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20160526  Earline  Paul Provost for Stroke Story 7138 1200x630

Erline's husband found her unresponsive – what happened next made all the difference

Innovative stroke treatment leaves Erline, and her doctor, smiling.

Category: Neurology

That morning, Paul Provost woke up around 6:30 am and tried to wake his wife, Erline. She had an appointment with an orthopedic surgeon about an ankle that was bothering her. But she never made that appointment.

“When I tried to wake my wife to take her shower and get ready for her doctor’s appointment, she was totally unresponsive. Her eyes were open, but she couldn’t move or talk. So, I called 911 and told them I thought my wife had a stroke,” says Provost.

“I was quite frightened for her, because I knew there was about a three-hour window in which doctors could administer clot-dissolving drugs to her. But I had no idea when the stoke occurred. When we arrived at Baystate Medical Center’s Emergency Room, there was a team waiting for us and by 7:30 am Erline was having a cat scan.

THE SIGNS OF STROKE

“Seconds matter during a stroke. The longer you wait, the more damage occurs to your brain cells,” says Dr. Edward Feldmann, vice president and medical director, Neurosciences and Rehabilitation, Baystate Health.

Two million brain cells die every minute during a stroke. As time passes, your risk of permanent brain damage, disability or death goes us. That’s why it is very important to be able to recognize stroke symptoms, because the drug t-PA (tissue plasminogen activator) may help reduce the impact of the stroke if it is given within three hours of the stroke. Earlier is better, though. People have the best results if treatment begins within 90 minutes of the start of the stroke.

The following 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 911 immediately.

Other common stroke symptoms include:

  • Sudden weakness in the legs or 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.

Stroke can happen to anyone—no matter what their age or health.

THE BAYSTATE STROKE SERVICES TEAM

Provost and her husband arrived at Baystate Medical Center by ambulance. They were met by members of the comprehensive stroke services team, who move quickly when a 911 call is received for someone suffering from a stroke or a burst aneurysm.

Called the Brain Attack Team, this rapid response team includes:

  • Neurosurgeons who perform interventional and cranial surgeries
  • Neurologists
  • Emergency physicians
  • Radiologists
  • Physiatrists
  • Nurses and other support staff

INNOVATIVE STROKE TREATMENT

After being wheeled directly into radiology for scans and having other tests, it was decided that Provost had an ischemic stroke, which is caused by a blood clot blocking a brain artery. Unfortunately, Provost was beyond the time window for the intravenous clot-busting drug t-PA. But there was another treatment option.

Dr. Farhad Bahrassa, the neurosurgeon on duty, decided Provost was a candidate for a procedure called a mechanical thrombectomy, only performed in Western Massachusetts at Baystate’s state-of-the-art neurointerventional laboratory.

Mechanical thrombectomy involves inserting a thin metallic stent-like device into an artery in the leg. The surgeon then threads the device up to the blockage in the brain. The device opens up to immediately restore blood circulation, eventually grabbing onto the clot and pulling it out.

Dr. Bahrassa recalls, “I ran down to the emergency room to evaluate Mrs. Provost after receiving a page from Dr. Feldmann about her condition. When I arrived at her bedside, she was awake, but could not understand me or follow my instructions. Her speech was incomprehensible sounds with no real words coming out.”

“I quickly explained to her husband how a mechanical thrombectomy could help her, and recommended to proceed immediately with the procedure in order to restore circulation to her brain and minimize any damage that could happen from the stroke,” he adds.

“The innovative procedure is a dramatically successful treatment for blocked brain arteries causing acute ischemic stroke, whether or not the patient receives intravenous t-PA. It has a proven benefit and is low risk. As always, the faster the circulation is restored, the better the outcome,” explains Dr. Bahrassa, noting it took less than 30 minutes from the time the procedure began on Provost to remove the clot and restore blood circulation to the brain.

AMAZING RESULTS

As for Erline, she says, “I didn’t know what was happening to me from the time I was in the ambulance until I woke up after the procedure and found myself immediately able to talk and move my body once again. There wasn’t even a scar where the doctor had gone through my groin, not even a band aid. It was all done so quickly and efficiently by Dr. Bahrassa. I was just so amazed afterwards by the remarkable speed at which I was treated.”

Provost, a longtime Springfield educator who is now retired, adds, “I am just so pleased to have returned to normal and that I am able to drive, since my husband’s glaucoma prevents him from getting behind the wheel.”

Dr. Bahrassa calls Provost’s stroke treatment “an incredible success story.”

“I checked on her every morning and every evening during her short time in the hospital, and both she and I could not stop smiling about her excellent recovery,” he says.

WHAT CAUSED THE STROKE?

It was eventually determined that the Wilbraham woman’s stroke was the result of a condition called hyperthyroidism. Approximately 10-15% of people who have hyperthyroidism develop atrial fibrillation, which can lead to a stroke.

“It’s funny, both of my sisters were diagnosed with hyperthyroidism and had their thyroids removed early in life, but I kept being tested over the years and showed no signs. My last test was in 2014, and I guess you might say it crept up on me,” says Provost, who now sees Baystate Medical Center endocrinologist Dr. Chelsea Gordner for her thyroid, along with regular visits to her primary care physician for follow-up.

DESIGNATED STROKE CENTERS

People in western Massachusetts have plenty of options for prompt, expert stroke care, thanks to Baystate. Below are the “Designated Stroke Centers” in our area:

This stroke designation means that the Massachusetts Department of Public Health has completed a detailed on-site survey. It awards hospitals who show they have the medical expertise, diagnostic equipment and treatment procedures available around-the-clock to treat strokes.