Christine Perras arrived at HSN in early June with a stroke, scoring 17 on the National Institutes of Health Stroke Scale (NIHSS)—which indicates a moderately severe stroke with significant neurological impairment and higher risk of disability. After receiving an emergency endovascular thrombectomy (EVT), her score dropped to zero, meaning no lasting neurological deficits.
Stroke occurs when the blood supply to the brain is cut off. In Canada, someone has a stroke approximately every 5 minutes, according to statistics from the Heart and Stroke Foundation of Canada.
Brain cells die at a rate of 1.9 million per minute during a stroke, so restoring blood flow as quickly as possible is critical to improve chances of survival and maximize recovery. EVT is one type of treatment that can restore blood flow to the brain.
Perras, 68, describes how she woke up one morning feeling off. She recalls stumbling a bit and reaching for some Tylenol to ease what she thought was a routine headache.
“Then I got really hot and had a massive headache,” she said, speaking from her recovery bed in HSN’s ICU.
Perras’ symptoms quickly escalated. As the morning progressed, her condition worsened until her husband, realizing something was seriously wrong, called for paramedics. By that point, her left side had begun to go numb — a warning sign of a stroke.
“When she was admitted, she couldn’t move her left arm at all, and her left leg was extremely weak. Her speech was slurred, but she wasn’t fully aware anything was wrong,” said Dr. Ravinder-Jeet Singh, Stroke Neurologist and Medical Lead, Northeastern Ontario Stroke Network.
Tests revealed a large clot on the right side of her brain, and the stroke/EVT team quickly sprang into action.
“We discussed the procedure, formed a plan, and removed the clot,” said Dr. Singh. “While she was still on the table, we saw her start to move her left arm, which hadn’t moved at all earlier.”
Within an hour, Perras had regained full movement and strength in her arm. By the next morning, it was as if the stroke had never happened.
In the days leading up to her stroke, Perras had no reason to suspect anything was wrong. She wasn’t on any medication and had no prior health concerns that pointed to an impending stroke. There were no red flags, said Dr. Singh.
After her admission, however, further investigation revealed an underlying heart condition that ultimately contributed to the stroke.
Improving outcomes across the region
HSN is one of only two hospitals north of Toronto offering EVT, a very specialized stroke treatment. That means eligible stroke patients are transferred from across Northeastern Ontario — from North Bay to Sault Ste. Marie to Timmins to the James Bay Coast — to receive it.
The EVT Program launched at HSN in February 2020 and the team celebrated its five-year anniversary recently.
“Before 2020, patients from the Northeast were transferred to southern Ontario for EVT,” said Susan Bursey, Regional Director, Northeastern Ontario Stroke Network. “Since the launch at HSN, 242 patients have now undergone the procedure.”
EVT requires a team approach. For example, the CT and Angiography teams are essential to every patient undergoing an endovascular thrombectomy, playing a vital role from the initial brain imaging to the procedure being performed in the Angiography suite, said Annette Tracey, Medical Imaging Manager at HSN.
EVT is one of a few medical procedures capable of changing someone's life almost immediately, said Dr. Alderado Costa-Alves, the Neurosurgeon and Interventionalist on Perras’ team.
“As a surgeon, there is nothing more rewarding than seeing such remarkable improvements in our patients' neurological condition so quickly,” said Costa-Alves.
Doctors Stefano Priola and Aviraj Deshmukh, both of whom are HSN Neurosurgeons and EVT Interventionalists, agree.
“EVT means we can go after the large clots in the brain that cause severe strokes and remove them, so many people, like Christine, have a chance to make an extraordinary recovery” said Priola.
“EVT has proven to be the greatest medical breakthrough in stroke treatment in decades,” said Deshmukh.
HSN’s new mobile interprofessional stroke team (MOTIVE) provided rapid response to support the ICU with their stroke-specific functional assessments, providing consultation and input so Perras’ discharge plan was comprehensive.
“The whole team did an excellent job,” Perras said, smiling. “I’m just so thankful to be able to drink water and have a shower again.”
Effective stroke care starts with early recognition
Time is everything during a stroke. In fact, there is a saying that “time lost is brain lost.”
If you are recognizing signs of a stroke in yourself or someone with you, call 9-1-1.
Heart & Stroke created an easy and memorable way to remember the major signs of stroke:
F-A-S-T signs of stroke
F: Face is it drooping?
A: Arms - can you raise them?
S: Speech - is it slurred or jumbled?
T: Time to call 911 right away.
Don’t drive yourself or the person having a stroke to the hospital. An ambulance will get you to the closest hospital that provides urgent stroke care.
Treatments can reduce the severity of a stroke, and reverse some or all of its effects, like in the case of Christine Perras.
More signs of stroke
The FAST signs are the most common signs of stroke and are more likely to be caused by stroke than any other condition.
There are additional signs of stroke that some people experience.
They include:
• vision changes - blurred or double vision
• sudden severe headache – usually accompanied by some of the other signs
• numbness - usually on one side of the body
• problems with balance
For more information, visitheartandstroke.ca.