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A Stroke at Twenty-Three
A Survivor's Story
IT FELT LIKE ANY ORDINARY MORNING.
23-year-old dental assistant Karissa Bray, who had been healthy all her life, was playing with her year-old son, Kai. There was no sign or warning that she was about to suffer a paralyzing stroke.
Suddenly, Karissa was struck by a severe headache. She collapsed to the floor, unable to walk or move her left side. Her boyfriend, Devon, and her stepfather answered her cries for help and immediately called 911.
Paramedics quickly suspected Karissa had had a stroke and called ahead to alert the staff at Northwest Hospital's emergency department. By the time Karissa arrived in the ambulance, the Northwest Hospital stroke team had been assembled.
"Karissa's family did exactly the right thing by calling 911 immediately when they saw her symptoms," says Northwest Hospital emergency medicine physician, Dr. Gregory Schroedl. "It's essential for stroke victims to get treatment as soon as possible following a stroke to ensure the best possible chance of recovery."
Dr. Schroedl was the first to see and evaluate Karissa, who was experiencing weakness in the left side of her face, left arm and left leg. Dr. Schroedl confirmed the stroke diagnosis and immediately sent Karissa for a CT scan to determine the type and extent of the stroke. At the same time, he called in neurologist Dr. Elena Robinson and stroke program clinical nurse specialist Nancy West for consultation.
There are two main types of stroke: ischemic, which happens when a blood vessel becomes blocked, usually by a blood clot; and hemorrhagic, which occurs when a blood vessel in the brain bursts, causing bleeding in the brain.
"Common stroke risk factors include cardiac arrhythmia, blockage of the carotid arteries due to build-up of plaque, high blood pressure, diabetes, high cholesterol, smoking, obesity and family history, among others," says Dr. Robinson. "Less common risk factors include inherited blood clotting disorders and abnormalities in the heart."
Karissa's CT scan showed no bleeding in the brain, indicating that she had had an ischemic stroke. Dr. Robinson explained that the team needed to administer "tPA," or a mixture of clot-busting medications, in order to break up a clot that was blocking Karissa's middle cerebral artery.
Conscious and scared, Karissa consented to the treatment.
"It felt like almost immediately, I was able to move again. I could put my hair up and feel someone tickle my toes," says Karissa. "The whole time, Dr. Robinson and Nancy were super reassuring and comforting, telling me stories and playing with my baby. They explained everything and told me it was going to be okay."
The goal is to be able to give stroke patients tPA within 60 minutes of arriving in the emergency room. Karissa actually received the medication 44 minutes after she arrived. "The fact that we were able to give Karissa medication so quickly played a very important role," says Dr. Robinson. "The sooner a patient is treated the better the outcome. Otherwise Karissa could have remained paralyzed."
After she was stabilized in the emergency department, Karissa was moved to Northwest Hospital's ICU for monitoring and observation. She also received an echocardiogram, a type of imaging test of her heart.
The echocardiogram showed that Karissa had a congenital heart defect called "patent foramen ovale" (PFO). A PFO is a hole in the septum. The septum separates the two sides of the heart and prevents blood from crossing from one side of the heart to the other. Dr. Robinson said the PFO may have increased Karissa's risk for stroke. She explained that blood clots that form in the legs or pelvis can travel to the heart, and then through the hole in the septum to the circulation that supplies the brain.
"We always look for the potential cause of a clot that may have caused the stroke," says Dr. Schroedl. "It may be a cardiac arrhythmia, where the heart is not beating correctly, a heart defect or damaged heart that allows a clot to form in the heart's left atrium, or a PFO," he says. "In Karissa's case, her PFO most likely allowed a clot to travel directly to her brain, causing the stroke."
About one in five Americans has a PFO. Many, like Karissa, don't experience any symptoms and don't know of the condition until an event like a stroke happens.
"Strokes typically affect older people, but even younger people can have them if there are risk factors like a PFO," says Dr. Robinson. As it turns out, Karissa is the youngest stroke patient Northwest Hospital has had in its stroke program.
From the ICU, Karissa was transferred to the hospital's stroke floor, where the staff is specially trained to work with stroke patients. She also saw a physical and occupational therapist, who helped her begin to regain full function on her left side.
After six days in the hospital, Karissa went home to continue her recovery. For a short time, she continued to receive occupational and physical therapy. "It was getting back into a routine that helped the most," she says. "My family encouraged me to do things with my left side, and at a wedding I was in about a month after the stroke, I forced myself to hold the bouquet in my left hand." Karissa says it took her a little more than two months to feel normal again.
Today, she has no residual symptoms from her stroke. She takes Coumadin to prevent any future blood clots, and is considering options for surgery to repair the hole in her heart. In the meantime, Dr. Robinson and cardiac specialists at the UW Medicine Regional Heart Center continue to monitor Karissa for any new symptoms.
"Karissa's case is a true example of the great team performance that typifies Northwest Hospital's stroke response," says West. "It was one of the best scenarios and the best outcomes of anyone I'd seen in my years as a stroke coordinator."
Northwest Hospital has long been a leader in stroke care, with a multi-disciplinary stroke team that can address any possible stroke scenario, even the most acute and complex. The hospital's award-winning stroke program incorporates rapid emergency response, comprehensive clinical care, rehabilitation, patient and family support, and ongoing stroke education. Northwest Hospital also has been designated a Level 1 Stroke Center by the State of Washington.
As a busy working mom, Karissa rarely has time to dwell on her experience. But she says it does make her look at life differently. "I feel lucky to be alive. I try not to let little things bother me, and I try to do things I might not have done before. Life is short."
Karissa says that besides everyone at Northwest Hospital who took such good care of her, she is also grateful for the family, friends and work colleagues who jumped into action. "They helped me with Kai because I didn't quite trust myself to be alone with him at first. They brought me cards, flowers, meals and a million other things. I heard from family I haven't heard from in years," she says. "They all helped me get through this. They were fantastic – everybody."