What It's Like To Have a Stroke

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A Few Words From Erin's Doctor

John R. Lynch, M.D., director of the Neurointensive Care Unit at Froedtert & The Medical College of Wisconsin in Milwaukee, had a tough case on his hands. The unconscious woman in front of him, Erin Puariea, was having two kinds of stroke at the same time. The first was a subarachnoid hemorrhage, or SAH. That's where an aneurysm, which is a blood vessel that has burst, floods the brain fluid with blood and disrupts the chemical balance that neurons need to function. And if the bleed is large enough, as it was in Erin's case, tremendous pressure builds up in the skull, damaging wide areas of delicate brain tissue. Worse, it often kills the person immediately.

The second was an ischemic stroke, the most common kind, where a blood clot lodges in a blood vessel, reducing or stopping critical blood and oxygen flow. The clot had been dislodged during the SAH and thrown into her brain by blood vessel spasms, which often accompany a hemorrhagic stroke. Basically, her first stroke caused her second stroke.

"She was in critical condition when she arrived," says Dr. Lynch. "She was in a coma, near death." But she also had enormous luck. She had arrived at Froedtert, which is a certified primary stroke center, the gold standard in stroke care. And she had arrived quickly, which allowed Dr. Lynch and his team to begin treatment within an hour of her stroke.

They worked with the speed of people who know that time is the most deadly enemy during a stroke. They inserted a shunt to drain the blood pressing on her brain. Next they did what's called a coil embolization, where they threaded a catheter up to the site of her bleeding and sealed off the balloon-like aneurysm with a tangle of tiny platinum wires. Then, using imaging, they hunted down the clot, broke it down with a tiny state-of-the-art clot retrieval device in the catheter, and vacuumed out its pieces. They had just saved Erin Puariea's life.

"Not very long ago the vast majority of people who came in like Erin either ended up in nursing homes or dead," says Dr. Lynch. "In the past five to 10 years, that has changed dramatically as we've developed new tools and techniques to treat stroke far more quickly and effectively. What she represents is quite a miracle."

But as miraculous as Erin's recovery is, it also shows an alarming trend. The number of people, especially women, who are having a stroke at a younger age is going up at record levels. "When I was training, seeing a stroke in someone under 60 was rare," he says. "Now we routinely see people in their 30s and 40s who are having strokes. It's truly a national tragedy."

Of the controllable risk factors for stroke, Erin had two: unmanaged high blood pressure and smoking (yes, social smoking counts). Erin has made changes in her life to address them both. Too many other people, though, have not. Obesity, a sedentary lifestyle, dangerous cholesterol levels, and type 2 diabetes also increase the chances of having a stroke.

"There's a certain unpleasant irony in that stroke victims are getting younger and younger while we've been getting better and better at treating them," Dr. Lynch says. "But you don't want me fixing your stroke in an emergency. The far better thing is to make the lifestyle changes to avoid having the stroke in the first place."

-- Christian Millman


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