MADISON, Wis. – Sometimes in life, being in the right place at the right time means everything, and that was certainly the case for Alysha Botsford of Milwaukee.
In April 2024, she was working out at her local YMCA, and after her workout, she went to pick up her then 2-year-old son, Theo, from the daycare center on site. Alysha was feeling a little off, she said, but thought it was from not drinking water during her workout. But then, when she started talking to the daycare director, her words weren’t coming out right.
Immediately, the daycare director brought her to the front desk to call for help because both the director and Alysha, who is a nurse, recognized that she might be having a stroke. Emergency personnel arrived and took her to a nearby emergency department.
“I was actually laughing a little bit when it was happening, because at 35. I couldn’t believe I was having a stroke,” Alysha said.
Alysha’s partner, Ryn, an elementary school teacher, was called at school and immediately went to pick up Theo at the gym, where the daycare director had continued to care for him while Alysha went to the emergency department, and then went to the hospital.
“I was in the middle of teaching a class, and I got a phone call from the YMCA, and I thought that was very weird,” Ryn said. “So, I answered it, and they said, ‘we need you to come pick up Theo, Alysha is getting into an ambulance, and she doesn’t know that she is married or has a child.’”
The hospital where she was taken had a stroke center, and the care team was able to identify that it was indeed a stroke, but with that news came a stunning surprise cause. Through an exhaustive number of tests and imaging, the team discovered the stroke wasn’t the result of a blood clot or any other common cause, but a rare condition called moyamoya disease.
The condition is diagnosed in about 2,500 people in the United States each year, and generally impacts women more than men. It is typically found in adolescents, but can be found in adults.
Knowing the cause of the stroke was important, but it set off a search for someone who could treat the condition. Alysha was in the right place — Wisconsin — to receive treatment.
One of the few doctors in the United States who can perform the surgeries necessary to prevent future strokes is in Madison at UW Health, just an hour’s drive from Alysha’s home. The other surgeons who could do the procedures were in California or Minnesota, they learned.
Dr. Mustafa Baskaya, neurosurgeon at UW Health, and professor of neurosurgery, University of Wisconsin School of Medicine and Public Health, first learned how to perform the bypass surgeries and other procedures needed to restore proper blood flow to Alysha’s brain during a fellowship in Japan in 1993, and has been performing them ever since in Wisconsin.
The disease was first identified in the 1950s in Japan, where the condition impacts more than others. The word moyamoya means “puff of smoke” in Japanese, and it refers to the narrowing of blood vessels that approach the brain and in the brain. In brain scan images, the vessels appear to thin and disappear, resembling a cloud. Since the vessels are so thin, they can’t deliver enough blood to the brain, and it causes a stroke. To remedy this, Baskaya would connect healthy, larger blood vessels from elsewhere in the head, specifically the scalp, into the parts of the brain receiving less blood. This triggers new blood vessel growth in those parts of the brain.
About a week after the stroke, she met with Baskaya, and he explained all this to her and took the time to answer all the family’s questions, Alysha said.
He performed the first procedure on one side of her brain, and then eight weeks later, did the other side. After each procedure, Alysha had to stay in the neurology intensive care unit at University Hospital for at least four days, in case of complications, such as the tender blood vessels or moyamoya vessels rupturing, since the procedure pushes more blood to the brain.
“Alysha was doing so well after the second procedure that she wanted to go home, but we told her she couldn’t,” Baskaya said, with a chuckle.
It was a good thing because, indeed, the moyamoya vessels did rupture and leaked blood, essentially causing another stroke, so he had to perform another surgery to drain the blood clot.
The second stroke was much more drastic than the first stroke because of the intervention needed to repair the rupture, so a lot of healing needed to happen in her brain, according to Alysha.
“I really wanted to get back to my life the way it was before, but I had to slow down,” she said.
Not only was the care team focused on Alysha’s healing, they were also focused on her family’s well-being during this process, according to Ryn.
“Every time they saw me, every medical assistant, every nurse, every doctor, they would ask how I was taking care of myself, if I’d had enough water or healthy food that day,” Ryn said. “They really brought home that idea that I can’t take care of Alysha unless I am taking care of myself.”
The months that followed included extensive physical and occupational therapy to help Alysha relearn to use the left side of her body.
After about a month, Alysha was able to slowly get back to her work as a nurse, and by November 2024, she was able to work 32 hours per week.
After about a year, most physical issues were gone, but some settings can still be a little overwhelming because of the brain processing needed to manage it, according to Alysha.
Now that life is back to normal, Alysha is trying to become pregnant again, and that deeply moved Baskaya, he said.
“What greater gift can you receive, as a surgeon, than learning a patient you helped bring back to life is in turn creating another life? That is an amazing feeling,” Baskaya said.
