Brain

Race against time

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medblog-stroke
Mary Alice Stam (right) with family friend Ellie Raj

Strokes are the leading cause of disability in the United States. Swift action is an antidote, something one North Texas woman will never forget.

For Mary Alice Stam, Nov. 11, 2014 – Veterans Day – started off as a day of remembrance. By noon, it had become a day worth remembering for other, extraordinary reasons.

There was a chill in the air that morning as Mrs. Stam, alone, tended to a veterans memorial at Sparger Park in Colleyville, near Dallas. She was clearing away debris and setting up a floral arrangement at the park’s stone marker when something, suddenly, went seriously wrong.

Although she was not aware of it, a blood clot had lodged in her brain’s internal carotid artery, blocking blood flow and affecting her perceptions. She was having a stroke.

“I had no headache, no pain, no symptoms whatsoever,” recalls Mrs. Stam, 77, a retired nursing professor familiar with the signs of stroke. “I was feeling and functioning just fine, I thought, but within the hour I was in bad shape.”

A friend indeed

The type of stroke Mrs. Stam was having impaired her ability even to realize she was having difficulties. By the time a family friend, out for a walk in the park, stopped to chat, Mrs. Stam no longer recognized the left side of her own body.

The friend, noticing that some of what Mrs. Stam said was garbled and seeing that she could put on her right glove but not her left, immediately called paramedics for help.

Mrs. Stam’s daughter, also a nurse and keenly aware that with stroke time is of the essence, was only a few miles away when the friend notified her. She arrived at the park even before the paramedics, who rushed Mrs. Stam to a nearby hospital in Grapevine. Doctors there performed a CT scan on her head and, quickly realizing that Mrs. Stam needed a higher level of care, called the stroke hotline at UT Southwestern, which has the only Joint Commission-certified Advanced Comprehensive Stroke Center in North Texas.

A short time later, when an air ambulance landed her at UT Southwestern’s Zale Lipshy Pavilion – William P. Clements Jr. University Hospital and Mrs. Stam was taken to the Robert D. Rogers Comprehensive Stroke Center, a team of stroke specialists was there to greet her.

Precious minutes

"With stroke, time equals brain,” explains vascular neurologist Mark Alberts, M.D., who had the initial phone consultation and serves as Professor and Vice Chair of Clinical Affairs in the Department of Neurology and Neurotherapeutics at UT Southwestern. “We call it the ‘Golden Three Hours.’ If we can get to the patient early in the stroke, we have a vastly improved chance of making a difference. Thanks to everyone involved with Mrs. Stam, we were given that chance.”

In order not to waste any precious minutes, every stroke center in the nation uses what’s known as the National Institutes of Health Stroke Scale as a benchmark of a patient’s stroke severity. A stroke rated 8 or above is considered especially serious. Upon arrival at UT Southwestern, Mrs. Stam’s number on the scale was 13.

“What that number told us,” says Amanda Dirickson, RN, a specially trained advanced practice stroke nurse and UT Southwestern’s Stroke Outreach Coordinator, “was that if we couldn’t make her better, and soon, she would very likely need constant nursing care. With every stroke patient, the clock is ticking, and the loss is almost 2 million brain cells per minute.”

Not all stroke patients can be treated with the same therapies. Because Mrs. Stam was actively taking a blood thinner for a heart condition, doctors quickly knew that she was not a candidate for a clot-dissolving medicine called tPA. The only option was to remove the clot mechanically through an advanced stenting procedure called endovascular rescue therapy (ERT) – an operation only a handful of hospitals in the Metroplex is equipped to perform. The team began the procedure just 32 minutes after Mrs. Stam arrived.

Leading the procedure, Lee Pride, M.D., Professor of Radiology and Neurological Surgery, inserted a catheter into Mrs. Stam’s femoral artery in the thigh, threading it up to the site of the clot in her brain. Extending a wire mesh stent into that internal carotid artery, the team was able to ensnare the clot and remove it, restoring blood flow.

Following the procedure, Mrs. Stam recuperated rapidly, improving overnight to a 4 on the NIH stroke scale. When she left the hospital almost a week later, she was back to 0 on the scale – a complete recovery.

Team effort

Today, Mrs. Stam has no visible signs that she’s had a stroke, and she’s back to her normal life, even as she continues occupational and physical therapy.

“The nurses say I’m a rock star,” she says. “I’m sure glad to be here.”

Dr. Alberts, who was integral in developing national criteria for primary and comprehensive stroke centers, notes that in Mrs. Stam’s case, everyone around her was responsible for the outcome.

“The fast actions of her friends, family, and the Grapevine professionals in getting her here quickly, as well as the speed and efficiency of our team here at UT Southwestern, gave her the best chance of having a good recovery and resuming her active and fulfilling lifestyle,” he says.

Ms. Dirickson agrees, noting the day was in many ways a textbook case for how things are supposed to go, with moments of good care every step of the way.

“In retrospect, when you consider the friend and her family members and the parts they played and all the different nurses and doctors involved, everything kind of happened like in an orchestra,” she says. “You have the string section over here doing its thing and the percussion people are here doing their thing, and at the end of the day you have this wonderful music of, ‘Hey, she’s better!’ and that’s sort of what happened. Everybody was doing his and her part.”

Epilogue

Almost three months to the day after Mrs. Stam’s stroke, the American Stroke Association held its annual conference. The big news at the event was the announcement that ERT procedures like the one performed on Mrs. Stam should be the standard of care for eligible patients.

“This is something that’s not theoretical,” notes Dr. Pride. “We now have evidence from several studies that this kind of care should not be exceptional or rare anymore. It should be common.

“Not every stroke patient is going to be a fit for this procedure, but when a patient is a fit and in need of that higher level of care, we are here and ready to provide it – any time of day, seven days a week – we are here.”

Recognizing stroke: Five "sudden symptoms"

“If there’s one thing I could tell people who face a stroke, it’s to take action,” says Mary Alice Stam, a longtime nursing educator and stroke survivor. “You might think you feel fine, but listen to those around you and get examined by stroke experts. There is hope for victims of stroke, but you must act – and act immediately.”

According to the National Stroke Association, the time to get yourself or loved one to a stroke expert is when any of the following five “Sudden Symptoms” of stroke appear:

  • Sudden numbness or weakness of the face, arm, or leg on one side of the body
  • Sudden confusion – difficulty talking or understanding
  • Sudden trouble seeing on one side
  • Sudden, severe difficulty walking, dizziness, loss of coordination or balance
  • Sudden, severe headache for no known reason

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