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After the Fall

Patient VideoLisa Weil plunged down a flight of steps, and into a frightening odyssey to uncover the source of her problem

It was August 2009, and Lisa Weil had spent a lovely day visiting at her sister’s home in Vermont. A former actress and weight loss program consultant, Lisa was enjoying her stay in the cozy, quaint apartment atop the summer home’s barn. That night, however, her sister found her lying at the bottom of the stairs, weakly calling for her husband.

Lisa Weil

The 57-year-old Lansdale woman’s eyes had turned black and blue. Her wrists were splintered. Worst of all, she had landed on her head.

When the local ambulance crew arrived, Lisa’s sister asked if she should call family members. Yes, they said, and "you better say goodbye to your sister."

The life support staff feared she’d suffered the same type of brain bleed as the late actress Natasha Richardson. No one knew how long she’d been lying there.

She was flown by helicopter to Dartmouth Hitchcock Medical Center, where the staff could only put makeshift casts on her broken wrists. With a brain bleed, patients cannot be placed under anesthesia, so properly resetting her twisted bones was not possible.

"I didn’t realize I had a head injury," Lisa says. "I thought my worst problem was my wrists and I wanted to return to work." Her sister watched helplessly as she thrashed to get out of bed.

After the initial stabilization and "watchful waiting" period was over, Lisa was discharged and returned home to a regional rehabilitation center for brain-injured patients.

She felt out of place, being asked to perform cognitive tasks that seemed the same for stroke and other types of brain-injured patients. "I kept being told that my brain had to heal, but putting a square peg in a square didn’t seem to be helping. My eyes were still black and swollen, as were the rest of my facial features. I began to hear a whooshing sound in my head that was as loud as a street cleaner."

Lisa followed the rehab team’s advice and saw a neurologist and ophthalmologist over several months, from August to December. She was repeatedly told her brain still needed time. Yet her eyes seemed even more swollen. She started wearing sunglasses, even indoors, as her eyes grew sensitive to any kind of light.

"At the same time, people found me very engaging,’’ Lisa recalls, "and all the symptoms I was having were typical of a brain injury. One day I took my dog for a walk, and the cars on the street appeared to be on top of one another." Double vision had developed.

Friends started telling her that her eyes were wandering, or that one eye was staring straight ahead while the other moved to the left or right. She became very scared. When tests for myasthenia gravis (a disease that causes muscle weakness in the eyes and eyelids, among other symptoms) were negative, she was sent to Abington Memorial Hospital’s Emergency Trauma Center.

Something was very wrong, but nothing showed in standard scans or blood work. The Emergency team even tested Lisa for stroke. The results proved negative. They admitted her to Abington, and called Qaisar Shah, M.D.

Dr. Shah, director, Neurointerventional and Neurocritical Care Services at Abington, is a neurointerventionalist, using innovative methods to diagnose and treat complex neurological conditions.

Lisa remembers, "It was early December by then. Dr. Shah came into my room, took one look at me, and said, ‘Your eyes are bulging. And I think I know why.’

"It was if a light had been turned on," she continues. "Not only did he explain that I likely had a brain ‘fistula,’ he drew a picture of it. Here was this extraordinary doctor who just knew."

Arteriovenous fistulas are quite rare. These abnormal openings between an artery and a vein cause blood to flow directly from an artery into a vein, bypassing the capillaries.

Dr. Shah says, "Lisa had difficulty moving her eyes, and they were red and swollen. Her right side was worse than her left. With a stethoscope, I could hear a loud ‘bruit’ in her neck and the back of her ear." A bruit is a sound within the blood flow of arteries leading to the brain, indicating that something is interfering with normal blood flow. In Lisa’s case, the bruit caused the "whooshing" she heard in her head.

The neurointerventionalist performed the first of several cerebral angiograms, and discovered that Lisa had a fistula behind each eye. "Eighty percent of people who do not have treatment lose their vision," Dr. Shah explains.

"Lisa had survived the initial head injury, but had later developed this serious consequence. Fistulas can happen spontaneously but mostly occur after a head trauma."

During each of the cerebral angiograms, Dr. Shah made a small incision in the groin, and threaded a thin, flexible catheter through a vein, moving all the way up through the veins in the face leading into the eyes. The specialist first maneuvered tiny platinum coils into the fistula behind her left eye to seal it. A month later, he repeated the process in the right eye. Altogether, Dr. Shah placed 40 expandable coils to contain the fistulas.

Today, Lisa’s facial features are no longer distorted. Her sight has returned to normal in the left eye, and her right eye is coming along as the coils do their work.

"I am amazed by Dr. Shah," Lisa exclaims. "His passion, intelligence, confidence are such a rare combination. From the very first time I met him, I was astounded by his excitement at knowing how to help me."

She will be forever grateful to the man whose vision restored her own. "He has given me back my quality of life," she adds. "I will have a lifelong attachment to him."


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