It all started with a simple sinus infection.
Jenay Benard, 12, contracted it the week before Thanksgiving 2022. She had the sniffles, but little else. Her mother, Jasmin McKnight, kept her out of school on Monday of Thanksgiving week. In a stroke of bad luck, Jenay caught RSV (Respiratory Syncytial Virus) from a classmate when she returned to school on Tuesday and was diagnosed the Friday after Thanksgiving. She was prescribed Advil to help manage her migraine headaches, but her symptoms were typical and her urgent-care doctors anticipated she would recover in a few days.
By the Tuesday after Thanksgiving, however, her condition became increasingly concerning. The migraines hadn’t gone away, and Jasmin was advised by Jenay’s pediatrician to keep supporting treatment for her symptoms.
On Wednesday morning, Jasmin tried to wake Jenay and couldn’t move her.
“When I tried to stand her up, she was silly putty in my hand,” said Jasmin.
Jasmin called the ambulance, and Jenay was rushed to the GCH Emergency Department and immediately received a CT scan. Jasmin was then informed that Jenay would need emergency surgery to remove an abscess in her brain that had paralyzed the left side of her body. At this point, the deterioration of Jenay’s condition was so rapid that Jasmin was left bewildered. A week earlier, Jasmin’s mother (and Jenay’s grandmother) had passed away, and she was now faced with processing two traumatic incidents at once.
“Here I was thinking it was RSV and it would be over in a week, and now my daughter is entering brain surgery.”
Relieving Pressure, One Surgery at a Time
Jenay was suffering from a subdural empyema, in which a collection of pus builds up between the brain and the skull, which was the result of her RSV infection spreading.
“She was tipping over the edge in terms of the pressure accumulating in her brain,” said Matthew Bender, MD, neurosurgeon and assistant professor in the Division of Stroke and Cerebrovascular Disease. “This pressure was threatening to cut off blood flow and oxygen to her head. It was the most urgent level of surgery possible.”
Bender was the on-call neurosurgeon that night and was assigned to operate on Jenay. Meanwhile, John Schroeder, MD, the on-call anesthesiologist, prepared for the patient to arrive in the OR. “Much of our role during an emergent procedure like this is supportive: taking measures that will reduce swelling, maintain blood flow, and prevent conditions that would further worsen any injury to the brain’s tissue,” he said.
The initial surgery on her brain took multiple hours. The operating team removed a part of her skull to relieve the expanding pressure, then made an incision on the abscess to drain the pus. Because of the abscess, the dura overlying the brain was rock hard, a “sign of overwhelming pressure,” according to Bender. When he made the incision, fluid shot out.
“I’ve occasionally seen fluid come out under high pressure, but never anything as impressive as that,” said Bender. “If the pressure was not addressed, it could have been fatal.”
After the surgery team successfully drained the abscess and removed the pressure, an Otolaryngology (ENT) surgical team was brought in to perform additional procedures to relieve the pressure that had accumulated in Jenay’s sinuses. Jennifer Brooks Fontanarosa, MD, MPH, led this team during the course of two separate surgeries.
Meanwhile, Jasmin and her family hoped for the best. “Those first few days, it was just a waiting game to see if she would come back to us.”
Re-Learning the Basics
Jenay woke up from her sedation on the day of her grandmother’s funeral. While the surgeries had occurred over days, Jenay’s physical and mental recovery presented a much longer path. The brain abscess had put tremendous strain on her body—triggering what is essentially a stroke-like experience—and she would have to re-learn many of her basic body functions.
Occupational and physical therapy teams were brought in to begin the recovery process. Anjelica Fortunato, OTD, led the occupational rehab effort. “One of the first couple things that I worked on was having her be awake and alert, and doing small functional tasks, such as washing her face and other basics of daily living,” she said.
Over several weeks, the physical and occupational therapists made gradual progress with Jenay. She started moving her fingers, then lifting her hands and arms. Around two to three weeks after she had been transferred from the ICU, she started to speak again.
Once she began talking, her engaging personality returned, indicating that her near-death struggle had not dampened her spirit. “She’s a very spunky, funny person,” said Fortunato, “She was vocal about not wanting to do things and would make jokes about it. Her mom was also very supportive and helped to motivate her in her therapy sessions.”
In the first week of February, more than three months after her initial sinus infection, Jenay was discharged from GCH and transitioned to daily, three-hour rehab sessions at a local rehabilitation center.
“By the time she had left us, she was able to stand up and sit in a chair,” said Lauren Gotsch, nurse. “That’s really good progress to be able to get to that point.”
The Long Road Ahead—and a Mystery to Solve
Through intensive physical and occupational therapy sessions, Jenay’s arms are moving very well, and her leg movements are starting to return. “It all about starting from a base and then getting through the week,” said Jasmine.
While her body continues to catch up, Jasmine’s core personality and energy has shone through. In a recent photo shoot for this issue, she expressed a desire to give a speech at the annual Miracle Kids luncheon to share her journey with others about perseverance and overcoming obstacles.
“Kids like Jenay are remarkable because they can have a very serious stroke-like condition and bounce back,” said Nathaniel Bayer, MD, a pediatric hospitalist who cared for Jenay while she was hospitalized. “They are still growing and learning and show tremendous resilience
as they heal.”
Ultimately, her experience raises the question: How could a simple sinus and RSV infection nearly kill someone and paralyze half of their body? These incidents are very rare, but clinicians at GCH have been seeing them happen more frequently and are engaging in research to determine the answers.
“It used to be that I operated on one, two, or three kids with this condition per year,” said Bender, “I’ve already seen three this year.”
Regardless of what the research finds, Bayer credits the vast network of interdisciplinary teams at GCH who were able to save Jenay and are prepared to help and treat any future child who becomes ill.
“During Jenay’s hospitalization at GCH, there was a tremendous team who cared for her. This team included over 100 members: nurses, social workers, care coordinators, patient-care technicians, pharmacists, nutritionists, child life specialists, therapists, doctors, surgeons, advanced-practice providers, and many others,” he said. “The size and scope of our team highlights how complicated it is to provide medical care to children when they are seriously ill. We are lucky to have such a dedicated and skilled group in our region.”