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Assistant Principal Starts School Year After Recovery From Rare Brain Injury at Texas Health Presbyterian Hospital Dallas
08/22/2011

DALLAS — The start of the 2011 school year this week is probably a bit more special for 36-year-old Patrick McLarty than most other teachers and school administrators. Earlier this year, McLarty, assistant principal at Ponder Junior High, finished the final round of physical rehabilitation after a brush with death two years ago.

It’s the first time he’ll start the school year with a clean bill of health — and no doctor appointments — since suffering a rare type of stroke that choked his brain of oxygen and forced surgeons to remove part of his skull to relieve pressure and spare his neurological system from major damage.

“I’m excited, as always, at the start of a new school year,” he said. “I love being around kids and educators, but this year is special because I feel like I’m moving on and getting back to life. No more doctor’s appointments or rehab sessions. I can put my focus on my work, school and family.”

His medical odyssey began April 21, 2009.

McLarty went to a local emergency room after a kernel of corn got stuck in his esophagus. It wasn’t all too unusual for McLarty, whose esophagus is smaller than normal. He grew up with the condition, which sometimes caused minor discomfort but nothing life-threatening. Usually, the food would pass into his stomach after a few minutes. Two times previously, though, he had to go to the emergency room for a procedure to dislodge the food.

After a few hours that April day in 2009, the kernel was still stuck in his esophagus. “Later that evening, I started to get a little more concerned,” he said. “I decided it was time to go to the ER.”

To clear the object, doctors performed a procedure that involved using a scope and air to dislodge the food. But McLarty’s esophagus tore during the procedure, allowing air to pass into his mediastinum, the central compartment of the chest that contains the heart, major cardiac blood vessels, lymph nodes, cardiac nerves, esophagus, trachea and other vital tissue.

A tiny air bubble leaked into an artery. The arterial gas embolism eventually made its way to his brain, causing a type of stroke so rare that fewer than 20 cases have ever been recorded in medical literature. Strokes, which happen when brain tissue is starved of oxygen, are normally caused by blood clots. And in the few cases when air embolisms form in the blood stream, the bubbles are usually “caught” and filtered in the lungs.

McLarty wasn’t so lucky. With a major portion of his brain suddenly cut off from oxygen, he slipped into a coma.

He was quickly flown to Texas Health Presbyterian Hospital Dallas.

“I woke up and didn’t know where I was, and all these doctors were hovering over me,” McLarty recalls. “I didn’t know what had happened.”

A team of physicians on the medical staff at Texas Health Dallas, including neurologists, neurosurgeons, pulmonologists and critical care specialists, devised a plan. First, they would try to shrink the air bubble using leading-edge hyperbaric medicine technology at the hospital’s Institute for Exercise and Environmental Medicine.

The air inside hyperbaric chamber is compressed to simulated depths of up to six atmospheres. When breathing 100 percent oxygen while at increased atmospheric pressure, patients receive up to 10 times more oxygen than normal. That makes the blood more “oxygen-rich,” which can aid in healing injured tissue. Additionally, the gasses in blood and organs undergo all the same physiological changes that people experience when deep-sea diving, often shrinking air bubbles like the one in McLarty’s brain.

With daily trips to the hyperbaric chamber, the embolism in McLarty’s brain shrank but did not go away completely. It still posed a serious threat: his brain tissue was beginning to swell.

So Dr. Jeremy Denning, a neurosurgeon on the medical staff at Texas Health Dallas, decided a craniotomy was needed to let his brain swell safely. The procedure involved removing part of the skull to allow the brain to expand without increasing pressure inside the head and damaging the brain and spinal cord. Denning eventually cut out half of McLarty’s skull so his brain could safely swell.

“Hearing that I needed the surgery was tough for my family,” McLarty recalled. “But Dr. Denning put my wife at ease. He was so confident that it was the right thing to do that everyone accepted it and knew I’d be OK.”

The surgery went well. His brain was allowed to swell, then began to shrink back to its normal size. In a matter of days, the embolism had disappeared. A follow-up surgery safely closed his skull.

