Subtle signs

(photo: Rick Dahms)

Steve Bertone never saw his stroke coming. A patent attorney who lives in Liberty Lake with his wife, Amy, and their three teenage sons, Steve spends his free time racing in enduro motorcycle events and competing in Ironman triathlons. He’s in excellent shape and doesn’t have any markers for stroke, such as high cholesterol, high blood pressure or tobacco use.

Even on Feb. 27, Steve woke up feeling normal—he was just getting over a cold but was on the upswing—and settled into his workday at his home office. At about 10 a.m., he blew his nose especially hard, and that’s when his life changed.

“I immediately felt the dizziest I’d ever felt in my life,” he says. “I hit the deck. It happened instantly. I broke out in a cold sweat and was disoriented.”

Steve crawled to a phone to call Amy, a former flight nurse who currently works as a regional coordinator for perinatal care at Sacred Heart Children’s Hospital. The two agreed she would remain on the phone with him and get home to take Steve to the hospital. Steve managed to get himself dressed and navigated down two flights of stairs when Amy got home, about 20minutes later.

“Steve looked awful, like someone who’s having a heart attack, but he wasn’t having chest pain,” she says. “He was coherent and talking, but I could not feel a pulse in his wrist, so I called 911.”

But Steve wanted to go by car. “He couldn’t get over the fact that if he had lost consciousness in the ambulance, he might end up at another hospital, and he wanted to be with me at Sacred Heart,” Amy says.

The paramedics arrived just as Amy and Steve were getting in the car. They checked him out and determined he wasn’t having a heart attack. Immediately, Amy drove Steve directly to Sacred Heart.

Calling “Code Stroke”

At the Providence Sacred Heart Medical Center emergency department, Steve was evaluated and given an electrocardiogram. With a heart attack ruled out, Steve went to the waiting room. There, he started to have searing pain in his neck. He had to lay down, and as soon as he did, he vomited. Then came the noise and double vision.

“There was a massive sound in one of my ears, as if I was right next to a jet engine,” Steve says. “When I looked up, I saw two of my wife. Not just blurred double vision. I saw, very clearly, two of my wife.”

When Steve asked Amy about the loud noise, Amy, given her medical background and familiarity with Providence’s systems, recognized it as an emergency: She ran to a nurse and told him to call a “code stroke.” (For details about this lifesaving initiative, see “What Is a ‘Code Stroke’?”)

Immediately, Steve was sent for a CT angiogram scan, and shortly thereafter Ruxandra Costa, M.D., a neurologist based at the hospital, told Amy that Steve had suffered a vertebral artery dissection—a spontaneous tear in an artery in the neck—and it had caused a stroke. Vertebral artery dissections make up just 2 percent of ischemic (clot) strokes and can be brought on by sudden neck movements, sneezing, coughing or vomiting. A blood clot at the site of the tear in Steve’s artery would need to be removed with emergency surgery called embolectomy.

At this point, Amy understood the gravity of her husband’s condition.

“Dr. Costa told me, ‘He may not survive this procedure, but he’ll definitely die if he doesn’t have it,’ ” she recalls. “And then she just kept telling me how Dr. Zylak is the best.”

Clearing the Blood Clot

Neurointerventional radiologist Christopher M. Zylak, M.D., of Inland Imaging, PS, performed the embolectomy. He inserted a device called a clot retriever into an artery in Steve’s leg and threaded it to the blockage in Steve’s brain. Dr. Zylak then opened the device inside the clot and pulled it out, while a balloon catheter kept clot fragments from traveling back to the blockage site.

Steve’s embolectomy was a success. He woke up “feeling 90 percent” in the intensive care unit, under the watch of physicians and nurses specializing in stroke. He went home 48 hours after surgery and returned to work the next day. Amazingly, Steve didn’t have any physical disabilities or cognitive defi cits, such as paralysis, pain, irritability, forgetfulness, or problems with speech, balance or motion control.

“Without this treatment, he would have been devastated from a neurologic perspective,” says outpatient neurologist Elizabeth Walz, M.D. “But Steve had full resolution and was back to work within several days.”

Success After Surgery

Besides embolectomy and other medical treatments for stroke, Providence’s stroke program owes its success to what happens after the procedure. Rather than simply being released with instructions to contact his primary care physician, Steve was referred to Dr. Walz for outpatient care.

“After patients have had a stroke, we make sure that they’re getting the therapies they need, make sure we’ve addressed all their stroke risk factors and follow up on any testing that may be pending from the hospital,” she says. “Through this program, we’ve been successful at preventing further stroke.”

Thanks to his care, Steve is back to his normal routine—he’s competing in an enduro race this summer—and enjoying life with his busy family.

“I am very grateful for Dr. Zylak,” he says. “The credit really has to go to him and my wife for saving my life. Without them doing what they did, I wouldn’t be here.”

What is a “Code Stroke”

“Code stroke” is an emergency protocol implemented at Providence Sacred Heart Medical Center and Holy Family Hospital to provide all stroke patients with the care they need as quickly as possible.

Every time a stroke is suspected, a paramedic in the field or someone on the hospital emergency team calls a code stroke, setting into motion a lifesaving chain of events: “We have rapid evaluation by an emergency physician as well as a stroke neurologist, and then expedited transport to CT scan or MRI for imaging,” says Daniel Getz, D.O., medical director of the Sacred Heart emergency department. “An emergency technician does a blood draw and expedites lab work, so we can get results as soon as possible. And we have clinical pharmacists involved from the beginning, preparing medication, so the second a neurologist says to administer it, we have it ready to deliver.”

Sacred Heart’s stroke protocol is so successful, it’s used as an example for other hospitals. Dr. Getz says, “People come from all over the West Coast to tour our facility to learn how to replicate our code stroke process.”

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AK: Providence Alaska Neuroscience Center

CA: Providence Neuroscience Services

MT: Providence Neurology Specialists

OR: Providence Brain & Spine Institute

WA: Providence Neurology; Swedish Neuroscience Institute; Kadlec Neuroscience Center; Spokane Neuroscience Institute

 This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.