Twelve-year-old Rachel Risko had always been a healthy child, so when she complained about a persistent headache over the weekend, her mom thought she must be worn out from school.
“Advil seemed to help the headaches and mild fever so Rachel went to school the next day,” says Stacey Risko, Rachel’s mom.
The headaches lingered, but Rachel did not want to miss the inauguration of her uncle, Stuart Spitzer, because it was his first term of office as a state representative in Austin and one of four physicians in the House. She even toured the Capitol. But the next morning Rachel woke up and her words came out jumbled.
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Stacey’s sister-in-law, a family physician, stopped by the house and quickly realized Rachel needed to head to the doctor. After arriving at the Emergency Department in their hometown of Athens, a CT scan revealed a more serious matter. Rachel needed care from a specialized children’s hospital.
“Two of my nephews were treated by Children’s Health, and I knew that is where we needed to be,” Stacey says. “I am so grateful they sent us there.”
From that point on, the rollercoaster ride began for the Risko family. Rachel had developed weakness on her right side, and she began to have altered mental status.
Scans at Children’s Medical Center Dallas confirmed meningitis and a subdural brain abscess caused by an acute bacterial sinus infection.
“Acute sinusitis is usually caused by an underlying virus and less than 5% are caused by bacteria,” says Gopi Shah M.D., a pediatric otolaryngologist at Children’s Medical Center. “In the majority of children, the primary care or ENT physician will treat acute sinusitis with oral antibiotics. As the sinuses are between the eyes and close to the brain, in very rare cases, these infections can spread into the orbit and brain. We call this complicated acute sinusitis. The incidence of brain complications in children hospitalized with acute sinusitis is approximately 3%.”
Rachel was wheeled to the operating room where Dr. Shah performed endoscopic sinus surgery using special lighted scopes through the nose to open and drain the infected sinuses. Several days after the surgery, repeat scans revealed that Rachel’s infection in the subdural space in her brain had gotten bigger. Her condition had taken a turn for the worse and was considered a life-threatening emergency.
Bradley Weprin M.D., a pediatric neurosurgeon at Children’s Medical Center, talked with Rachel’s parents about a possible craniotomy and the risks involved with it.
“We could see that Dr. Weprin was really torn about whether to do the surgery,” Stacey says. “The chaplain came in and prayed with us. I got all of my tears out and then had peace about it; that whatever Dr. Weprin decided would be right for our daughter.”
When Dr. Weprin came back to Rachel’s room to let them know that he thought surgery was the best option, her parents had a special request. Rachel’s dad wears a St. Christopher charm that her grandfather wore while proudly serving in the Air Force in Vietnam before attending medical school. They asked if Dr. Weprin would wear it during Rachel’s surgery.
“I have received various requests before going into surgery, but nothing like this,” Dr. Weprin says. “It hit me hard.”
With the charm around his neck, Dr. Weprin removed part of the bone from Rachel’s skull, irrigated and cleaned out the infection, and reattached the bone.
After surgery, Rachel did remarkably well. She started waking up and moving, and with every day came significant improvements. Within the week, Rachel moved out of the Pediatric Intensive Care Unit to the regular floor. Child life specialists and Blair, the therapy dog, kept her distracted during her stay. Music therapy lifted her spirits as music is a big part of her life – she loves to play piano and had just started playing the saxophone in the band.
“Rachel has such a servant’s heart, and we believe there is a reason and purpose that this happened, even in the chaos of it,” Stacey says. “I feel like she is going to come out of this. I can see her using this experience to become a nurse or child life specialist to give back.”
After being discharged from Children’s Medical Center, Rachel spent five weeks at a rehabilitation facility where Dr. Weprin delivered the reassuring news that the swelling in her brain was improving and that he expected a full recovery.
“That is the point at which I let go of all my fears,” Stacey says. “It meant the world to us that he came in person to give us the MRI results.”
After a couple of months at home, Rachel continues to improve and attends school on a part-time basis for now.
“I know that not everybody makes it out,” Stacey says. “We are blessed with the care she received and how far she has come.”