“Patrick’s condition was serious enough that surgical intervention was needed,” Denning said. “We knew the brain would continue to swell, and the craniotomy was a way to give it room to expand without additional neurologic damage.”

But McLarty’s journey was not over. He would spend weeks in the hospital’s intensive care unit. He soon began to respond to doctors, nurses and family, including wife Emily, who waited vigil at his bedside. While still in bed, the Ponder football team came to the hospital to visit their coach. A woman who had suffered a major brain injury and been cared for at Texas Health Dallas came to visit Emily and give hope.

“It’s very powerful as a clinician to see the network of people who stop their lives to be at their loved-one’s side in a moment of crisis like this,” said Dr. Gary Weinstein, chief of pulmonology and critical care medicine at Texas Health Dallas and a physician on the hospital’s medical staff. “I think all the doctors and nurses involved in Patrick’s care did a great job, and we’re proud of the recovery he was able to make. But I think the support of his friends and family, especially his wife Emily, also played a major role in his recovery.”

While making strides after the surgery, he still couldn’t talk or walk and his left side was almost completely paralyzed. But he was awake and every hour clinicians would run tests to ensure he was out of danger.

Then one morning he seemed more awake than usual, Emily recalled. He signed to her that he loved her.

“At that point, I knew everything was going to be OK,” she said.

Despite the success of the surgery, doctors warned Emily that it might be months, maybe years before he fully recovered. He might not be able to feed himself for six months. Going back to teaching and coaching football? Focus on the small things, they told her. Those were goals for another day.

But like the arterial gas embolism that traveled to his brain, there would be another unusual chapter in McLarty’s story, something no one anticipated.

With the kind of determination and fight he instilled in his players, McLarty put everything he had into recovery and rehabilitation … hours every day, learning to talk again, learning to walk again, learning to feed himself again.

Each day that went by brought a new milestone.

“He recovered quicker than I think anyone could have predicted,” Denning said. “In many ways, we were simply happy that he had survived and had hopes for a normal life again. We never imagined his rehabilitation would progress so quickly. I think that’s a credit to his determination and willpower.”

Less than five weeks after surgery, McLarty was discharged from the hospital. He went to inpatient rehabilitation, where he underwent three more weeks of intensive work. Every day, he made major strides in his recovery.

Then, four months after the arterial air embolism traveled to his brain, he returned to coaching the Ponder High School football team full-time — just in time for the first game of the year.

“It was very emotional for me,” he recalls. “To be back doing what I love and know that everything was going to be OK was a big moment for me.”

It was a fitting return for McLarty, who in 2006 had started Ponder High School’s football program, helped build its state-of-the-art field house and was the team’s first head coach. The next semester, he was offered and accepted a job as assistant principal at Ponder’s junior high, a position he still holds today.

Despite the apparent success of treatments and his dedication to rehabilitation, there would still be more than a year and a half of grueling work to get his balance, movement and body back to normal.

But this week, as school starts, McLarty plans to be going full steam ahead. Aside from a slight loss of dexterity in his left hand, the father and husband says he’s back normal.

Back to normal except for something he gained during his medical journey.

“I learned a big lesson that you never know what life is going to bring you. One day everything seems fine, everything is going normal and something like this happens. It’s taught me not to take things for granted.”

About Texas Health Presbyterian Hospital Dallas
Texas Health Presbyterian Hospital Dallas is an 898-bed acute care hospital and recognized clinical program leader, having provided compassionate care to the residents of Dallas and surrounding communities since 1966. U.S. News and World Report has ranked Texas Health Dallas among the nation’s best hospitals in digestive disorders, orthopedics, and neurology and neurosurgery. An affiliate of the faith-based, nonprofit Texas Health Resources system, Texas Health Dallas has approximately 4,000 employees and an active medical staff of more than 1,000 physicians. For more information, call 1-877-THR-WELL, or visit TexasHealth.org/Dallas.

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