In July 2012, Jane Anne Eppard was camping along the Shenandoah River in Elkton when she felt a headache coming on, and her vision started bothering her. She had experienced migraines for years, so she was used to enduring severe headaches for several days at a time—but this was different.
“I had never had problems with my vision before,” says Jane, now 53. “I was seeing double. And it was rolling like on old TV sets.”
It was Sunday morning, and other family members who had been on the same camping trip had packed up and gone to church. The only ones remaining at the campsite were Jane; her husband, Elston; and Elston’s brother, Bryan.
Jane climbed into her camper to lie down and see if her symptoms would subside. As she lay there, however, she began to have the sensation of floating—and she knew something was terribly wrong.
“Help!” she managed to cry out.
“Where are you?” her husband replied.
When Elston appeared at the door, Jane was lying on her right side, and her left side had gone “completely dead,” as Jane remembers. She was also gagging, as if she might vomit.
“Something wrong,” Jane said.
Quickly realizing that they had an emergency on their hands, Elston, along with Bryan, helped Jane into their truck. Then, she recalls, “He took me to the hospital really fast.”
Jane kept her eyes closed all the way to Sentara RMH because the motion in her vision, along with the truck’s motion, was making her feel nauseous. Her husband kept talking to her on the way. She tried to respond, but according to Elston, her words weren’t making sense. Her condition appeared to be getting worse.
When the Eppards arrived at the Sentara RMH Emergency Department (ED), the stroke team went into action very quickly.
Time of the Essence
When it comes to treating strokes, each minute matters, so everyone on the Sentara RMH stroke team—which includes neurologists, ED physicians, ED nurses, charge nurses, pharmacists, and the lab services and imaging departments—has a pager that alerts them to the arrival of a potential stroke patient. When a patient is being transported by an area rescue squad, emergency medical technicians call ahead to the ED en route. In those cases, the stroke team meets the patient at the door when he or she arrives.
“When I got there, everything happened so fast,” Jane recalls. “The Sentara RMH team was fantastic.”
The neurologist working at the hospital that morning, Fouzia Siddiqui, MD, noted Jane’s symptoms: speech problems, double vision, weakness and numbness on one side of the body. Jane was also cross-eyed and couldn’t move her eyes.
“I could see that Jane was experiencing a stroke, so we needed to act immediately,” says Dr. Siddiqui.
For stroke patients, the clot-busting drug Alteplase—also known as tissue plasminogen activator (tPA)—dissolves clots and restores blood flow quickly, often leading to improved recovery. However, Alteplase can’t be given to patients who have bleeding in the brain, so Jane first underwent a computed tomography (CT) scan to ensure that she was eligible to receive the drug.
During a stroke, more brain cells die with every passing minute—so the sooner Alteplase is given, the better.
“With a stroke, we’re always in a time crunch,” says Dr. Siddiqui, who has been at Sentara RMH for six years and serves as medical director of the hospital’s stroke program. “The sooner we give the drug to the patient, the sooner the stroke and its symptoms will stop.”
If administered within three hours of the onset of symptoms, Alteplase can greatly improve the patient’s chances of recovering from a stroke. Sentara RMH also has its own treatment target: to get the medication to the patient within 45 minutes of his or her arrival at the hospital.
“The team works together closely and quickly to strive to meet the 45-minute goal,” Dr. Siddiqui says. “And we meet that goal more than 50 percent of the time.”
Following Jane’s CT scan, Dr. Siddiqui briefed the Eppards on Alteplase.
“I explained to them about the drug and its possible side effects,” Dr. Siddiqui says. “Administering Alteplase does present the possibility for bleeding in the brain or gut, along with other potential complications.”
After learning about Alteplase, Jane and her husband took a moment to pray together for guidance.
“I used my right arm to pick up my left arm, and it was like the arm on a rag doll,” Jane says. “I had no feeling at all in my face. At that point, I realized we needed to stop the stroke.”
Once a patient decides to go ahead with Alteplase, every second counts, so all members of the stroke team must work quickly and efficiently. The pharmacist on the team calls the Pharmacy Department, where another pharmacist starts mixing the drug. In the meantime, the nurses set up the intravenous (IV) lines, through which Alteplase is administered. Everyone on the team has an important role to play.
By the time Jane received Alteplase, she was well within the three-hour window since the onset of her symptoms—and that quick response made all the difference.
Restored to Normal
Alteplase takes about an hour to administer. When the IV was completed, Jane was taken to Critical Care for close monitoring. By the time another hour had passed, her vision had returned to normal.
