Brain Surgery Revitalizes Young Dad’s Life

Cerebrospinal fluid (CSF) is a normal bodily fluid that surrounds your brain and spinal cord, which is made by a structure deep inside your brain called choroid plexus. Most adults have about two-thirds of a cup of CSF in their nervous system, which serves many functions, including cushioning the brain from injury, removing waste products, and helping deliver nutrients throughout the central nervous system.

Your brain makes spinal fluid constantly, and under normal conditions, it flows from deep inside the brain to the outer surface of the brain and spinal cord, where it is ultimately absorbed back into venous blood. Many diseases have the potential to impact this normal process of CSF production, flow, and reabsorption, resulting in a variety of symptoms that range from headache to visual loss, gait disturbance, or even life-threatening increases in the pressure within the head.

Unexplained Symptoms

Hudson Haskins was in the 10^th grade when he started stuttering and falling asleep in class. He was put on medication for ADHD to help him stay awake. Next, he started experiencing migraines that were so severe he would at times, lose his vision. Hudson was prescribed a variety of medications and was advised to sleep off the migraines.

His chronic fatigue worsened in 2018, leading to the diagnosis of Crohn’s disease. Like the migraines he was experiencing, this progressed over several years, and at one point Hudson was constantly exhausted, despite sleeping more than 12 hours a day. Crohn’s disease is an inflammatory bowel disease that causes inflammation of the tissues in your digestive tract. It causes abdominal pain, fatigue, severe diarrhea, weight loss, and even malnutrition. Once he started taking the right medication, he was better able to manage the illness.

Drastic Changes

In 2023, at 21 years old, Hudson was a creative writing student in his junior year at the University of Oklahoma. The fatigue was crushing, and Hudson would drive home between classes to sleep. He began slurring his words, became unsteady on his feet, and began experiencing a loss of depth perception that caused him to walk into walls or hit his head on the doorframe of his car. Hudson’s mother regularly asked him if he was okay, as she was worried about the dramatic change in his behavior and function over a relatively short period. Hudson reassured her and felt that all his symptoms stemmed from the demands of a busy college schedule.

During the second semester of junior year, Hudson enrolled in a physical fitness class that began each day with a one-hour workout. Despite his young age, Hudson felt awful after every workout — he had severe headaches and fatigue. He thought that maybe he was working out too hard, or that a certain neck exercise was causing the increase in migraines. By mid-April the number of severe migraines increased to once a week.

The Trials Increase

Hudson was working as a campus guide while studying at OU, and his speech deteriorated further. He stuttered through tours and struggled to get his words out. He saw his doctor about the increase in migraines and was prescribed additional medication, but his headaches inexplicably stopped before he filled the prescription. Not long after, Hudson developed a stiff and sore neck that was so severe he could barely move his neck. A trip to a massage therapist provided no relief. The stiffness lasted for a month, and he felt miserable. Hudson was sure that the neck problems were coming from his workouts, but when he stopped exercising, nothing improved, and his walking became even more unsteady.

Around this time, Hudson’s girlfriend found out she was pregnant. Exhausted and overwhelmed, Hudson wondered if perhaps all the strange and seemingly unrelated symptoms were due to stress and anxiety. He mentioned this to his primary care provider and was prescribed antidepressants, but these had little impact on his symptoms. Not long after starting the medication, Hudson developed new symptoms — double vision and a constant, loud whirring noise in his left ear. He thought these symptoms may be a side-effect of the antidepressant and stopped it immediately. However, the symptoms continued to worsen, to the point that he could barely hear people talk and had to wear an eye patch due to the double vision.

A Diagnosis at Last

By May 26, 2023, Hudson was completely overwhelmed by the symptoms, all of which seemed to be worsening. His girlfriend was due to deliver their baby in a month, and Hudson feared that he would miss the birth.

Hudson’s primary care physician knew something was wrong and urgently referred him to an ophthalmologist. Hudson now had facial asymmetry, and when the ophthalmologist found high pressure in his eyes, he and his family made the decision to take him to the emergency room at OU Health University of Oklahoma Medical Center. It was there he met neurosurgeon Dr. Christopher Graffeo, M.D., M.S., assistant professor in the Department of Neurosurgery at the University of Oklahoma College of Medicine.

