BY AMBER SMITH
Anyone can have a stroke.
Three people who did, and who were treated recently at Upstate’s Comprehensive Stroke Center, share their experiences, illustrating how strokes differ.
The people had different symptoms and different treatments.
One is in her 20s. The other two are in their 60s — one with a risk for stroke, and one without. Two are female.
Two made use of telemedicine at smaller hospitals in Rome and Watertown; the other lives in Syracuse and came straight to Upstate.
All three had “ischemic” strokes, 3caused by clots that blocked the blood flow to their brains, but the clots developed for different reasons.
Two were treated with the clot-busting medication tPA, tissue plasminogen activator. One underwent a surgical procedure to retrieve the clot.
All three survived.
A blinding headache
Suzanne Sachetti, 65, of Watertown is retired as an information technology director.
The Sachettis have a lawn tractor. Mark Sachetti remembers that on May 19, 2019, his wife came into the garage saying she was going to mow. She went into the house to use the bathroom first. Twenty minutes later, she still had not returned. He went inside to check on her. Suzanne Sachetti told her husband she had developed a blinding headache, become dizzy and started feeling strange — and now she saw two of him.
“Around that time, there were a lot of stroke commercials on TV,” Mark Sachetti recalls. He recognized the signs of a possible stroke, and he knew what to do. His wife just wanted to rest.
He insisted they get to a hospital. She had trouble walking, but he helped her to the car. They drove to nearby Samaritan Medical Center. “I think she could be having a stroke,” he said as they entered the emergency department.
After a computed tomography (CT) scan, Sachetti was put in a room with a telemedicine connection to the Upstate Comprehensive Stroke Center. Neurologist Karen Albright, DO, PhD, appeared on the screen. “Dr. Albright took control,” recalls Mark Sachetti. To him, his wife looked fine. Albright was not convinced.
After examining Suzanne Sachetti, looking at the scans and talking with the emergency doctor, Albright told the Sachettis she believed Suzanne Sachetti was having an ischemic stroke, caused by a clot. She told them about tissue plasminogen activator, or tPA, a clot-busting medication that can be effective if given early in the course of a stroke. It can also cause bleeding. That was a risk the Sachettis were willing to take.
Soon after she received the medication, Sachetti was transported by ambulance to Upstate. She stayed in a room in the neurological intensive care unit. “All of those nurses and all of those doctors, they treated her very well, and they knew what they were doing,” Mark Sachetti recalls. He brought his wife home three days later.
Both of Sachetti’s vestibular arteries — the major arteries in her neck — were blocked. Some plaque broke off in one of them and traveled through the bloodstream until it blocked an artery in the cerebellum. That is the section of the brain that controls speech and balance. Strokes in this area can be devastating. Mark Sachetti says he realizes connecting with Albright so quickly for treatment made a big difference in his wife’s recovery.
Sachetti has some cognitive and short-term memory issues, her husband says, but physical therapy has helped improve her dizziness and balance.
Nauseated and dizzy at 4 a.m.
Debra Born, 25, is a new graduate of Utica College with a public relations degree. She lives north of Rome.
Born awakened feeling off about 4 a.m. on Aug. 6, 2019. She was nauseous and extremely dizzy. “I thought I was just exhausted and figured that was why I could not move. I kept trying to say that I was fine, but I had a hard time talking.”
Her father, Frank Born, says it’s fortunate she couldn’t speak. “She was trying to tell us, ‘I’m OK. Just let me sleep.’ And we might have.”
Instead, he dialed 911.
An ambulance brought Debra Born to the hospital closest to her home, Rome Memorial Hospital. The physician in the emergency department, via a teleconference with stroke specialists at Upstate, arranged for a helicopter to fly Born to Upstate University Hospital in Syracuse.
She had a blood clot in her brain that was swiftly removed by Hesham Masoud, MD, an interventional neurologist with specialization in vascular neurology and endovascular surgical neuroradiology. Eighty percent of strokes are caused by clots, when an artery that feeds the brain becomes blocked. The other main type of stroke happens when a vessel bursts and bleeds. The treatment options are different for each type of stroke, and care is tailored to each patient based on the size and location of the clot or bleed, and the patient’s condition and medical history.
Masoud explains that Born’s stroke developed from an arterial dissection, a small tear in the lining of an artery at the base of her neck. This likely happened when the artery rubbed against her vertebrae, perhaps when she lifted something heavy or twisted in a certain way during physical activity. A clot developed, which caused an ischemic stroke when it obstructed blood flow to the brain.
The clot retrieval is performed in an operating suite, using micro catheters (tubes) and X-ray guidance. Born was feeling back to normal within hours of the procedure. When Masoud came to her bedside, she remembers, “he was thrilled to see how well I was doing.”
She was hospitalized overnight and able to go home the next day, with no lingering deficits from her stroke. Born says she appreciates the prayers of loved ones. “The skill of Dr. Masoud and my whole stroke team was impressive, and I am grateful to them for doing their best to ensure that I walked away alive and well.”
‘I can’t use my arm’
Leonard “Larry” Johnson, 67, of Syracuse, is a retired truck driver and construction worker.
He wasn’t feeling good the whole week. That Friday, Nov. 8, 2019, watching ESPN on television, Johnson hit the bed with his right arm. His fiancée, Karla Rosen, thought he was excited about whatever game he was watching. Then he tapped her. That got her attention. “I can’t use my arm, I can’t use my arm,” he muttered. “I feel funny.”
Rosen remembers Johnson’s lips weren’t working right, his words were slurred, and his left side was weakened.
She called 911.
Because Johnson has congestive heart failure, the couple is used to making trips to the hospital emergency department. “The doctor asked me, ‘How did you know to act so quickly?’ He said that’s what saved his life, why he was able to bounce back so quickly,” Rosen says. “I thought this had something to do with his heart. I didn’t think of stroke until we got to the hospital.”
Johnson underwent a computed tomography scan that revealed a clot on the right side of his brain. Neurologist Hesham Masoud, MD, ordered a thrombolytic medication called tissue plasminogen activator, or tPA, which dissolves clots when administered in the early stages of a stroke.
A person with congestive heart failure has an increased risk of stroke. Because the heart does not pump with optimal force when it’s in congestive heart failure, blood may stagnate in one of the chambers of the heart. This can create circumstances for a clot to form, which may eventually travel to the brain and cause a stroke, Masoud explains.
In addition, people with heart failure can also have an irregular heart rhythm called atrial fibrillation that increases the risk for stroke.
Johnson went home after three days at Upstate University Hospital. Rosen says he’s not 100 percent back to himself, yet. “He’s got to go to physical therapy,” she says. “We were really blessed that he was able to bounce back.”
This article is from the winter 2020 issue of Upstate Health magazine.