Thanks to some quick thinking by a patient, effective teamwork and new medical technology, a 28-year-old Central Texas man is well on his way to recovery from a devastating, usually fatal ischemic stroke.

Joe Shin loves basketball, a sport that is physically demanding. But during an early April 2009 pick-up game with some friends, Joe realized what he was feeling went beyond simple fatigue. Weakness, dizziness, difficulty speaking. At age 28, he was having a stroke.

Joe asked his friends to call 9-1-1, a quick and crucial decision that Dr. Neal Rutledge, chair of the Seton Family of Hospitals Stroke Committee and Setons medical director of neuroradiology for the Seton Brain & Spine Center, wishes more people would make. If someone is having the classic symptoms of stroke, getting to a hospital quickly is vital.

Joe was taken to Seton Medical Center Austin, where a CT scan revealed a large clot. He was immediately given the clot-busting drug, t-PA. Dr. Rutledge then chose a new device called the Penumbra System that uses endovascular catheter-guided technology to break up and remove the clot restoring blood flow back to the patient's brain.

Before the development of clot-busting drugs and Penumbra, Joe might have faced life in a wheelchair - or death. "I had visions of being paralyzed for the rest of my life and didn't know what to think. I definitely didn't expect to walk out of the hospital just five days later," adds the patient.

Expanding the Window

Time is the most important factor in determining how well a patient can recover from a stroke. Like heart attack patients, individuals often postpone seeking treatment because they believe the condition will go away on its own.

The type of blood clot Joe had is a bad one, typically fatal or else the patient survives in a vegetative state. Most patients do not get to the hospital in a timely manner for treatment. Knowing when to call 9-1-1 is key, believes Dr. Rutledge. He says to remember the word FAST:

• Is there asymmetric Facial weakness?
• Arm weakness?
• Difficulty Speaking?
• Then it's Time to call 9-1-1.

He describes the urgency for immediate stroke care in terms of windows. Clot-busting drugs have expanded the treatment window to three hours. Newer tools like the Penumbra System expand that window to eight hours.

Doctors at the Brain & Spine Center participated in the initial clinical trials for the Penumbra device. It was FDA-approved in January 2008. He and other interventional neuroradiologists at the Brain & Spine Center received specialized training on the Penumbra System that allows them to use the device within the Seton Family of Hospitals. "Fortunately for this patient, the Brain & Spine Center is one of a very few stroke programs in the country offering this treatment," says Dr. Rutledge.

Researchers at Setons Brain & Spine Center are exploring other ways of expanding the stroke treatment window to 14 hours.

Symptoms of Stroke

According to the American Stroke Association, warning signs of stroke include:

• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
  
  
• Sudden confusion, trouble speaking or understanding
  
  
• Sudden trouble seeing in one or both eyes
  
  
• Sudden trouble walking, dizziness, loss of balance or coordination
  
  
• Sudden, severe headache with no known cause

If one or more of these signs occur, don't wait, take action. Don't ignore them and hope they go away. Quick thinking and taking action gave Joe Shin back a normal life.

J. Neal Rutledge, MD
Neurointerventional Surgery, Radiology
Austin Radiological Association

Medical Park Towers
1301 W. 38th Street, Ste 113
Austin, TX 78705
Phone: (512) 926-3876

Dr. Rutledge received his medical training at the University of Oklahoma Health Sciences Center, then was a resident at Baptist Medical Center in Oklahoma City. He was a diagnostic and interventional neuroradiology fellow at Columbia Presbyterian Hospital Neurological Institute in New York City. He is board certified in neuroradiology by the American Board of Radiology and a member of the American Society of Therapeutic and Interventional Neuroradiology, American Society of Neuroradiology, American College of Radiology and the American Medical Association.