While in the hospital following her treatment, she underwent numerous tests, including an evaluation by a physical therapist to check her strength—something all stroke patients undergo. The therapist found that Jane’s recovery was happening so quickly, she didn’t need any rehabilitative therapy.
Blood tests revealed that Jane has a genetic blood condition that makes her prone to blood clots, a condition of which she was unaware. Her likelihood of having a stroke was further increased by medications she was taking to treat chronic migraine headaches. Fortunately, her blood condition is fairly easy to treat.
By the time she checked out of Sentara RMH two days later, Jane had full use of her left arm. She could walk, although her left leg was dragging a bit. Her speech was normal, but her language was somewhat confused.
“My words were mixed up,” Jane notes. “I called the bed pan a ‘dust pan,’ and I called the dog’s collar a ‘necklace.’ When I was speaking about someone who had died and been buried, I used the word ‘planted.’”
To help with her complete cognitive recovery, Jane was instructed to work puzzles and engage in other similar games, she says.
Within a week of returning home, Jane’s leg function and language abilities were back to normal. She says she still has a problem with short-term memory loss—but to overcome that issue, she has developed the habit of writing things down and making lists.
Thankful for a Happy Outcome
Jane is grateful that her stroke occurred during the day. Had it happened at night while she slept, she says, she might have died or been permanently debilitated by morning. She’s also thankful for the top-notch care provided by the Sentara RMH stroke team.
“I was exceptionally pleased with my care at Sentara RMH,” she says.
According to Dr. Siddiqui, Jane’s recovery was not unusual. For stroke patients who receive Alteplase within a three-hour window, 30 percent of them achieve significant recovery within 24 hours. Another 30 percent recover within a few days, and the rest attain little to no recovery.
“I knew my condition was getting worse by the minute,” Jane observes. “My advice to others in similar circumstances is to get to the hospital as quickly as possible. If you’re experiencing stroke symptoms like being unable to talk or move, don’t hesitate! Get medical help right away.”
Helping someone like Jane recover is very gratifying for Dr. Siddiqui.
“I love taking care of patients and making them feel better,” Dr. Siddiqui says. “I try to educate them about taking care of their health and removing those risk factors they can control.”
Dr. Siddiqui recommends that people keep their blood pressure and weight under control, drink water, and exercise. She also recommends doing yoga for stress relief.
“If you remove those controllable risk factors,” she adds, “you’re much less likely to experience a stroke.”
A stroke occurs when a vessel in the brain ruptures or becomes blocked by a blood clot. Strokes fall into one of three general types:
Ischemic strokeoccurs as the result of an obstruction within a blood vessel supplying blood to the brain. These account for 87 percent of all stroke cases.
Hemorrhagic strokeoccurs when a weakened blood vessel ruptures. Two types of weakened blood vessels—aneurysms and arteriovenous malformations—usually cause hemorrhagic stroke. The most common cause of hemorrhagic stroke is uncontrolled hypertension (high blood pressure).
Transient ischemic attackis caused by a temporary clot. Often called “mini-strokes,” these warning strokes should be taken very seriously as potential precursors to more serious and damaging strokes.
Jane Eppard had a type of ischemic stroke called an embolic stroke, which is caused by a clot within an artery that forms somewhere other than in the brain itself. Often from the heart, these clots, or emboli, travel through the bloodstream until they become lodged and cannot travel any farther. This type of clot restricts blood flow to the brain and causes physical and neurological damage almost instantly.
Sometimes the symptoms of other conditions can cause a person to believe they are experiencing a stroke, says Fouzia Siddiqui, MD, medical director of the Sentara RMH stroke program. For instance, low blood pressure can cause slurred speech and blurred vision. A migraine headache can be accompanied by numbness or slurred speech. Anxiety attacks can make the body weak all over. Bleeding in the brain can affect one side of the body. So when a stroke is suspected, a computed tomography (CT) scan is performed to pinpoint the exact cause of a patient’s symptoms.
“With a stroke, the side goes weak and the face droops. The CT scan can determine what the effects of the stroke on the brain are,” Dr. Siddiqui says.
Sentara RMH gets stroke alerts about 20 to 25 times per month, and the hospital administers the clot-busting drug Alteplase approximately three to five times per month.
“We try to be overly cautious when diagnosing and treating potential stroke patients, just to be on the safe side,” says Dr. Siddiqui. “The entire stroke team at Sentara RMH is ready to assess these situations quickly and get patients the treatment they need.”