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Thursday, June 21, 2018

The Road to Recovery After Emergency Brain Surgery

Posted By: Advancing Care

A teenage bicyclist forgets her helmet, leading to emergency brain surgery.

By David Levine

Last November, Jordan Duffy, 14, of  Tappan, was riding her bike to school with a friend at around 4 p.m. Her helmet was hanging off her handlebar. The two teens had barely left Jordan’s driveway when a car approached. Her friend was able to narrowly avoid it, but Jordan was unable to stop. She collided with her friend, went over her handlebars and hit her head on the pavement.

A neighbor witnessed the impact and the seizure that followed, and called 911. Other neighbors ran over to help. “It was surreal,” says Jordan’s dad, Matthew. “She was out of it. Moving but not moaning. Rubbing her head but not speaking.”

An ambulance whisked her to a nearby hospital, where a CT scan revealed a fractured skull and bleeding between the skull and the dura, part of the membrane that covers the brain. The bleeding, called a subdural hematoma, can put pressure on the brain if not controlled quickly, so Jordan was transferred to Maria Fareri Children’s Hospital, a member of the Westchester Medical Center Health Network (WMCHealth), for emergency brain surgery. The family knew the hospital well: Matthew’s brother Kevin is a Westchester Medical Center ICU nurse and happened to be on duty that day.

Jordan’s mother, Tracie, rode in the ambulance with her. “She was still out of it. They told us to keep her awake,” Tracie says. Jordan never lost consciousness but remembers only bits and pieces of events from when she got on her bike to arriving at Maria Fareri Children’s Hospital. Once there, the family was met by pediatric neurosurgeon Avinash Mohan, MD, who rushed to the Emergency Department. “He was out of breath, but he took the time to introduce himself to us and to Jordan and explain what he was going to do,” Matthew remembers.

He needed to remove the fractured pieces of Jordan’s skull as quickly as possible. The bleeding had increased, and pressure on her brain was mounting. “With children especially, the earlier you decompress the brain, the better,” he says. “When I saw her, she was sleepy and clearly not herself but looked okay. These things can deteriorate quickly, and the CT scan showed that she wasn’t going to be okay within the next 15 to 20 minutes.”

Dr. Mohan cauterized the leaking blood vessel and cleaned out the blood clot, then restored the dura to its normal shape. He put the pieces back in place with titanium plates and screws. The procedure ended around 11:30 p.m., about seven hours after the accident. “She did very well,” Dr. Mohan recalls. “It could not have gone better.”

A music lover, Jordan is currently learning to play the bass guitar. Photos By Toshi Tasaki

Jordan passed all cognitive tests after she woke up. After six days in the hospital she went home. She spoke with a small stutter for a short time but is fully recovered now. “I feel good,” she says.

Jordan’s not sure she will get back on a bike anytime soon, though. If she does, her parents have been reminding her to wear a helmet, according to Tracie. Case in point: “Instead of an angel, we put her bike helmet on top of our Christmas tree.”  

Bike Safety 101

Every year, 19,000 people are treated in New York State emergency rooms after bicycle-related crashes. Of those, 1,650 require hospitalization following traumatic brain injury, and more than 50 die. Wearing a bicycle helmet greatly reduces the risk of head and brain injuries in a crash, and New York State law requires everyone under age 15 to wear a helmet when riding a bike.

Westchester Medical Center Health Network (WMCHealth) works hard to educate the public about safety issues, like bicycle safety. But only about 48 percent of bicyclists wear helmets, says Angela Katz, WMCHealth’s Trauma Injury Prevention and Outreach Coordinator. “Everyone, regardless of age, can help protect themselves by wearing a properly fitted bike helmet every time they ride,” she says.

A proper helmet should be certified for use. It must fit properly and be well-maintained, age-appropriate and worn consistently. Find a helmet that has adjustable auto-fit straps in the back. “This secures the helmet on the head, for a perfect fit for children,” Katz says. The helmet should also be ventilated, with openings to allow airflow, to keep riders cool.

Katz says that there are other ways to make bike riding safer and prevent injury. Wear bright, fluorescent clothing, so drivers can see the rider. Equip the bike with front white lights and rear red lights, to improve the visibility of the bicyclist. Finally, set a good example. “Remember, wearing a helmet starts with parents wearing their helmets, so be a role model for your children,” she adds. 

Neurosurgery at WMCHealth

Westchester Medical Center 914.493.2363

Maria Fareri Children’s Hospital 914.493.2363

MidHudson Regional Hospital 845.483.5305

Good Samaritan Hospital 866.596.8456

HealthAlliance Hospitals 845.483.5305