Having a Stroke? Minutes Matter

She heard the crash and knew something was wrong.

It was shortly after 1 a.m. when Karin Ybarra woke to find her husband lying on the bathroom floor. The torn shower curtain betrayed his failed struggle to pull himself up.

What happened? asked Karin. But her husband didn’t answer. He was mumbling, his speech slurred. Karin peered closely at Richard’s face. The left side was drooping.

“I knew right away he was having a stroke,” she said.

Racing against the window

But Richard didn’t believe her. Yes, he later recounted, he’d developed a headache that night while watching TV. But he’d been working on his laptop, too. Although it was only March, he’d been busy in his lawn care business. He was probably just exhausted, which would account for the blurry vision. As for his left arm going numb and his breaking out into a cold sweat...

“Look in the mirror,” Karin instructed, as she half-dragged her husband onto the bed. A startled Richard saw that his wife was right. The local hospital in Ottawa, Kan., was just five minutes from their house. Karin figured she could get there faster than the ambulance could get to Richard. Quickly she got her husband dressed (“I couldn’t find his other shoe and then realized it didn’t matter.”) and into the car. She was acutely aware that minutes mattered.

“I knew about the window,” Karin said.

‘Time is brain’

Five months earlier, Karin’s boss had suffered a stroke. He’d been transferred from their local hospital to Saint Luke’s Hospital. After his recovery, he told Karin about his symptoms and about the window.

“In the case of strokes, we say ‘time is brain,’ ” said David Scheffler, D.O. he emergency physician at Saint Luke’s who treated Richard. “We have three hours from the onset of a stroke to administer tPA, which could alter the course and improve outcome.”

The most common treatment for a stroke is the blood thinner called tPA. It breaks down the blood clot that obstructs the flow of oxygen to the brain. But if the window has closed, or if doctors don’t know when the stroke occurred, administering the tPA can make things worse rather than better. It may, for instance, cause bleeding in the brain.

“It was absolutely critical that Richard’s wife knew what time he had the stroke,” said Dr. Scheffler.

In the window

Karin made it to the Ottawa hospital within her own five-minute window. Almost immediately, the Emergency Department staff alerted Saint Luke’s and got Richard on the Life-Star helicopter that would take him the 60 miles to Kansas City. After consulting with Saint Luke’s, the ER staff in Ottawa started him on an IV of tPA, the clotbuster drug that could reverse the stroke.

“I don’t remember anything until the helicopter,” Richard said. “The next thing I knew, I was in ICU.” Karin, of course, remembers far more—the hour-and-a-half, middle-of-the-night drive to Saint Luke’s Hospital on the Plaza; the doctors’ and nurses’ careful questions about what time she’d found her husband; the sense of relief knowing that Richard was being treated at the place her boss had spoken of so highly.

“At the Neuroscience Institute, we can do more advanced tests to find out where and how big the clot is,” said Dr. Scheffler. Richard’s clot was far down in the blood vessel and relatively small. The best course of action was to continue him on the IV of tPA.

“He was showing improvement, so we wanted to give the medicine a chance,” said Dr. Scheffler. “His brain was getting oxygen.” By 2:59 a.m., Richard was on tPA. He was well within the three hour window.

‘Miracle boy’

When Karin saw her husband of 27 years a day and a half later, her calm demeanor finally cracked.

“My knees wobbled,” she confessed. From conversations with her boss, she knew that stroke patients who didn’t make the window often struggled for weeks, months, forever to recover their speech and mobility. And yet here was her husband, the droop on the left side of his face almost gone, his speech no longer slurred.

“In the ICU, they called him the miracle boy,” Karin said. In fact, judging by the images from his MRI, Richard should have been in tougher straits than he was.

“There was a significant amount of abnormality on Richard’s MRI,” said Michael Schwartzman, D.O. the neurologist affiliated with the Neuroscience Institute who treated Richard. “Often we see a strong correlation between a patient’s neurological damage and his MRI, but sometimes they’re discordant.”

Happily, in Richard’s case, his neurological damage was far less than what his MRI suggested.

Lessons learned

Just two weeks later, Richard started back to work. Initially, numbers confused him—ZIP codes and analog clocks made no sense. His numeracy has improved, although division and subtraction are still a struggle. But that’s typical.

“What’s atypical is that this usually occurs in left-hemisphere strokes, and Richard’s was in the right hemisphere,” Dr. Schwartzman said. “There are parts of the brain we still don’t understand—but that’s what makes us human.”

Karin works with Richard every night, giving him short math lessons. For Karin, there’s also a larger lesson in what happened.

“What helped me was being able to recognize stroke symptoms and to know how to react after my boss told me about his experience at Saint Luke’s,” she said. “It’s important to be informed.”

For Richard, there’s another moral to the story.

“Always listen to your wife,” he said with a laugh.” I sure do.”

Think Fast

Recognize the signs of stroke and act

Knowing the signs of stroke helped Karin Ybarra get help for her husband before permanent damage set in.

The operative word for strokes is fast. Symptoms come on suddenly; observers must act quickly. Doctors have just three hours from the initial signs of stroke to administer the medication most likely to avoid long-term disability.

To help you recognize signs of stroke, the National Stroke Association shares this mnemonic for acting FAST:

Face - Does it droop when you ask the person to smile?

Arms - Does one or both drift downward when you ask the person to raise them?

Speech - Is it slurred or hesitant?

Time - If you see any of these signs, call 9-1-1 immediately.

Other symptoms include:

• Severe headache
• Dizziness
• Loss of balance
• Blurred vision
• Numbness
• Confusion

Be sure to note the time when you see these signs. The clock is ticking: The window for medical treatment is just 180 minutes wide.