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UAB Comprehensive Stroke Center Helps Patient Make Unprecedented Recovery

This May, during Stroke Awareness Month, health care professionals and organizations raise awareness by emphasizing data such as risk factors for stroke, how to identify signs and symptoms of a stroke, and methods for mitigating long-term effects.

At UAB Medicine, one data point that can’t be over-emphasized is the increased chance of recovery that a comprehensive stroke center provides for patients. Perhaps no one appreciates that more than Terri Daniels, a UAB Medicine patient who recently received treatment for an acute ischemic stroke at the Emergency Department and the hospital’s dedicated Stroke Unit. Her care team describes the recovery as miraculous.

While shopping with her husband at Sam’s Club, the 62 year-old Pleasant Grove resident began feeling weak and experiencing blurred vision and a strange sensation in her face. When she collapsed on the floor, her husband – who attended nursing school – recognized that Daniels was having a stroke.

“I went down pretty quickly; it’s like my face and then my body had no control,” Daniels says. “My husband saw my hand and my legs just drop and he said, ‘Oh no, she’s having a stroke.’ Almost immediately some employees and other customers gathered around to help us and call EMS. Some of them stood around me and held up large towels so that what was happening wasn’t visible to other shoppers. Everyone was so caring and thoughtful. When EMS arrived, I recall sitting up, and I can remember someone in the ambulance discussing which hospital to take me to.”

Severe Symptoms

Daniels was taken to the UAB Emergency Department, where an initial evaluation scored her at 23 on the Stroke Scale, a diagnostic measure created by the National Institutes of Health that helps determine the impact and possible outcomes of a stroke. Anything above 22 is regarded as severe. Daniels was suffering complete aphasia (the inability to speak or understand what you hear), facial droop, inability to look in one direction, and severely decreased sensation on her right side. Within 35 minutes of arrival at UAB, Daniels received an injection of alteplase, a tissue plasminogen activator (TPA) drug that breaks up the blood clots that cause acute conditions such as a stroke.

The good news for Daniels was that she was being cared for at a designated comprehensive stroke center, where the TPA injection usually is a frontline treatment and the first step toward achieving a good long-term outcome. The bad news is that she was still not fully responding to the injection. Emergency medicine physician Linda Thompson, MD, recalls that Daniels’ CT scan revealed a clot blocking a main artery to her brain.

“Alteplase is beneficial to stroke patients, but in this case it was not enough,” Dr. Thompson says. “But due to UAB having the ability to perform an embolectomy, Mrs. Daniels was taken in a timely fashion to the catheter suite for that procedure. That procedure is the reason for the great outcome this patient experienced. This worked out because she happened to come to UAB.”

An embolectomy is a minimally invasive, catheter-based treatment that removes clots to restore circulation in the brain. Patients treated in this manner often constitute the most acute cases and require expert neuroscience care during all phases of recovery. These extensive resources and technologies found in UAB Medicine’s neurovascular stroke service – along with a team of expert stroke physicians on duty 24/7 – are available thanks to UAB’s Comprehensive Stroke Center.

Unprecedented Recovery

In Daniels’ case, the embolectomy was so successful that she recovered quickly and sufficiently enough to return home just two days after her severe stroke.

“This is a remarkable outcome,” Dr. Thompson says. “To drop from a NIH Stroke Score of 22/23 down to 2 is miraculous. This is what we hope for with all strokes. Having practiced emergency medicine for 30 years both in the academic and non-academic settings, I can say this is unprecedented, and it is my hope that this will become the standard outcome as the technologies and therapies used in designated comprehensive stroke centers become widespread.”

Daniels counts herself lucky that the EMS team took her to UAB Medicine. “It’s the best place I could have possibly been,” she says. “If I had gone anywhere else that day, I don’t think I would even be talking about what happened right now.”

After experiencing what she calls “the best care in the world” and then “a good head start” with therapy at UAB Medicine, Daniels is resuming her normal lifestyle. She already has made considerable progress in regaining most of her language skills, though she’s aware of some minor speech obstacles.

“There are some words I want to use, but I have to sort of talk all around that word I’m trying to say in order to get my idea across,” Daniels says. “It’s very selective, what I can say or can’t say, but I’m getting much better with that. My therapist, Nancy Keller, told me that one possible problem is that I’m trying too hard to talk as fast as I used to. I’m Italian, so I guess that complicates my therapy! When you’re Italian and something stops you from saying a certain word, well, that doesn’t work for me. I’m also competitive. Nancy was so sweet in dealing with someone like me with no patience, but she tried very hard to get me to stop thinking of every exercise as a contest. After each session I would watch her take notes and then I would ask, ‘Did I win?’”

Click here to learn more about the UAB Comprehensive Stroke Center, how to identify a stroke, and what factors may put you at risk.