In treating a stroke, time is brain. Because treatment must be administered within 3 to 4 ½ hours to be eff ective, one of the first things a doctor or EMT must do is determine the moment when the stroke began.
For Marlene Grimes, 82, playing card games and replying to Facebook posts on the computer may have saved her life by establishing the time when she was last healthy and coherent.
Grimes was using her computer at her Milford, Ohio, home when she tried to get up but couldn’t move. While Grimes did not know exactly what was happening to her, her ability to call 911 proved critical.
“Everything you do for stroke care is time, time, time,” says Julian Macedo, MD, neurocritical care and emergency medicine physician with the UC Comprehensive Stroke Center. “So you have a stopwatch going in your mind – sometimes quite literally counting minutes – when you’re talking about getting
the best outcome for treating acute stroke.”
“When a stroke occurs, we want to work to get blood flow back to the brain as soon as possible. A blockage of blood fl ow to the brain can result in stroke symptoms, like difficulty talking, paralysis, sensation loss, imbalance and vision trouble, some of which can be extremely debilitating.”
Macedo received a call from Bethesda North around 5:30 p.m. that evening. “When I got the call, she (Grimes) had left-sided weakness and difficulty talking. They were sending her to get a CAT scan.
A big problem, in her particular case, is she lives on her own and the last time anyone had seen her well was at noon. Not knowing when this occurred, she could be already out of the window for treatment.”
Thankfully, there was a Facebook post.
Grimes’s granddaughter, waiting for family members to arrive at the hospital, had begun scrolling through Facebook to pass the time and spotted the comment posted by her grandmother – “very cute idea’’ – at 3:49 p.m. “Immediately I got chills,” April Gorman recalls. “That felt weird to me, knowing she was on her way to the hospital, and here I am seeing her Face book post from less than an hour ago.”
Gorman promptly shared a screenshot of the post with the emergency room staff.
“She was well enough to type a comment in this Facebook post, suggesting that she was normal, and we had evidence. Once I knew this, I felt confi dent about treatment. Is it the perfect way of knowing the last known wellness of a patient? No, seeing someone actually well is preferred, but it’s not always feasible,”
The medical staff began treatment with the clot-busting drug tPA immediately. (Tissue plasminogen activator, or tPA, is the only FDA-approved treatment for stroke caused by a blood clot. Stroke
specialists at UC Health helped develop the drug in the 1980s.)
Then Grimes was flown by Air Care to UC Medical Center for clot-removal treatment by Todd Abruzzo, MD, an interventional neuroradiologist.
Grimes stayed overnight and then returned home. Back to her thriving, independent lifestyle, she says her determination and positive attitude help keep her active. She admits that she doesn’t fully understand Facebook, but she enjoys reading about and seeing photos of her family.
Macedo says it certainly made the difference in Grimes’s care. “As we are getting more and more married to technology, I think we’ll be able to find interesting new ways of recognizing time-dependent change in human beings, and we can be early adopters of incorporating this information into our decisions.”