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Carson Genter

A GRATIFYING GIFT

Gift shopping keeps families on their toes in December. But Carson Genter lay flat on his back at Children’s Hospital Central California in late 2008. A 6-year-old at the time, Carson had contracted the H1N1 virus and pneumonia. “He spent about a week in the Hospital,” says Carson’s mother, Nicole Genter. He recovered and was discharged, but soon began passing out.

“We’ll investigate the cause,” says Dr. James Horspool, medical director, Charlie Mitchell Children’s Center. “Is there an infection, like meningitis? Are there structural malformations? Is the problem with the brain?”
An MRI revealed an abnormality of the brain known
as Chiari malformation.

“With Chiari malformation there’s a small descent of the cerebellar tonsils into the upper spine, compressing the brain and spinal cord,” says Dr. Meredith Woodward, a pediatric neurosurgeon at Children’s.
At the time of Carson’s MRI, the structural defect was not blocking the flow of cerebrospinal fluid, the clear liquid that surrounds and cushions the brain and spinal cord, and did not appear to be causing his
seizures. He began treatment for a seizure disorder.

Unwrapping a package of symptoms

Shortly after Carson turned 9, his health problems intensified. “He didn’t want to go out in the sun because the light hurt his eyes,” says Nicole. “He used to love being outside, but all of a sudden he would stay in his room and pull the blankets over his head.”

Carson’s speech slurred. He fell frequently, developed double vision and began vomiting. A visit to the gastroenterology practice at Children’s quickly changed course when dilated pupils indicated possible brain swelling. Carson was sent to neurosurgery and admitted.

“Sometimes Chiari malformation plugs up the flow of the spinal fluid like a cork in a bottle,” says Dr. Woodward. Carson required immediate surgery to relieve the pressure. Usually a one-time procedure, Chiari decompression surgery increases space between the cerebellum and the spinal column, and can cause immediate relief. “Often I’ll hear parents say, ‘He was already better in the recovery room.’”

Neurosurgeons at Children’s perform as many as 50 Chiari decompressions a year, and always watch for possible fluid buildup around the brain. “A lot of the kids can have a very rocky course after surgery,” says Dr. Woodward. “We do approximately one Chiari decompression per week and over the past year only five of those did not require a shunt.” Neurosurgeons insert a shunt when necessary to drain cerebrospinal fluid away from the brain to where it can be absorbed naturally by the body.

Carson’s recovery proved extremely difficult and symptoms indicated excess fluid on his brain. “Carson is autistic and doesn’t communicate his pain effectively,” says Nicole. “He would say, ‘Someone’s pushing on my head from the inside.’”

Receiving a welcome surprise

Three weeks after his Chiari decompression, Carson returned to surgery for a shunt. “There was so much going on and they literally caught everything,” says Nicole of the medical professionals treating her son. “They notice something’s wrong. They find out what it is. And they fix it.”

One outcome of Carson’s surgeries came as a complete – and welcome – surprise. Carson suffered daily seizures after recovering from H1N1. Medication reduced them to once every three days. “He was on two meds and still had seizures,” says Nicole. Routine MRIs never connected the seizures to the Chiari malformation. No one suspected otherwise. While an inpatient at Children’s, Carson stopped taking his meds. “We’ve been here two months and a week,” says Nicole, referring to her son’s extended Hospital stay. “And he hasn’t had a single seizure.”

In 2008 Carson spent part of the holiday season at Children’s Hospital Central California. He didn’t visit in December this time, but the Hospital enjoys giving the gift of improved health every month of the year. “When I brought him in here he was falling down, he was in pain, and he didn’t always know how old he was,” says Nicole. “Trying to say thank you is not enough. This place is a gift not just for the children, but for the parents. Children’s Hospital gave me back my son.”