Tying it all together: Hope’s journey
Eight years ago, however, cameras captured a very different story. Hope, then 7, lay in a hospital bed surrounded by teddy bears, half of her smiling face paralyzed by a stroke.
“We were at my brother’s basketball game,” Hope said, adding that she and her other brothers were playing with a spare ball. “I got really hot, so I went to my mom, and she said to go fill up my water bottle. I went and did it, and then when I came back, I fell.”
Hope’s mother, Michelle, said her daughter was lifeless in her arms. Gripped with panic, she called an ambulance, which took Hope to Arkansas Methodist Medical Center in Paragould. Michelle sat outside the room where staff members performed a CAT scan on Hope.
“I just started to pray,” Michelle said. “I’d just lost my mom in November, and there was no way I was going to lose Hope.”
The next thing she knew, Michelle said, she and Hope were aboard the Angel One helicopter flying to Arkansas Children’s in Little Rock. Staff in the pediatric intensivecare unit performed more tests, then told Michelle that Hope had had a stroke.
Still shaken, Michelle spent the next month at the hospital, learning more about strokes while Hope gradually recovered.
A RARE OCCURRENCE
Although strokes are not uncommon in adults, they are extremely rare in children, and only about 3 in 100,000 children have strokes, said Dr. Kapil Arya, a neurologist at Arkansas Children’s who researched Hope’s case, although he was not at the hospital when she was being treated.
A stroke, he said, is a neurological deficit caused by brain damage as a result of decreased blood supply in the brain. Hematologic strokes are caused by bleeding in the brain, he added, while ischemic strokes are caused by a disruption in blood flow to the brain.
“Any and all parts of the body can be affected,” he said. “All of our body, all of our muscles, are supplied by nerves coming out of the brain or spinal cord, which is, again, supplied by impulses from the brain.”
The area of the brain damaged by the stroke determines which parts of the body are affected. In Hope’s case, the stroke occurred on the right side of her brain, leaving her left arm, left leg and the left side of her face paralyzed. Strokes in other areas of the brain might affect language comprehension, memory or behavior, Arya said.
Adult risk factors for stroke are connected to heart disease or atherosclerosis — hardening of the blood vessels, he added, and conditions such as uncontrolled high cholesterol, high blood pressure and diabetes increase the likelihood of having a stroke.
“If we can prevent those, then a lot of incidents of stroke could be decreased,” he said.
Adults can reduce their risk of stroke by avoiding smoking, participating in aerobic exercise for at least an hour a day and eating a healthy diet, he said, adding that people who have the aforementioned conditions should receive appropriate treatment.
Although strokes are most commonly associated with older adults, they can happen at any age. In fact, newborn infants and seniors have similar rates of stroke, he added.
“We have two peaks of stroke along our lives,” he said. “High chances of stroke are as soon as you’re born and, too, when you’re closer to the end of life, so very old individuals and very young individuals are at the highest risk of stroke.”
Babies often have strokes as a result of traumatic births, tissue or amniotic-fluid clots, or simply because they have thicker blood than adults and older children, he said, adding that babies almost always make a full recovery because their brains are very malleable, even compared to older children. That plasticity allows undamaged parts of young brains to take over functions of areas that were damaged, leading to better recoveries.
In older children such as Hope, the causes of strokes are quite different. Most childhood strokes are caused by genetic problems that affect the fibrinolytic system, which breaks down clots, or the connective tissues of the blood vessels, causing the vessels to rupture or defect, Arya said.
Hope’s stroke was caused by the latter — a break in the wall of an artery transporting blood from the heart to the brain cut off her brain’s blood supply — but doctors were unable to find a genetic cause, he added. Had there been a genetic cause, it is likely that Hope’s twin brother, Chance, would have also experienced a stroke.
“It might just have been an unlucky defection of the artery,” Arya said. “It may not be something that was genetic because, yes, we would expect her twin brother to have similar genes, if not the same genes, so at least genetic studies done at the time were quite unrevealing.”
He added that any change from baseline brain function can be a sign of stroke, such as suddenly seeing double, weakness on one side of the body or part of the face drooping. If a stroke is suspected, bystanders should call emergency services to take the victim to an appropriate medical facility.
If adults reach the hospital quickly enough, Arya said, physicians can use a medication called tissue plasminogen activator to break down clots, but they can only use the drug safely 4 1/2 hours after the stroke’s
“SHE COULD SAY, ‘MOM,’ AND THEN EVENTUALLY GOT, ‘MOM, I WANT TO GO HOME.’ I TOLD HER, ‘HOPE, IT’S GOING TO TAKE YOU TO GET US HOME. … YOU HAVE TO PUT IT IN YOUR MIND THAT YOU’RE GOING TO GET US HOME. YOU HAVE TO DO WHAT THE DOCTORS SAY, FOLLOW THE RULES AND GET US THERE.’” MICHELLE ESPINOZA HOPE ESPINOZA’S MOTHER
onset. After that, neurologists must use more dangerous methods to remove the clot.
The medicine is not approved for children, although it is sometimes used for older teens, he added. Instead, medical professionals administer heparin to children for the first day or two after the stroke while doctors work to determine its cause and inspect the brain for any continued damage.
Various forms of therapy can help patients recover after a stroke, he added, but no medications have been approved to help the brain recover.
“It’s our body’s own ability to repair itself that helps,” Arya said, “but what helps the body do that at a faster pace and better is preventing further damage.”
Using aspirin as a blood thinner can help prevent clots, he added, and all the factors that decrease the risk of having a stroke — not smoking, exercising and controlling other medical problems — can also help the body heal. The extent of recovery is difficult to predict following a stroke, he said.
“I am very happy to learn that Hope has recovered quite well,” he added, “and that is often the case with children.”
ROAD TO WELLNESS
After her stroke, Hope had to relearn almost every ability. She was unable to walk, take baths or eat the food that she ate before her stroke. To this day, she uses braces to stabilize her left arm and leg. Even seemingly trivial matters, such as brushing and washing her long hair, were a source of frustration, Michelle said. Hope’s speech was also affected.
“She could say, ‘Mom,’ and then eventually got, ‘Mom, I want to go home,’” Michelle said. “I told her, ‘Hope, it’s going to take you to get us home. … You have to put it in your mind that you’re going to get us home. You have to