Dr. Graffeo examined Hudson, reviewed his MRI, and placed him in acute care. Hudson was diagnosed with aqueductal stenosis — a rare condition where a central pathway for normal CSF drainage called the “cerebral aqueduct” is blocked, leading to inadequate CSF drainage and increased pressure in the head that presents as a clinical condition called “hydrocephalus.” Hydrocephalus may be associated with a wide variety of symptoms, including all of Hudson’s: headache, fatigue, impaired vision, lack of coordination, double vision, facial paralysis, tinnitus, and many others. Since Hudson’s hydrocephalus was due to blockage of his cerebral aqueduct, Dr. Graffeo explained that he was a candidate for a minimally invasive procedure called an endoscopic third ventriculostomy (ETV), rather than the conventional treatment of a ventriculoperitoneal shunt implantation.

“Through a small burr hole the size of nickel, just behind the hairline on the right side, a small camera called an endoscope is passed through the right frontal lobe and into the ventricular system,” explained Dr. Graffeo. “There is a safe zone in the floor of the third ventricle where a small perforation can be made surgically, which allows CSF to exit the ventricles through an alternative route, bypassing the area of stenosis.”

Hudson and his family were surprised by the seriousness of the diagnosis.

“Up until this stage I’d been pretty casual about it all,” said Hudson. “But once I received the diagnosis and knew that people were going to be drilling in my head, I finally broke down. The thought was terrifying. Even though the success rate is really high, I was still scared at the thought of getting a procedure on my brain.”

The Operation

On June 2, 2023, Dr. Graffeo and his team performed the ETV. His surgery went exceptionally well, and Hudson was able to go home two days later — his headache dramatically improved, although still bothered by visual issues and the whirring in his ear. Hudson’s daughter was born on June 9, exactly a week after his surgery, and he was able to be present, cut the umbilical cord, and hold his new daughter right after her birth.

“I still had double vision and was wearing an eye patch over my right eye,” shared Hudson. “In all our family photos from that day, I look like a pirate.”

Two weeks later, Hudson returned for follow-up, and expressed frustration that his eyesight and tinnitus hadn’t improved. Dr. Graffeo updated an MRI, which was reassuring. A minor skin infection due to the immunosuppression from his Crohn’s medications was cleared by antibiotics and a routine washout, and within a few more weeks, everything finally began to resolve. Within three months, Hudson’s eyesight returned, and all his other symptoms dissipated. After such a long journey, Hudson and his family were relieved.

“It was crazy, terrifying, and stressful for everyone around me,” said Hudson. “But we got there in the end, and it feels like a light switch was turned on.”

Unmatched Neurosurgical Expertise at OU Health

Dr. Graffeo said that there’s no specific explanation for why Hudson’s condition became symptomatic when it did, but pointed out that CSF dynamics are complicated, poorly understood, and subject to change throughout a patient’s life.

“Hudson likely had subclinical disease since birth, but it was not symptomatic until some other change in his physiology such as increased CSF production or decreased CSF absorption resulted in too much fluid being retained within his ventricles,” said Dr. Graffeo. “This in turn raises the pressure in the head, and that in turn was the driver of all his symptoms, including the vision changes, cranial nerve deficits, neck pain, and of course the headaches.”

The neurosurgery team at OU Health has unmatched expertise with advanced treatments and rare diagnoses, such as the ETV that offered the most elegant solution for Hudson’s hydrocephalus.

“OU Health has not only the most expertise with these procedures in Oklahoma, but we also have the most sophisticated equipment, a highly experienced neurosciences ICU, and a comprehensive multidisciplinary team, all of which help us ensure safe procedures and favorable outcomes for as many of our patients as possible,” said Dr. Graffeo.

Learn more about our neurosurgery services and treatment, request an appointment or get a second opinion, or find out more about the neurosurgical team at OU Health by calling (405) 271-4912.