So You're Having a Stroke: The frist few seconds, minutes, hours, days and weeks

So You Are Having a Stroke

The first few seconds, minutes, hours, days and weeks

by Dalia Lorenzo, MD

This book is intended to be informational, engaging and is not intended as a substitute for the medical advice of physicians. The reader is advised to regularly consult and obtain recommendations from a physician regarding their specific medical conditions and risk factor modification and particularly with respect to any symptoms that may require diagnosis or immediate medical attention.

The author and publisher expressly disclaim responsibility for any adverse effects arising from the use or application of the information contained in this book.

This work includes fictitious patient and other scenarios. Names, characters, businesses, places, events, locales, and incidents are either the products of the author’s imagination or used in a fictitious manner. Any resemblance to actual persons, living or dead, or actual events is purely coincidental.

No part of this book may be used or reproduced in any manner without prior written permission from the author.

Copyright ©2019 by Dalia Lorenzo, MD

All rights reserved

ISBN:9780578522654

Every year in the United States, 800,000 people have a stroke, with many of them presenting to the hospital as stroke alerts.

I have had the good fortune to be able to help many stroke patients that present to the hospital with an acute stroke, guiding the patient and his/her family during the patient's time in the hospital. Many times, doctors are providing the family with information and asking for decisions quickly, and the whole experience can end as a blur for the patient and the patient's family.

I write this book in an effort to educate patients and their family about what can happen when the patient comes to the hospital with an acute stroke. This particular book focuses only on ischemic stroke, or stroke that is caused by the absence of flow of blood to an area of the brain. Some patients that have strokes will have another form of stroke called a hemorrhagic stroke, where they bleed into an area of the brain, thus damaging it. I felt that the discussion would get too complex if I tried to cover both things at the same time. Ischemic stroke is much more common than hemorrhagic stroke, and for the purposes of this book, I will focus on ischemic stroke almost exclusively.

CHAPTER ONE

Introduction

So you are out one evening having dinner with friends, sipping your wine between bites of juicy steak and creamed spinach when it happens.You become aware that the right half of your face has become numb as if you had received anesthetic at the dentist, except that you have not. No one has noticed and the conversation continues to flow around the table. Your wife is animatedly discussing the last movie you watched together as she chats with her good friend. The couples at the table are successful professionals, middle-aged, fond of showing off their latest acquisition or exciting vacation. You decide that the numbness must be related to that molar that had been giving you trouble. After all, last week you had something similar happen and it went away after 2 to 3 minutes. You continue enjoying your dinner, the lingering thought should I been worried? buried deep in the clouds of whipped cream accompanying that first bite of a decadent dessert.

It was a wonderful dinner you comment to your wife as you drive home. She looks over at you and says,

You sound….drunk

Well maybe I had more wine than I realized as you maneuver your car through traffic on your way home.

Now dear reader, there are two optional endings for this tale.

Option one

Your wife, always as sharp as a tack, well read and well aware of your tendency to minimize symptoms, gives you a CIA-worthy interrogation and realizes you have slurred speech, trouble speaking and right facial numbness. She realizes you have been having a stroke right in front of her eyes. The next thing you know, you are in an emergency room being rushed around to different scans and that silent timebomb, that clot in your brain threatening to change your life forever, has been sucked out by the talented hands of your interventional neuroradiologist, who was about to take the first bite of his dessert when the 'stroke alert' page went off.

Option two

Your wife, still as sharp as a tack, realizes you're having a stroke and insists that you go to the hospital. You on the other hand, although somewhat apprehensive, refuse, rationalizing how this is likely not a stroke. After all, you had some numbness in the face last week that went away. You are of the wait and see camp and despite her very insistent protestations, are able to drive home well and get ready for bed, confident that once the wine wears off, everything will be back to normal and after all, there is that important meeting at work the next morning.

The night deepens and you relax into sleep, your pulse and blood pressure lowering. That timebomb, that clot that was sitting in your left middle cerebral artery, now gets larger as less and less blood flows by, finally choking areas of the left side of your brain of blood