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Ava Karpowecz had emergency brain surgery at Cardinal Glennon after slipping on a patch of ice at home.

This story originally appeared in the St. Louis Post-Dispatch on Feb. 4, 2010.

     Five-year-old Ava Karpowecz of Eureka was headed for gymnastics class Saturday morning, when she slipped on a patch of ice in her driveway, slamming the right side of her head against the pavement.

     Her mother was warming up the car and didn't see Ava fall. But she heard her cry.

     "We decided not to go to gymnastics," Sue Karpowecz said. "We went inside instead and she took a nap then ate lunch and was running around, eating cookies and being totally Ava."

     Sue and Mike Karpowecz were sitting on either side of their sleeping daughter Wednesday morning at Cardinal Glennon Children's Medical Center. The right side of Ava's scalp had been shaved and was marked by a long red curvy incision, held together with several dozen staples.

     The impact of her fall had ruptured an artery between the membrane of her brain and her skull. But it would take 11 hours for symptoms to show as blood slowly leaked into her cranium and formed a clot. Last year, actress Natasha Richardson died of a similar injury after falling and hitting her head during a ski lesson, says Dr. Kurt Eichholz, the neurosurgeon who operated on Ava.

     Ava seemed fine when the Karpoweczes took her to a Kid's Night Out program Saturday evening and headed out for dinner. But the couple received a call at about 8:30 p.m. Ava was crying. She had pain in her head and ear. They picked her up immediately and were driving home when she vomited then dozed off.

     They called a doctors exchange and were instructed to wake her every four hours to make sure she wasn't confused and give her Tylenol for pain, which they did.

     She seemed fine, the Karpoweczes said, but she did vomit Sunday morning after eating cereal.

     Sue Karpowecz was painting Ava's fingernails that afternoon when she began crying and complaining about her head again. Ava fell asleep at about 2 p.m. A half hour later, she woke up, crying the kind of wailing cry that chills a mother's bones. Sue Karpowecz knew immediately something was horribly wrong.

Ava and her mom just before the accident.

          They loaded Ava into the car and whisked her to the pediatric emergency department at St. Anthony's Medical Center. She vomited a third time during the ride.

     The doctor who examined Ava suspected she had the flu, but ordered a CT scan to be safe. Within minutes, the Karpoweczes recall, he was sprinting back to their room, explaining that Ava had a blood clot on her brain. They were airlifting her to Cardinal Glennon for emergency surgery.

     "She was comatose and her right pupil was dilated. Another hour and we would have had a very different outcome," Eichholz said. She very well could have died or suffered brain damage, he added.

     Two days later, Ava was walking, brushing her teeth and asking when she could go home from the hospital.

     Dr. Jason A. Werner, assistant professor of pediatrics at St. Louis University, treated Ava in the intensive care unit.

     "She's fixed," he said, confidently. "Once the injury is repaired, it's repaired. Now with some rehab, she has every chance of being a happy, healthy kindergartner in the fall."

     Werner noted that Ava's injury is unusual in children, and much more common in elderly people, because their veins are more fragile and they're often on aspirin and other blood thinners.

     Ava is a good example of the symptoms to look for after hard impact to the head, he said.

     "Persistent pain that doesn't get better as the hours go on. Vomiting more than twice in 24 hours. Changes in level of awareness," he said. "And the last, most ominous sign is when the pupils are different sizes because one has dilated. That's a sign that you have, not hours, but minutes to get treatment."

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