SPOT A STROKE
The American Stroke Association reports that almost 800,000 people in the United States have a stroke every year. With stroke being so prevalent, one would think that it would be something easy to recognize and quick to treat; however, that isn’t always the case. At times, it can be difficult for family and friends to recognize stroke symptoms and even mistake stroke symptoms for other ailments. Such was the case with my mother, Kathie, in recent months.
For almost six months, my mother had been suffering episodes in which she would get violently dizzy and nauseated, often vomiting, that would cause her to lie down and be unable to walk without assistance. These episodes would last up to two hours each time, and then the symptoms would completely subside. Being borderline diabetic and taking blood pressure maintenance medication, stroke was never something that crossed anyone’s mind. After all, she didn’t have the drooping face or slurred speech you typically associate with a stroke; so, it couldn’t be a stroke – it must be her blood sugar.
After months of these episodes, her blood sugar and blood pressure always registered within normal range during repeated visits to her family physician. “Stroke” was a word that didn’t even enter our vocabulary when speaking about my mother until November 2018.
On Tuesday, Nov. 27, 2018, my younger sister went to check on my mother in her bedroom at 9:30 a.m. to find that she had been battling one of her dizzy episodes and vomiting all night. This episode was different. It was lasting much longer than previous episodes, and the symptoms were worse. We knew that this was something that required immediate attention, but even then, stroke didn’t cross our minds.
My younger sister took our mother to the Willis-Knighton South Emergency Room, where even her CT results showed no sign of stroke. Her blood pressure, however, was uncontrollable with IV blood pressure medication, registering at 237/136. This initially even left the emergency room physicians puzzled, questioning whether she was having an episode of vertigo and that was the cause of the blood pressure spikes. After being admitted to Willis-Knighton South for a complete CT angiography (CTA) work-up and an MRI, we heard the word we never expected – “stroke.”
Our mother had suffered an ischemic stroke in her cerebellum – one of the rarest types of strokes, only accounting for approximately 20 percent of all strokes. The dizziness episodes that she had been having for months were transient ischemic strokes, or “TIAs,” which are often labeled as mini-strokes. Upon recognizing that she had suffered strokes, she was transferred to Ochsner LSU Health Shreveport Academic Medical Center, where the only 24/7 thrombectomy-capable stroke center in the region is housed.
Upon arrival, she was found to have established cerebellar and brainstem strokes with a stable clinical exam. Her workup revealed an occlusion of one of two blood vessels supplying blood to the brainstem with a narrowing of the one that remained opened but adequate blood supply to the posterior circulation. Over the course of the following days, her symptoms worsened, caused by a progressively decreasing blood flow to the brainstem, which prompted stroke specialist Dr. Hugo Cuellar, associate professor of neurosurgery at LSU Health Shreveport and director of neurointerventional surgery, to perform a procedure called thrombectomy in which the blood clot was surgically removed from her brain. This operation is done through a small incision in the groin and navigating a catheter from there to the brain to “catch” the clot and remove it. The procedure was successful removing the clot and also revealed that the cause of the clot was underlying stenosis (narrowing) of the vessel, which was treated at the same time by inflating a small balloon and restoring the normal caliber to prevent another occlusion.
This has been a learning experience for our family. Dr. Cuellar explained to us that the vertebrobasilar system is located in the back of the brain and supplies oxygen to the brainstem, cerebellum and occipital lobes. Hardening and blockage of these arteries can reduce or stop flow to these areas giving symptoms that are not readily recognized as “stroke,” when the symptoms fluctuate is called vertebrobasilar insufficiency (VBI) and is a sign that a blockage may be reducing flow. Symptoms associated with VBI or a stroke in the vertebrobasilar system include: loss of vision or double vision, dizziness, vertigo, nausea, vomiting, slurred speech, loss of balance or coordination, confusion and/or weakness. We learned that it is because of people like our mother who do not exhibit the conventional signs of strokes that there is an awareness campaign called BEFAST, which is championed by the Departments of Neurology and Neurosurgery at LSU Health Shreveport and the Ochsner LSU Health Shreveport Academic Medical Center.
BEFAST stands for Balance, Eyes, Face, Arm, Speech and Time. Formerly known as FAST (Face, Arm, Speech, Time), balance and eyes, symptoms that are not typically recognized as stroke, were included to create BEFAST that can help identify a person suffering from an acute stroke, such as the ischemic stroke my mother suffered from. If anything good were to come out of this bad situation, it is educating people to recognize stroke and take prompt action. It is showing people that there are many symptoms of stroke to look for – some being much more unconventional symptoms. It is teaching people to truly BE-FAST.
The LSU Health Shreveport Department of Neurosurgery is dedicated to offering an excellent combination of clinical and research opportunities, and providing the highest quality undergraduate and graduate medical education experiences led by some of the most knowledgeable and renowned neurosurgeons in the field. The Ochsner LSU Health Shreveport Neurosurgery Clinic, the clinical division of the LSU Health Shreveport Department of Neurosurgery, is committed to providing comprehensive patient care using the most innovative surgical approaches for skull base and aneurysm surgery, seizure surgery and interventional neurosurgery, and providing state-of-the-art neuroscience treatment facilities including Gamma Knife, Neuro ICU and Interventional Neuroradiology. To learn more, call (318) 675-6404.