40s with a wife and two daughters. He had been playing football and had twisted his neck slightly during a tackle. The following day he suffered paralysis in his left arm and leg.

At this point he was taken into hospital where they thought he'd had a transient ischemic attack - a mini stroke. They showed he had split the lining of his carotid artery during the fall - called arterial dissection, which is an uncommon but recognised cause of stroke in young people. After a few days in hospital he woke one morning with a dense paralysis of his left side - his leg, arm, face - and loss of vision to his left eye. Within about six hours he became increasingly drowsy, almost to the point of unconsciousness. He was re-scanned and it showed that massive swelling had developed around the stroke.

This swelling was basically squeezing everything else inside his skull. I was asked if there was anything we could do to save this man's life. At that time we were just beginning to get reports of an operation called a hemicraniectomy, which essentially involved removing half the skull, allowing the swelling to come outside of the confines of the skull to reduce pressure on other parts of the brain. Due to the infrequency of this diagnosis it had been difficult to do extensive research into the procedure. He had the operation at around 11pm and by midday the next day he was on intensive care, minus half a skull, but alert, awake and able to interact with his family.

Perhaps the main reason I remember this case is the amazing recovery he made following that point. He recovered to a point where he was able to return back to work, back to driving and back to see his daughters grow up.

Dr John Bamford is a Trustee on the board of The Stroke Association and Chairman of their Research Awards Committee.