Piedmont Midtown sees several stroke alert patients daily, but not every day are we able to intervene or treat with medication depending on the circumstances with each patient. Recently, there was a 39yr old female who presented to the Emergency Department via EMS as a possible stroke. The stroke team evaluated the patient at the back door and noted her last known well time to have been at 10 pm the night before when she went to bed. She was excluded at this time for treatment with the clot busting drug.

The patient was expedited to CT and upon initial assessment with her nurse, Megan began to ask more detailed and pointed questions. The patient, a mother to a 2-month-old, was telling Megan about her baby when Megan realized, “oh wait, if you have a baby who got up and took care of the baby in the night?”. The patient stated she had gotten up with the baby every 2 hours from the time she went to bed until around 8 am when she had fixed the baby a bottle and laid him back down. She sat down and, from that point forward, was unable to get up and ambulate. Megan immediately contacted the ED provider to update him with these pertinent findings. The patient was re-evaluated and included for treatment with the clot-busting medication. Her initial stroke severity score was 13 which is considered a moderate stroke. She was treated and taken to IR for a mechanical thrombectomy, retrieval of the clot occluding blood flow in her brain. The clot buster, breaks the clot up allowing for the IR team to more readily remove this clot. After completion of the procedure, her stroke severity score was 0. All of her symptoms had resolved. The patient was discharged home, with no residual deficits, on day 3.

Without Megan's very detailed assessment and asking more questions, this patient may not have been able to be treated with Alteplase and her outcome could have been negatively impacted. Instead, she is back home with and was able to care for her baby. Kudos to Megan and the Stroke Team at Piedmont Midtown.