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One day after returning home from the hospital for parathyroid surgery, Kathy Downey welcomed her sister for a visit.
Their conversation quickly turned ominous.
“What’s wrong …?” the sister asked.
“What do you mean?”
“I think you’re having a stroke!”
Downey’s symptoms were obvious to her sister, a registered nurse in Davenport, Iowa. Slurred speech and a facial droop were clear signs of a possible stroke.
Downey—herself a registered nurse in Davenport—had no idea anything was wrong. She thought she was speaking normally and the droop was unnoticeable to her.
Fortunately, her observant sister called 911.
Thus began a desperate race against time. Strokes interrupt blood flow to the brain. The sooner a stroke is treated, the less brain damage is likely to occur.
Standard therapy for ischemic stroke (one that is caused by a cerebral artery blockage) involves a clot-busting drug called tissue plasminogen activator (tPA). Studies have shown that tPA can reduce damage and save lives if administered within three hours of a stroke or heart attack.
Downey got off to a good start, since paramedics immediately took her to the emergency room at Genesis Medical Center-West. Unfortunately, because of the recent surgery, Downey could not receive tPA in the usual way, through an intravenous (IV) line inserted into the arm. This was because when tPA is administrated by IV, the drug circulates through the whole body to break up clots.
Clots from the surgery, if dissolved, would have risked bleeding complications.
Downey’s challenging scenario prompted her transfer to University of Iowa Hospitals and Clinics. She arrived at UI’s Emergency Treatment Center (ETC) with weakness on her left side, slurred speech, and a tendency to look to only one side.
Stroke specialist Enrique Leira, MD, an assistant professor of neurology, suspected an ischemic stroke involving the right middle cerebral artery, a major vessel that supplies blood to the brain. He performed an emergent transcranial Doppler evaluation immediately upon arrival, which confirmed the occlusion of that major vessel.
Leira knew that without treatment, Downey faced a more than 95 percent chance of death or disablement within three months, so the stroke team mobilized quickly.
An angiogram identified the precise location of the clot. Neuro-interventional radiologists Minako Hayakawa, MD, and Coleman Martin, MD, then devised a treatment strategy in which t-PA was administered through an artery directly to the clot, thereby avoiding the complications of “whole body” IV thrombolytic therapy.
In addition, Hayakawa and Martin—who are among a relatively few specialists in the region who are qualified to perform innovative or highly unusual neurointerventional procedures—placed a stent in her cerebral artery to keep the blockage open.
Clinical nursing specialist Erin Rindels, RN, recalls remarkable improvement.
“I saw her the day before discharge and I could hardly believe she was the same woman I had seen in the ETC,” Rindels says. “She was alert and communicating clearly.”
Downey underwent three days of rehabilitation therapy at Trinity Medical Center-West in Rock Island, Illinois, followed by another two months of rehabilitation at home.
Today she feels much improved. Her speaking and walking skills are excellent, she has earned back a driver’s license. While her penmanship is not good enough yet to permit a return to work, she’s making progress.
“I feel fortunate that under unusual circumstances, the doctors at Genesis knew enough to send me to UI Hospitals and Clinics,” she says. “That was a key to my recovery.”
For more information, patients and family members should call UI Health Access and ask for the UI Stroke Center.
For consultation or referral, physicians should call UI Consult.
—Michael Sondergard
3 causes of stroke
Strokes occur when the blood supply to `the brain is disrupted by any of three causes:
- Thrombosis (a clot within a blood vessel)
- Embolism (a clot formed elsewhere in the body that travels through the bloodstream and ends up blocking a brain artery)
- Hemorrhage (bleeding in the brain tissue).
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