The critical hour of Stroke

October 29, 2020

Better Health chats with Prapai Kittipatwong, a stroke patient at Bumrungrad Hospital, and her daughter Oranuch “Bee” Thanaratsuthikul, as they share their experience of facing the disease commonly known as “the silent killer.”

“Everything seemed normal that day,” 65-year-old Prapai recalls the events of 19 January 2016. “I got up and did chores around the house. But in the afternoon I started feeling dizzy like never before. I felt so unsteady that I couldn’t stand without holding onto furniture for support. I called my daughter, telling her about my extreme dizziness and that I was unable to lift my right arm. I felt drained of energy. I was terrified, and I had no idea what was causing this.”

Bee suspected that her mother may have had a stroke. “She sounded strange, tongue-tied,” she says. “I remembered an article I read about cerebrovascular disease. I suspected it could be a stroke, but naively thought I could finish my errands, then go home to see my mom. I called my friend who works at Bumrungrad to get her advice. She told me to drop everything and call an ambulance immediately.”

Twenty minutes later Bee arrived home at the same time Bumrungrad’s ambulance pulled up. Seeing her mom so weakened filled Bee with fear. Prapai could not stand up without assistance, and one corner of her mouth drooped. The attending emergency doctor confirmed it looked like she’d had a stroke.

On the ambulance ride to the hospital, Prapai worried the stroke would paralyze her. Bee adds, “We were so lucky traffic was light. As I drove to the hospital, Dr. Roekchai called to update me on my mother’s condition. The whole process, from picking her up to taking her to the hospital and diagnosing her took only 45 minutes.”

The initial crisis was over

Prapai says the diagnosis was quick. The CT scan revealed there was no bleeding in the brain, but there was thrombosis from a blood clot. She needed an injection of medication that would dissolve the blockage, and improve her condition. With the doctor’s explanation, Bee gave her consent for the injection.

After a night of close monitoring in the Intensive Care Unit (ICU), Prapai woke up the next morning to find that she was once again able to partially lift her right arm. Even more function returned the next day, bringing with it a sense of relief. Prapai recalls, “I was so relieved there was no permanent paralysis. I no longer feared I would be a bed-ridden burden to my daughter who has so many other responsibilities in her life.”

The doctor kept Prapai hospitalized for four days, during which she started physical therapy (PT). After discharge, she continued PT treatments at the hospital and home.


Stronger but still on alert

“I feel much better now, just a little stiff sometimes,” says Prapai. “I can even do yoga again, after having quit for so many years. And I’m taking much better care of myself. I have diabetes, hyperlipidemia, and hypertension, but would sometimes skip taking my medications. Now I take them regularly and make an effort to cut down on sugar. No more carelessness! I never thought I’d endure such a health crisis because I was very strong before the stroke happened,” says Prapai.

Bee summarized the fortuitous conditions that helped Prapai survive and recover from her stroke: her immediate call to Bee, light traffic conditions that allowed the emergency medical team to reach her quickly, and the hospital’s expert medical team that treated her. “I am so grateful to my mother’s doctors and the other healthcare providers for their tremendous response,” says Bee.

“I think they made the right decision.”

Dr. Roekchai Tulyapronchote, a specialist in neurology and cerebrovascular disease, believes that the success of Prapai’s stroke treatment began with the patient’s and family’s decisive actions.


What was Prapai’s condition when she arrived at the hospital?

She was conscious but inarticulate, and with weakness in her limbs on one side.


What are Bumrungrad hospital’s diagnosis and treatment processes for strokes?

Our Neuroscience Center follows international standards in delivering treatment for patients with cerebrovascular disease. We have three consecutive JCI (Joint Commission International) accreditations for exemplary stroke treatment and prevention practices. When a patient arrives at the emergency room with possible stroke symptoms we activate the stroke code to notify our cerebrovascular disease team to prepare for urgent action. Our specialists include neurologists, radiologists, laboratory technicians, and nurses.

We consider the patient’s medical history, and do a neurological exam and CT scan to exclude intracerebral hemorrhage. Using the National Institute of Health Stroke Scale that measures stroke severity, we found Prapai suffered an ischemic stroke with acute cerebral ischemia. Standard treatment is intravenous thrombolytic drugs such as tissue plasminogen activators (t-PA) within four and a half hours after stroke symptoms start. They’re highly effective if given in time, reducing disability risk by 30 percent. I walked Bee through hour diagnosis of her mother’s condition, which showed she met the thrombolytic drug criteria. But there’s a six percent risk of hemorrhage and three percent chance of death, so I needed the family’s consent. Bee agreed that Prapai should get the medication.

Prapai stayed in the ICU to monitor her response to t-PA, with the nursing staff on alert for complications. Everything went well. We also wanted to determine what caused the stroke, enabling us to tailor her aftercare to prevent another one.


Know the emergency plan for strokes

Time is literally of the essence with strokes. If you see these signs of cerebrovascular disease: numbness, weakness in limbs on one side, incoherence, inability to speak or understand words, double vision, dizziness, headache, swag, or instability, you need to get help immediately. Symptoms can suddenly appear all at once.

Get to the nearest hospital that can treat cerebrovascular disease. There’s no time to waste transferring from one hospital to another. But we must also keep in mind that quick treatment alone can’t guarantee a successful recovery. Many factors come into play with intracerebral hemorrhage or massive thrombosis. The good news is experienced doctors can help patients protect and develop their remaining strengths.


How would delays in treatment have affected Prapai?

She could have permanently lost the ability to use the right side of her body. Prapai’s successful recovery proves she and her family took the right actions and made the right decisions.

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