AVM Stroke: Hemicraniotomy

Young stroke victim reclaims her life
Originally Published: May 16, 2008
New Orleans Times Picayune

On a September morning last year, Sarah Abrusley awoke to face a normal day, heading to work at a French Quarter hotel and attending dance rehearsals that evening. But a piercing headache over her right eye would signal big changes ahead for the 29-year-old ballet dancer.

“As I stood to get ready for the day, I started losing my balance,” Abrusley said. “My whole left side wasn’t working.”

She awkwardly continued her usual dressing routine while assuring her husband, Damien, that everything was all right. She pulled herself up, thinking herself dressed, and announced, “OK, I’m ready!”

Her husband saw the left sleeve of her jacket hanging empty, her arm dangling. Abrusley had not yet realized that her left arm was paralyzed.

Damien swept her up into his arms, headed to the car and drove her to the emergency room.

During a CAT scan of her brain, Abrusley overheard one of the technicians say, “Ooh, big bleed on the right.”

From there, Abrusley was sent by ambulance to the stroke center at West Jefferson Medical Center.

An athletic, nonsmoking vegetarian under the age of 30 isn’t the typical candidate for a stroke. But before the day was over, Abrusley would be counted among Louisiana stroke victims.

When Abrusley arrived at West Jefferson, she required immediate surgery to save her life. A hemicraniectomy was performed.

“It’s the same procedure (brain-injured ABC News war correspondent) Bob Woodruff had,” Abrusley said. “They saw out a piece of the skull to let the brain swell as much as it needs to because the damage happens when the brain presses against the skull.”

Despite her stroke, Abrusley says she will one day dance again.

When it was time for Abrusley’s first physical therapy session the following day, a nurse rolled in a wheelchair to take her there. That’s when the dancer realized she couldn’t walk.

“My doctor reminded me later, ‘You never asked me if you would walk again; you asked me if you would dance again,’¤” Abrusley said.

It would be five weeks later, when Abrusley returned home, that she would cry for the first time.

“The tears were about losing who I was before,” Abrusley said. Months of physical and occupational therapy were ahead.

“First, I had to learn to walk again. I walked like a doll, kicking out my left leg like the dolls in the ‘Nutcracker’ (ballet).”

Abrusley never walked with a cane or a walker once she left her wheelchair. This was a way for her to focus on putting weight on her damaged left side.

She also had to learn all over again how to hold her head straight; it tended to tilt to the left. Now she goes to occupational therapy at Touro Infirmary once a week to work on her left arm and hand.

Abrusley performs 100 modified push-ups daily to gain control and strength in her left arm and hand, and she wears a brace on her left hand at night to straighten the fingers that still want to curl as a result of her stroke.

“Her motivation is the reason she has come so far,” said Frannie Bienvenu, a Touro occupational therapist, who utilizes Abrusley’s pre-stroke life as a dancer and a yoga student in her therapy. “She has a nice awareness of her body due to her dancing.”

Bienvenu works with Abrusley to create new neural pathways so that the brain and the left side of Abrusley’s body can begin to communicate. Lying on her back, Abrusley is encouraged to move her arms in ballet positions from first to fifth. As the therapy session continues, Abrusley executes a challenging yoga pose, the cobra, to strengthen both arms in a weight-bearing move, concentrating on keeping her left hand open and flat.

“A person’s recovery (from a stroke) is a lot like building a house: It’s tremendous when the frame is going up, then the millwork and the fine work is difficult to see, but definitely happens,” said Dr. Frank Culicchia, Abrusley’s surgeon and chairman of neurosurgery at the Louisiana State University Health Sciences Center. “It is the patient who notices it most.”

The majority of recovery occurs in the first six months and continues for a year, he said. Abrusley entered the hospital comatose and was back in ballet class four months after her stroke.

“I wasn’t dancing the way I used to, but rather as a new version of myself,” said Abrusley, who is still not dancing en pointe due to limitations in her left foot and ankle as she continues to recover.

That recognition — seeing the new version of herself — is key in her recovery, she said.

Before her stroke, Abrusley was working in hotel guest relations from 7 a.m. to 4 p.m., and she was active in four local dance companies — Loyola Ballet, Komenka Dance Ensemble, Lula Elzy Dance Company and the New Orleans Dance Academy — in the evenings and on weekends.

“I had a primary passion supported by a day job, as do so many young dancers who live here,” Abrusley said. “Now, when I try to reconstruct the person I was, the more I focus on the new me, and the better off I am.”

Abrusley applied some of the lessons of recovery from Hurricane Katrina to her medical recovery.

“When I speak of my stroke, I tell people my own levee broke,” she said, referring to the bleeding in her brain.

Although Abrusley and her husband lived Uptown during Katrina, her parents lost their home in Gentilly, the home in which Abrusley grew up. Gone are the ballet costumes and dance videos of her childhood, but Abrusley was stung with the loss of her city more than anything.

After suffering from a stroke last September, Sarah Abrusley appeared in her first performance, “Moscow Nights,” in January.

“Prior to Katrina, I was looking for a purpose to my life. After Katrina, I felt that helping rebuild the culture in this city was a way I could contribute to rebuilding the city,” she said. “There are so many great local performers, and I want to promote this cultural resource.”

Abrusley took her first post-stroke steps back onstage wearing white go-go boots on the arm of her husband for the Moscow Nights Russian Winter Carnival this past January. Later this month, she will have a walk-on role in La Boutique Fantasque at Loyola University with the New Orleans Dance Academy.

Before her stroke, ballet took precedence over the newlywed’s thoughts of motherhood. All her free hours went to the studio. But as Abrusley continues to strengthen her left arm, she sees a new purpose in being able to use both arms again.

“I want to be able to hold a baby. I’m hoping that next Mother’s Day will be a very special day for me,” said Abrusley, who hopes to get the official OK from her doctors to start working on that goal in September, one year after her stroke.

Staff writer Chris Bynum can be reached at cbynum@timespicayune.com or (504) 826-3458.

Are you having a stroke?

Five symptoms that demand immediate treatment:

WALK: Is your balance off?

TALK: Is your speech slurred or face droopy?

REACH: Is one side weaker than the other?

SEE: Is your vision all or partly lost?

FEEL: Is your headache severe?

All stroke symptoms are sudden. Do not ignore symptoms—even if they go away. It could be a TIA (transient ischemic attack) or mini stroke. Call 911 and get to the hospital emergency room fast. For more information, call 1-888-4STROKE or visit the website www.giveme5forstroke.org.

Source: American Academy of Neurology, American College of Emergency Physicians and American Stroke Association.