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Brain Attack Team to the rescue

May 19, 2015

No one will know when Eileen Engels’ symptoms began, but around 2 p.m. on October 31 last year, her husband Paul returned home to find her lying helpless. He had last seen her at 1 p.m. after lunch, and all seemed well, but just one hour later, everything was different. The left side of her face was drooping, and she had no movement in her left arm and leg. Her speech was slurred.

Rushed to the hospital

Her husband immediately called 911, and while the ambulance was on its way to Baystate Medical Center’s Emergency & Trauma Center, the on-call stroke services team was alerted, ready and waiting for her. It was clear from scans and other diagnostics that she had suffered an ischemic stroke, registering 17 on the National Institutes of Health stroke scale, which is considered severe.

Less than two hours later, a neurosurgeon removed a clot blocking a critical artery in the 78-year-old woman’s brain. Two days later, she walked out of Baystate, virtually unaffected.

“It was a great, great save for her. She went home completely restored,” said Dr. Farhad Bahrassa, who removed a one-inch clot in the new, state-of-the-art neurointerventional laboratory at Baystate, the only pace in western Massachusetts where she could have this result. “She could have been permanently disabled and unable to care for herself, with the result of being placed in a nursing home.”

According to Dr. Bahrassa, who is on the medical staff at Baystate Medical Center, the interventional procedure to remove the clot restored the flow of blood to the patient’s brain.

The Brain Attack Team

But key in this dramatic success story is the fact that Baystate has launched a comprehensive stroke services team that moves swiftly and collaboratively when a 911 call is received for someone suffering from a stroke or a burst aneurysm. Called the Brain Attack Team, this stroke-specific Rapid Response Team includes neurosurgeons who perform interventional and cranial surgeries, neurologists, emergency physicians, radiologists, physiatrists, and other support staff.

Their work is supported by Baystate’s 24-7 neurointerventional laboratory and Telestroke Services, where clinical carts are equipped with a computer monitor and video technology. The accurate, highly sensitive cameras allow Baystate’s neurologists to remotely evaluate stroke patients at hospital locations where there is no neurologist on call, and to evaluate whether patients are good candidates for tissue plasminogen activator (t-PA), so that the clot-busting drug can be administered in a timely manner. Also, a special Neurosciences ICU is expected to open soon at the hospital, further advancing care for these patients.

A speedy system

Two million brain cells die every minute during a stroke, increasing your risk of permanent brain damage, disability or death.

That’s why it is extremely important to be able to recognize stroke symptoms, because the drug t-PA may help reduce the impact of the stroke if it is administered within three hours of the initial stroke. Earlier is better, however, and the best results are within the first 90 minutes from stroke onset.

"We’re putting in place this system to serve stroke patients along the entire continuum of care at every possible level they might need it,” said Dr. Edward Feldmann, vice president and medical director of the Baystate Neurosciences Program. “This comprehensive level of care never existed in western Massachusetts before this.”

“With any stroke, the optimal outcome depends on being evaluated and treated quickly. Time is brain. Our intent is to have a smoothly operating system that allows for quick mobilization to provide care in the timeliest fashion – similar to what happens in cardiovascular care when a person is having a heart attack. The quicker this gets done, the better the outcome for the patient,” said Dr. E. Jesús Duffis, a neurointerventional neurologist at Baystate.

He noted that in addition to strokes, the stroke services team also provides care for patients with brain bleeds, brain aneurysms, and other conditions.

What patients need to be further aware of, noted Dr. Bahrassa, is that clot removals restore blood flow to the brain, but do not reverse damage done before blood flow is restored. The goal is to save undamaged but “at risk” areas of brain before they become damaged. With a burst aneurysm, an interventional procedure that closes off the aneurysm is performed to reduce the chance that it will bleed again, because the chance of re-rupture is high.

“Patients are treated so they don’t suffer another bleed, which could be terminal,” said Dr. Bahrassa, “but the damage from the bleed cannot be reversed.”

Care continues even after patients leave the hospital through Baystate’s Stroke Clinic, which also offers preventative care for patients at high risk for stroke. Depending on their need, patients are also referred for rehabilitation at Baystate Rehab Care.

Know the signs

To honor National Stroke Awareness Month in May, Baystate Medical Center is joining hospitals nationwide to educate Americans to learn about risk factor management and how to recognize and respond to warning signs.

The following simple test can help you detect your own or someone else’s stroke symptoms and to Act FAST:

  • Face – Smile. Does one side of the face droop?
  • Arms – Hold both arms up evenly. Does one arm drift downward?
  • Speech – Repeat a simple sentence. Are the words slurred or mixed up?
  • Time – If you or someone else exhibits any of these symptoms, call 9-1-1 immediately.