Young woman thrives after severe stroke, thanks to the experts at Inova Alexandria Hospital

Time is Brain

Having moved to the East Coast from California to complete her law degree, Cynthia Swift, 34, was busy launching a new career in public policy. The job required numerous hours at a computer and Cynthia pushed herself to adjust to the demands of her new workload. In late November, she began to experience pain on the left side of her neck and headaches that wouldn’t go away.

One morning, after a poor night’s sleep, she felt dizzy, so her roommate drove her to Inova HealthPlex – Franconia/Springfield. There, after undergoing a complete physical examination, she was sent home with a pain reliever and a muscle relaxant. “Because of my age and because I didn’t have the normal symptoms of stroke, the doctor suspected it was muscle issues in the neck and said they see that a lot in people with jobs on the computer,” says Cynthia.

Stroke: a “Brain Attack”

But later in the afternoon, Cynthia lost sensation on her right side and began slurring her speech. She returned to the HealthPlex. A CT scan revealed a stroke, which occurs when a blood vessel carrying oxygen and nutrients to the brain is either blocked by a clot or bursts. The emergency team administered tissue plasminogen activator (tPA), a clot-busting medication that improves blood flow. But it was clear she needed further treatment, so Cynthia was rapidly transported by ambulance to the Emergency Department at Inova Alexandria Hospital (IAH), a facility designated as a primary stroke center by the Joint Commission for Stroke Care Excellence.

“Once we treat a patient with tPA, our work does not stop there,” says Jalil Bentaleb, RN, Stroke Program Management Coordinator at IAH. “tPA is the only FDA-approved treatment for ischemic strokes. It works by dissolving the clot and improving blood flow to the part of the brain being deprived of oxygenated blood. However, at times, tPA alone may not help us achieve the desired outcome. Thus, IAH provides an approach to stroke care that involves 24/7 interventional radiology. Mechanical treatments include the use of a catheter to directly deliver tPA at the site, or a retrieval device to remove the clot. Recent multicenter studies have shown that patients benefit from a combined approach of both tPA and mechanical thrombectomy.”

Team Work

As Cynthia deteriorated rapidly, losing her ability to speak and becoming paralyzed on her left and right sides, the stroke team acted quickly. “I remember them asking me questions and I remember thinking, I know how to do this, but I just couldn’t speak,” says Cynthia. “I was aware of things going on in my mind; I just couldn’t verbalize them. It was pretty bad.”

After moving her to the Interventional Radiology Department, Keith Sterling, MD, Chief of the Department of Cardiovascular and Interventional Radiology, performed a procedure called basilar artery thrombectomy to remove the clot that prevented blood from flowing to the entire back of her brain. “She had a very severe stroke. A large blood clot had formed in the basilar artery,” says Dr. Sterling. “We completely removed the clot, which restored normal blood flow to the brain immediately. When you have a large blood vessel occlusion, tPA can help, but the results are much better when using specialized catheters to remove the clot.”

A few hours after the surgery, Cynthia awakened and was speaking normally. She spent a week in a rehabilitation program at Inova Mount Vernon Hospital, where she worked with the therapy team to improve her motor function, balance and speech. “I feel as though my outcome would not have been as good if I had not been near a hospital like Inova Alexandria Hospital with the knowledge and expertise of their doctors,” she says.

As part of her recovery, Cynthia takes medication to control her cholesterol, two baby aspirin daily that act as a blood thinner, and acetaminophen for minor headaches. Now, just months after having a stroke, she looks forward to resuming her legislative work and getting back to her gym workouts. She hopes to go snowboarding again next winter. “Her outcome is phenomenal,” comments Dr. Sterling.

Is it a Stroke? Act “FAST”

If you think someone is having a stroke, act F.A.S.T.:

• F = FACE  (Ask the person to smile)
• A = ARMS  (Ask the person to raise both arms)
• S = SPEECH  (Ask the person to speak a simple sentence)
• T = TIME  (No time to waste. If the person has trouble doing any of the above, call 911 now)

Excellence in Care

For two years in a row, under the leadership of Lewis Eberly, MD, PhD, Medical Director of Neuroscience and Stroke, Inova Alexandria Hospital (IAH) has been awarded the American Heart Association/American Stroke Association’s Get With The Guidelines®—Target: Stroke Honor Roll-Elite Plus Quality Achievement Award. This award recognizes the hospital’s commitment to ensuring that stroke patients receive the highest quality treatment according to national stroke care guidelines. IAH also earned The Joint Commission’s Gold Seal of Approval® for stroke care. This certification as a Primary Stroke Center recognizes facilities that make exceptional efforts to meet the unique needs of stroke patients and foster better outcomes for stroke care.

Stroke care in Northern Virginia

To learn more about the Inova Stroke and Cerebrovascular Disease Program, call Jalil Bentaleb, Stroke Program Management Coordinator, at 703.504.7758 or 703.776.4700.

Care Around the Clock at the HealthPlex

Inova HealthPlex – Franconia/Springfield, a freestanding emergency department that is part of Inova Alexandria Hospital (IAH), offers top-notch stroke care.

“We have a very comprehensive approach to the stroke patient who is having an emergency,” says Martin Brown, MD, FACEP, Chairman, Department of Emergency Medicine at IAH. “We work closely with Emergency Medical Services, so if a person is identified in the field as possibly having a stroke, then we activate our stroke team, and when the patient arrives they go immediately to get a CT scan for an image of their brain to determine whether they are having a stroke. Then they’re seen by the emergency physician and the stroke team, and the decision is made as to whether they need a clot-dissolving medication, tPA, or interventional radiology.”

If a patient requires interventional radiology services, they are transported via ambulance to IAH, where the team is ready to care for them the instant they arrive.