TeleStroke Technology Connects Specialist Quickly to Treat Patient
Gale McCune opened the Sentara Williamsburg Medical Center gift shop on a Saturday as she had every week for years. This time, about 15 minutes into her shift, she felt disoriented.
“When my customers were ready to check out, I went around the counter and put my hands on the cash register, but I had no idea what to do next,” Gale, 78 of Williamsburg, recalls of the January 2019 morning. “I tried four times and it didn’t come to me.”
Her customers suspected a stroke and called for help immediately.
Stroke Team Springs to Action
A medical response team transported Gale from the gift shop to the emergency department.
“I passed a mirror on the way to the ER and Iooked at my face,” Gale says. “My right side was drooping.”
Her ER team called a stroke alert, which initiates the TeleStroke program. Staff wheeled in a cart with sophisticated video equipment that links the patient, ER doctors, and a neurologist experienced in treating strokes.
“It’s similar to an interactive Facetime,” says Barb Runk, a clinical nurse specialist at SWRMC. “The neurologist controls a camera that can zoom in on the patient to look closely at the eyes and face. This technology gives us access to a board-certified neurologist 24/7.”
Sentara has implemented TeleStroke technology at 11 hospitals and five free-standing emergency rooms.
Gale’s symptoms began to clear up without any further treatment, but the staff kept her at the hospital for observation. A couple of hours later, Gale experienced more severe symptoms.
Stroke Symptoms Worsen
“I didn’t realize what kind of trouble I was in until I saw my hand curled up on my right side,” Gale says.
Dr. Alexander Grunsfeld, the medical director of neurosciences at Sentara was the neurologist on-call that day. He connected with TeleStroke to assess Gale again. This time she had trouble forming words, the right side of her face drooped and she couldn’t lift her right arm or leg.
A CT scan revealed a clot in blood vessels was blocking proper blood flow to Gale’s brain, causing the stroke. When that happens, the brain can’t get the blood and oxygen it needs, so brain cells begin to die.
Dr. Grunsfeld ordered a drug called Alteplase, also known as a tissue plasminogen activator (tPA). The injected drug breaks up blood clots, but must be given within 4.5 hours in order to be effective.
“Time is brain,” says Dr. Grunsfeld. “Our emergency room physicians team up with neurologists and endovascular surgeons, who are board-certified and specialty trained in neurovascular disease, to quickly assess and treat acute stroke symptoms. TeleStroke means access to the patient within minutes, 24/7, speeding diagnosis and intervention.”
Transfer to Norfolk and Recovery
Gale’s medical team decided she should be moved to Sentara Norfolk General Hospital for an embolectomy, a procedure to remove the clot from her blood vessel.
By the time she arrived in Norfolk, doctors determined that the tPA had worked successfully to dissolve the clot.
After she was discharged, Gale moved in with her daughter in Richmond to recover. She went to physical therapy several times a week. Therapists played games to exercise her brain. They also worked to improve her balance and speech.
“My speech wasn’t garbled, but I was losing words,” Gale says. “I would phase out. I’d lose what I was talking about and not be able to get it back.”
Eventually, Gale was well enough to return home to Williamsburg where she continued therapy. Gale’s speech has returned to normal, and after relying on a cane for stability for several months, she is now walking steadily, unaided, playing golf and exercising at the gym. She was happy to be able to wear heels to her grandson's wedding. Gale’s pleased with her progress and grateful for her care at Sentara.
“I appreciated the superb attention and care I received,” Gale says. “I wasn’t aware how serious the situation was because everyone involved in taking care of me was very professional and did exactly what they were trained to do.”