Wednesday, September 02, 2009
I witnessed the most bizarre stroke I have ever seen a few weeks ago. A nice woman, relatively young, came in by ambulance with a terrible stroke.
She had her eyes locked off to the right. With this she had 'hemineglect' for the left side of her body... Couldn't see me on her left side or hear me. That's a stroke phenomenon and it's very bizarre when you see it. She couldn't move her right side, upper or lower, and while she could understand speech, she couldn't speak. She was either going to die from this or we were going to fly her to a stroke center or we were going to give her thrombolytics right there.
Enter the family. No, we would not fly her, she was staying with us. Still don't understand that, but those were the rules.
About ten minutes into our evaluation and after the head CT showed a small basilar artery thrombosis, the patient vomited, partly on me and partly on my nurse and a lot on herself. And the patient was cured in the space of three seconds. Eyes back to midline, speech returned to normal, and only a few residua of the initial massive stroke.
The neurologist explained that the patient, with this forceful 'valsavla' maneuver, had split the clot in two and sent it higher in the cerebral circulation allowing for meaningful blood flow to most of the previously ischemic brain. The clerk reminded me that this patient had a lot of people praying for her. Interesting. Miraculous. One in a million.
Posted by 911DOC at Wednesday, September 02, 2009