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Early Intervention Saves A Stroke Victim
Mary Baxter was having a pretty ordinary day. She'd been on home oxygen therapy for COPD – chronic obstructive pulmonary disease – for several months, and was waiting for the oxygen tank delivery man that August morning. She got up from the couch and headed for the bathroom, but something went wrong. "I remember my husband saying, ‘I'll help you,' but then I collapsed on the floor," Baxter recalls. Her husband called 911. Minutes later, paramedics and an ambulance arrived. "I heard the driver say we were going to Northwest Hospital, because they suspected I'd had a stroke," Baxter says.
When she arrived at the Northwest Hospital Emergency Department, Baxter was unable to move her left arm or leg and was unaware of their existence, a condition neurologists call neglect. The stroke had injured the right side of Baxter's brain, which controls the left side of the body. She also was having trouble speaking. Neurologist Dr. Marc Kirschner was immediately called. It was still well under an hour since Baxter had first started showing stroke symptoms.
"After about three hours into a stroke, we're often not able to give people the most effective treatment," Dr. Kirschner emphasizes. "The popular saying among neurologists is, ‘time is brain.' The faster a suspected stroke patient gets to the ER, the more likely we can choose from several beneficial treatment options. Those options diminish if too much time passes."
Dr. Victor Erlich, neurologist and director of the Northwest Hospital Stroke Program, agrees. "Early intervention is our best tool against stroke. While we may not be able to prevent some effects of stroke, in many cases we can blunt its damage if a patient gets to us in time."
In Baxter's case, studies ordered within minutes of her arrival at the hospital confirmed the stroke, and the hospital's stroke team was called in. Tests showed that Baxter did not have bleeding in the brain, but had a blood clot blocking a major vessel there. Left untreated, or if treatment was delayed, the stroke could have easily killed the 58 year-old woman.
"That's when we determined it was essential to get an interventional radiologist involved," Dr. Kirschner recalls.
"We quickly mobilized an intervention team, to do what's called intra-arterial thrombolysis," says Dr. Stephen Whipple, an interventional radiologist at Northwest Hospital and Via Radiology. Thrombolysis is the process of dissolving a thrombus, or blood clot.
Whipple and his team introduced a tiny plastic catheter into the clot in the artery and slowly infused a "clot-busting" drug called tissue plasminogen activator (tPA). If it's given within three hours of the start of stroke symptoms, tPA can often reduce long-term disability.
"The clot slowly melted over the course of about two hours," Dr. Whipple says. "We used an angiogram to see how it was progressing, which meant injecting contrast dye into the arteries and taking X-rays to monitor the clot."
In younger stroke patients like Baxter, the brain ordinarily fills the skull, unlike older adults, where a certain amount of brain shrinkage is normal When blockage of a major artery that nourishes a large portion of the brain occurs, the brain starts to swell as cell death begins. That swelling against the skull can be deadly for a younger stroke patient without speedy intervention.
Baxter benefited from her husband's immediate 911call and the well-trained response of the emergency medical services team that got her to the emergency department in time for the most effective treatment. As a result, Baxter today shows virtually no signs of having suffered a life-threatening stroke. She's even started driving her husband's scooter.
"The entire team that works to prevent stroke damage is vital to positive outcomes, from the emergency department physician and nurses to the neurologist and interventional radiologist who are just moments away," says Dr. Kirschner.
Northwest Hospital's award-winning stroke program doesn't end when the emergency does. If the effects of Baxter's stroke had been more severe, she would have been like many patients in the Northwest Hospital Center for Medical Rehabilitation. The center features a multidisciplinary team of physicians, nurses, social workers and professional staff who help patients recover from conditions ranging from stroke and brain injury to hip fractures, amputations and arthritis.
Therapists specializing in speech, language, physical, occupational and other therapies often use Easy Street, a unique, life-size replica of a city street that allows patients to re-learn everyday physical, cognitive and communication skills. The center's safety and gait enhancement and industrial rehabilitation specialists also work with stroke patients.
"The main goal is to get stroke patients to the hospital as quickly as possible," Dr. Erlich says. "It can make a dramatic difference in the outcome for the patient, as it did in Mary Baxter's case. We don't provide miracles – we do provide treatments that make the chances of good outcomes better."