Marcos Velazques likely will never forget the night he felt like his head was about to explode.
The painful feeling he suddenly described to his parents in their Coal Township home last November was more than just a headache.
Marcos, then 14, and his family had no way of knowing the seriousness of his condition.
Celebrating Marcos “Mikey” Velazques Jr.’s recovery are, from left, his father, Marcos “Mike” Velazques; his mother, Jessica Lopez; Mikey, 15 years; and Dr. Tarun Bhalla, his cerebrovascular and endovascular neurosurgeon.
A CT scan at nearby Geisinger-Shamokin Area Community Hospital that day revealed bleeding on the brain.
And so, Marcos, a basically healthy teenager, soon was being flown by helicopter to Geisinger Medical Center in Danville where further tests revealed the bleeding resulted from a ruptured cerebral arteriovenous malformation, otherwise known as AVM, an abnormal connection between arteries and veins.
Dr. Tarun Bhalla, a Geisinger neurosurgeon, had seen such cases before, although not many.
"It's uncommon overall, way less than 1/2 of 1 percent of the population," he said. "It's not something we routinely screen for. It's not picked up unless it's symptomatic."
As it turned out, Marcos was among those very few people who would need to be treated for the life-threatening stroke.
Bhalla previously had operated on a handful of patients for a ruptured AVM, and given the nature of Marcos's condition, he figured he would have to perform three procedures on the same day.
Initially, he had to relieve the fluid and pressure in Marcos's brain. That required him to drill a hole in the brain and implant a tube.
"The head is essentially analogous to a suitcase. You can only fit so many things in there," Bhalla explained. "When he had his hemorrhage, the pressure was very high. We passed a catheter from the surface of brain to one of the fluid spaces."
Next, he did an angiography to assess the bleeding.
He then removed the blood clot.
All told, Marcos was in surgery about 12 hours.
"Nobody was doing this at Geisinger before 2013," Bhalla said.
He noted that quick action from Marcos's family and medical staff at Shamokin likely helped save his life.
"I think they recognized the problem," he said.
Marcos remembered how it all began - the painful feeling in his head that night and, soon after, the vomiting.
"It came out of nowhere," he said.
Up until that day, he had no symptoms, no warnings that he suddenly would be on the brink of death.
His mother, Jessica Lopez, recalled her son coming downstairs in their home and describing the pain in his head.
"He was weak," she recalled. "He could barely stand. He was sweating profusely."
Marcos carries fuzzy memories from other events of that night.
The short trip to Geisinger Shamokin, for one.
"I just remember getting in the car. I passed out and then I woke up in the helicopter," he said.
Jessica and her husband, Marcos Velazques Sr., remembered making the drive from Shamokin to Danville.
"It was the longest drive of our lives," she said.
Marcos recalled waking up after the surgery.
"He remembered everybody," his mother said. "He remembered everybody's name."
Bhalla said a big concern post-surgery would be Marcos's coordination and balance as the AVM occurred in the cerebellum of the brain where those functions are controlled.
His mother noted that her son for a time did struggle a bit.
"He was a little off balance. It took him a while to open his eyes and look at you because all he wanted to do was look down," she said.
Therapy helped him regain much of his coordination and balance, and these days Marcos said he's doing just fine.
"I'm good. I'm back to normal," he said.
He returned to school earlier this year.
His mother noted that he gets occasional headaches and has been advised to stay away from contact sports, at least for now.
Medical science knows little about the causes of a ruptured AVM.
"This is something he was probably born with," Bhalla said. "You can't predict who it will happen to."
But he also noted that Marcos was one of the lucky ones.
"I think the unusual thing about this is Marcos was on the brink of death and just the remarkable recovery he's had," he said. "Most people don't fair as well as Marcos did."