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After a Stroke,
Mom-to-Be Recovers for Two

On July 21, 2012, Natalia Tsymuk, 31, lay in the Emergency Trauma Center at Abington Memorial Hospital, unable to speak or move her right side, as doctors told her that she’d suffered a stroke. And although she realized her condition was serious, there was a moment when she knew that she’d recover. It came when she saw an ultrasound image of the baby she was carrying and heard the heartbeat, strong and steady. “As long as my baby is okay,” she thought, “I’ll be fine.”

Natalia, Sergy and
Mary Tsymuk

To Natalia and her husband, Sergy, the pregnancy itself was “a miracle,” she says. “We’d been trying to conceive for seven years, and we were so excited to become parents. I was 19 weeks pregnant, and everything was looking fine.”

But earlier that Saturday afternoon, while talking to a neighbor in her backyard, she suddenly felt dizzy, and her right arm started going numb. “By the time my neighbor helped me upstairs, my entire right side was paralyzed, and I could no longer speak,” she says. “My neighbor called my obstetrician, who told her to call 911.”

A Rare Diagnosis

As soon as Natalia arrived at Abington Memorial Hospital, she was grateful that even though she couldn’t speak, the staff knew that she could still understand them. “They explained everything they were doing, and they reassured me that my baby was okay,” she says.

Qaisar A. Shah, MD, director of Neurovascular and Neurocritical Care in the Neurosciences Institute at AMH, was the first to shed light on what had happened to her: A tangle of blood vessels in her brain called an arteriovenous malformation, or AVM, had started to bleed.

According to the American Stroke Association, brain AVMs occur in less than 1 percent of the general population. A cluster of blood vessels bypasses normal brain tissue and diverts blood directly from the arteries to the veins, causing the vessels to weaken. AVMs are congenital, and nobody knows exactly why they occur.

“Depending on where they are, AVMs can cause headaches and seizures,” Dr. Shah notes. “Natalia’s AVM, which was in the left frontal lobe of her brain, had been completely asymptomatic, and she had no previous medical history of brain issues. But her pregnancy could have been a contributing factor in causing the hemorrhage.”

Choosing to Wait

Natalia was now faced with a choice. In most cases AVMs are treated quickly to avoid the chance of a second bleeding episode. But the treatment, which would include radiation and anesthesia, would pose unknown risks to the baby. So she and Sergy decided to wait until the baby was born.

“I was grateful that even though my doctors took the time to explain the risks of waiting, they understood how important it was to me and my husband to keep our baby safe,” Natalia recalls.

Although there’s no clear consensus on the recommended waiting period before treating an AVM in a pregnant woman, Dr. Shah notes that he was involved in a similar case at Abington about a year earlier. “That patient also waited to deliver, and both the mother and baby were fine,” he recalls. “So we were able to support Natalia’s decision to wait.”

Recovery in Time for a Birthday

Natalia spent the next few days in the ICU, until doctors were sure that she’d passed the high-risk period in which a second bleed could most likely occur. She then moved to the rehabilitation unit, where she threw herself into intensive physical, occupational and speech therapy.

“I was working so hard to recover as much as I could before the baby came,” she says. “A friend arranged the ultrasound pictures in my room, and I looked at them when I grew frustrated. And every day, the staff would check my baby’s heartbeat – that was the best part of the day.”

On August 18, nearly a month after her stroke, Natalia went home and continued her recovery with the help of family and friends. Although her original plan was to deliver at Abington, she experienced sudden dizziness and a spike in her blood pressure on November 4. She was taken to the closest hospital, where her daughter, Mary, was delivered via C-section, weighing in at four pounds, 10 ounces.

“The first time I saw her in the NICU, I was happy, crying, and thanking God that she was finally here,” Natalia recalls.

A Successful Surgery

On December 4, Natalia returned to Abington for a procedure to cure her AVM. First, Dr. Shah blocked off the abnormal blood vessels with a glue-like substance delivered through a catheter, in a procedure called an endovascular embolization. Then Steven J. Barrer, MD, chief of Neurosurgery and medical director of the Neurosciences Institute, performed open brain surgery, removing a portion of her skull and excising the AVM.

Natalia spent the next two weeks recovering at Abington and a local rehab facility. “At first, I was very weak and in a lot of pain, but every day, I got a little better. I was focused on getting home in time for Mary’s first Christmas.” She got her wish on December 19, just in time for the holiday.

A few days later, her doorbell rang. “It was Dr. Shah and Dr. Pawar, paying a surprise visit (Swaroop Pawar, MD, is a physician completing a fellowship in neurovascular care at AMH). I was so surprised and touched,” Natalia says. “It was a wonderful Christmas gift, and they enjoyed meeting Mary for the first time.”

Today, Mary is a bright and happy baby who continues to inspire her mother’s recovery. Natalia’s speech has completely returned to normal, she can walk with minor difficulty, and she’s gradually retaining function in her shoulder and upper arm.

“I’m optimistic that I’ll continue to recover and even play the violin again, as I used to do,” she says. “I feel very grateful and very blessed.”

 

For more information about the Neurosciences Institute at Abington Memorial Hospital, visit our website at www.amh.org/brain or call 215-481-MEDI.


Do You Know the Signs of Stroke?

The faster a stroke victim gets treatment, the better the chances of making a full recovery and avoiding long-term disability. Stroke symptoms include:

  • Sudden numbness or weakness of face, arm or leg, especially on one side of the body.
  • Sudden confusion, trouble speaking or understanding.
  • Sudden trouble seeing in one or both eyes.
  • Sudden trouble walking, dizziness, loss of balance or coordination.
  • Sudden severe headache with no known cause.

If you notice any of these symptoms in yourself or someone else, call 911 immediately, even if the symptoms go away.


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