Time Saves Brain when Treating Stroke
“On March 24, a little after 8 a.m., you sprang into action and I am back after only four days at St. Joseph’s. I have no noticeable effects from a stroke and I owed that to you and the North Memorial team. Thank you and please continue your dedicated work”. –Maria P. Perry
An A-typical Morning
Maria Perry had just brewed her morning coffee on Thursday, March 24, when her right arm began shaking violently as she lifted the pot. She had steadied herself enough to put the pot back on the counter when her right leg suddenly collapsed.
“After my leg gave out, I was pretty sure things were not okay. I wondered if I was having a stroke, but I’m only 47 years old,” said Perry, who works in customer service for Norwood & BIC in Sleepy Eye. “I sat on the floor for 20 minutes, unsure of what to do.”
Her only phone was in her bedroom, along with her husband, who slept soundly through her calls for help. Eventually, Perry used the left side of her body to pull herself up the stairs to get help.
“My husband asked if we should call 911 and I refused,” Perry recalled, laughing. “I must not have been communicating well because my husband knew better than to listen to me.”
When the ambulance arrived at Perry’s home minutes later, emergency responders saw redness around Perry’s neck. This small signal prompted them to test Perry’s nervous system by running a small instrument up the bottom of her right foot. That response was all they needed to alert Redwood Area Hospital’s emergency department that they were bringing Perry in.
“When the emergency department receives a CODE STROKE call, we work quickly because stroke is the leading cause of adult disability,” explained Louise Anderson, RN, the acute care project coordinator who oversees the hospital’s state-of-the-art Telestroke program. Through video-conferencing technology, Telestroke brings a stroke physician into the hospital’s emergency department 24 hours a day.
Redwood Area Hospital partners with Dr. Sandra Hanson, a stroke neurologist at St. Joseph’s Hospital Certified Stroke Center in St. Paul, Minn., which holds a gold seal of approval for stroke care by the Joint Commission.
“By working with St. Joseph’s we are able to diagnose and treat strokes within one hour of arrival, a critical time window to minimize brain damage and disability,” Anderson said. “The time of symptom onset is the biggest piece of information we need. By treating patients within three hours of symptom onset, we can offer them the greatest opportunity to minimize disability and maximize recovery.”
A Powerful Drug
Perry arrived in the emergency room about an hour after her symptoms began. She received a short stroke screening and then underwent a CT scan to examine the blood vessels in her brain.
Meanwhile, the stroke team, consisting of the ER physician, two registered nurses, lab, radiology and the neurologist, interviewed Perry’s family to gain more information about the events leading up to her arrival.
“When we got to the hospital, it was almost a blur of activity,” Perry recalled. “The doctor was on the video monitor and they were running tests and diagnosing my stroke very quickly.”
Perry was diagnosed with an ischemic stroke, the most common type. It occurs when a blood clot blocks an artery to the brain.
Collaborating with St. Joseph’s, Redwood staff treated Perry with tissue plasminogen activator, or tPA, a powerful medicine to break up the clot.
“It is vital to have the neurologist on the monitor because they can see things so detailed in their exam – even the pupils of the patient’s eyes,” Anderson explained. “We also discuss other symptoms that the patient may have had to be sure that it is safe for the patient to receive the clot-busting drug.”
The team has had great success in treating ischemic strokes. From 2008 to 2011, the national average tPA treatment for patients arriving with stroke symptoms was just 5 percent. At Redwood Area Hospital, 31 percent of patients with stroke symptoms were treated with tPA. The other stroke patients did not receive the treatment because they were diagnosed with another type of stroke, did not fit the optimal time window from symptom onset, or had complications that wouldn’t allow for the treatment.
“There’s often an attitude that rural healthcare is not the best healthcare available.” Anderson said. ”Our rural hospital requires cross training, strong teamwork, and networking to bring the best possible care to our patients. That makes this program a success. All of our physicians, nurses and area ambulance crews are trained to recognize stroke symptoms and participate in the Telestroke program.”
A Changed Life
Just 45 minutes after arriving in the emergency room, Perry was transferred by North Memorial helicopter to St. Paul. Less than an hour later, the North Memorial team called Perry’s husband to let him know they had arrived. Perry was prepped for a number of procedures at St. Joseph’s to continue her stroke care, but an MRI showed the treatment was not necessary. The tPA treatment had broken up her clot during the helicopter ride.
“By the next morning I was up and moving and on my way to rehab,” Perry said. “It really is amazing to see how this treatment changed the outcome of my stroke. There were others at St. Joseph’s who were not as lucky.”
She stayed at St. Joseph’s for four days before heading back home. Perry now watches her cholesterol, has successfully given up smoking, and takes aspirin and vitamins each day.
“I’ve learned now that time is vital when you have a stroke,” Perry said. “Even at a young age, we should all be aware of stroke signs because it really does make a difference when you seek treatment quickly.”
Know stroke symptoms:
- Sudden numbness or weakness of the face, arm or leg – especially on one side of the body
- Sudden confusion, trouble speaking or understanding
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking, dizziness, loss of balance or coordination
- Sudden severe headache with no known cause