Stroke Under 40
Lost vision due to stroke at the end of January, 2014 at 31 years old.
On January 27th, 2014 I was driving North on I-81 from Charlotte, North Carolina to move with my family to our new home in Milton, PA. I was admiring the scenery of snow capped mountains and fluffy white clouds. It was about a week before my 32nd birthday and I was ready to get moved into my new house with my family. Right after lunch my head felt a bit fuzzy, almost light headed or dizzy but more painful than those. My right arm went weak, and felt heavy and floppy. I could still drive but my vision was impaired, I could only see half of the dashboard. I couldn't tell how fast I was going but I knew as cars continued to pass me that I was going too slow. I couldn't see to pull over. When I looked straight or left everything was clear, but I could not see anything right of my nose. I was scared, but not too much because I have gotten migraines in the past, specifically those with visual disturbances, so I wasn't too scared. I was more annoyed that it happened so close to home yet still too far, as I was driving with my 84 year old grandmother and 89 year old grandfather. I hated to make either one get out of their comfortable chairs to drive. Luckily my 84 year old grandmother was in the passenger seat, and helped me get off the next exit since I couldn't see anything out of the right side. Once we stopped I drank a bunch of water and took a couple advil. I walked around the car a bit but the cold air made my head throb. So I gave in and let my grandmother drive home. I wasn't able to relax since I helped my grandmother with merging and directions, but I was just hoping the migraine headache wouldn't come on before I got to the new house. My grandmother drove home and I relaxed for the evening, as much as you can do in a brand new house with a 2 year old. I went to bed early, thinking that since I had a migraine, I would wake up and feel better the next morning.
I woke up on Tuesday the 28th and I still couldn't see. Being new to the area, I hadn't visited any doctors yet, let alone sign up with a primary care physician. Because I saw an ophlamologist the previous times I experienced migraines, I called around for an emergency appointment with an opthamologist. I got in at the Eye Center of Central PA, in Lewisburg PA for an emergency appointment. I still felt sick, with some nausea and a headache. I had limited energy. My husband took off from work and drove me, since I was still experiencing vision loss. I saw the physician's assistant, Jennifer, who dilated my eyes and performed a 30-2 vision field test. Instead of missing just vision in my right eye like I assumed, I was actually missing vision in the lower right quadrant of both eyes. The opthamologist, Dr Hartzell, came in immediately with the test results and he said that I needed an emergency MRI. He knew that something was affecting the nerves in my eyes and I needed help immediately. At this point I got very nervous and cried, but he assured me that it was a small possibility of a tumor or cancer. Little did I know that I had a stroke already! His office called over to our local hospital, and my husband drove me over to the Evangelical Community Hospital. I suffered through a 40 minute MRI with a blasting headache. They said it would take about an hour after the MRI for the results and Dr Hartzell would call me.
Dr Harzell called just after 7:30 on Tuesday, a good 29 hours after my event. He said I had a clot in the back left side of my brain that was blocking my optical nerves and that is why the vision was impaired in the lower right quadrant of my eyes. He and the ER doctor on duty put me on aspirin therapy immediately and scheduled a duplex on my carotid artery for the next day along with an echocardiogram. The two doctors' best guess was that I had a PFO--patent foramen ovale. This would allow the blood clot to switch chambers in my heart and travel to my brain, causing the stroke. Before we are born, the right chamber of the heart is open to the left chamber for speedy passage of oxygen in the womb. Once we are born, this little flap called the foramen ovale closes up so that the chambers remain separate and nothing passes to the brain. Sometimes, this little flap doesn't close. Or it closes only a little. And sometimes this little flap isn't so little after all. That is when you are at risk for things like a stroke during stressful or strenuous times in your life. Patent foramen ovale is common, about 1 in 4 people have this defect. Most people won't ever know that they have it, or if they do they will find out when an echocardiogram is conducted. In most cases, the patient is placed on aspirin therapy and sent on their way. It is only in rare cases that the cardiologist will push to have the PFO closed.
So Wednesday the 19th I had the duplex and the echocardiogram. The results came back on Thursday that I do indeed have a PFO. The regular echocardiogram did not show the size of the PFO, just its presence. At this point I was referred by my opthamologist to a general practitioner who could prescribe more medication, keep the event from occurring again and also refer me to a cardiologist.
I saw Dr Pellegrino, a general practitioner on Friday afternoon. He had seen all of the tests from Evangelical Community Hospital and he said I had a pretty sizeable stroke. I had a lesion in the back left side of my brain--dead brain cells from the clot. That was the area that was affecting my eye sight. He said that he would get me in to see a cardiologist and have a procedure called a TEE, which is basically a scope down your esophagus to get a better view of the heart and see the extent of the PFO. He put me on Plavix along with the aspirin therapy and told me to call 911 if I felt any more symptoms, or if I felt weird at all. He also cautioned to me and my husband that I probably would not be able to have any more children via natural childbirth, as the strain would be too much on my heart.
So at this point I am 31 years old, had a stroke, have dead brain cells, low vision and now he's telling me I can't have any more children! With a 2 year old at home, it was hard for me to grasp what might be my realty. I spent the weekend trying to relax (anyone with a 2 year old can imagine this is difficult, let alone being in a new house with nothing unpacked). The cardiologist worked early the next week on getting me in, but snow hampered our plans. On my birthday, February 5th, right before lunch I started to have similar stroke symptoms. My head felt weird, like fuzzy and confused. My right arm was again weak and floppy, very heavy. My mom watched for signs of stroke but everything seemed even. I didn't lose any more vision but mine was already considerably damaged. We called the general practitioner but they were out of the office because of the snow. So, we called 911 and I was taken to the local hospital to get checked out. Talk about scary! I didn't want to leave my daughter again and I really didn't want to miss my birthday but I was afraid of what was happening to my body.
While it was awful going to the Emergency Room on my birthday, I did meet an excellent ER doctor who questioned why I hadn't seen a neurologist before my doctors decided that I needed heart surgery for the PFO. He had another MRI performed to check if there had been any change since the week before, and nothing was better and nothing was worse. Then he sent me to Geisinger Medical Center in Danville, PA, so that I could see a neurologist and get more tests run before deciding on heart surgery.
At Geisinger I was admitted to the neurology floor and had a bunch of tests performed. They did ultrasounds on both of my legs to see if there were any more clots. I had an MR angiogram to check out the health of the vessels and the TEE that was going to be scheduled on an out-patient basis. They did coagulate studies on my blood. They really worked to find where the clot came from and how it got to my brain. I spent two nights at the hospital while they figured everything out.
The neurologist, Dr Cummings, and his team of residents decided that I have a genetic predisposition for clotting. Because I did a lot of driving right before my stroke, the prolonged sitting formed a blood clot in one of my legs. While normally this blood clot would dissipate on its own or with medication, since I have the PFO in my heart the clot traveled across the chambers and up to my brain. He referred me to a cardiologist on an out-patient basis regarding the closure of the PFO, but it is not his recommendation. He said that because I am still at risk for a clot, even if we close up the PFO I could be at risk for the clot to lodge itself elsewhere, such as a pulmonary embolism. Therefore I will continue the aspirin and Plavix therapy along with Lipitor to keep my risk down. I am not allowed to drive for at least 6 months. This is also pending how my vision improves. He said that it will take time for the brain to repair itself. While I will not regain any vision, my eyes will learn to compensate and adapt for one another so my vision will improve.
So at this point I am not on any physical restrictions, in fact doing moderate physical activity is recommended. But as an otherwise healthy 32 year old, my vision defects are holding me back. I have a daughter that goes to school three times a week. My husband work a full time (plus) job. I have a job that is mainly computer work, which is difficult with my vision. I am thankful for kind, helpful and efficient doctors and nurses at all of the offices and hospitals I visited. Everyone treated it as an emergency. I am lucky that I did not suffer paralysis or a major car accident while driving. I am hopeful that my vision will return so that I am able to drive and work. I am trying to become an active ambassador for stroke risk prevention, education activism for young adults.