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I'm Dr. Coleman Martin an interventional neurologist at the Saint
Luke's Marion Bloch Neuroscience Institute.
This is Interventional Stroke Rounds. Today's patient tells her own story
My name is Bonnie
I am 26, no, 27 years old.
and I got I was on my way
I was on my way to work Friday morning
and I got into a car accident. I ran into a
FedEx truck. My car is Totaled. After the accident I can picture
the air bag and I can picture my foot being broken. But that is all.
Bonnie was stabilized at another hospital and underwent reconstruction of
her ankle.
The accident injured her spleen but she seemed to be stable until
a new problem started.
I was having stroke and I couldn't use
the right side of my body.
They say my face was drooping.
Bonnie had an injury of her left carotid artery.
Arteries are composed of three layers the innermost innermost intima,
the muscle layer media and the outer adventitia. If we look at the artery in
longitudinal section
we can see the blood flows along the intima. A severe injury such as a car
accident can compress the artery and tear the intima.
As the blood flows up
the carotid a blood clot in the artery wall grows.
This condition is called a carotid dissection and it is a common cause of
stroke in young people.
The dissection narrowed her carotid artery
and limited blood flow to the left side of her brain. Let me introduce her trauma
surgeon Dr. Beggs.
When Bonnie arrived she did not look good.
She was in obvious shock and we were concerned about her carotid injury.
We also know she had a splenic injury. We rushed bonnie to the CT scanner.
The brain CT suggested that we were early in the stroke.
To make sure that the brain tissue was still salvageable
we obtained a CT perfusion scan. The blood was slow in entering the left hemisphere
but eventually it did arrive.
A good sign. We also scanned Bonnnies abdomen and pelvis.
her radiologist Dr. Andresen joined us in the scanner control room.
You can see a large amount of blood associated with her spleen.
and that is consistent with a shattered spleen which is a surgical emergency.
Bonnie what you remember about your arrival at Saint Luke's?
I remember being in the bed and being wheeled into a room
with the people in it.
I couldn't really see the people. I could see that there were people there,
but I could not see a whole person at once.I could only see part of a person. Because the
stroke was the more immediately threatening up the two problems we whisked
Bonnie to the neurointerventional operating suite.
There I asked my partner Dr. Holloway to join me
It is helpful to have two physicians who routinely
perform these types of procedures during an emergency,
because one physician can assist
and prepare devices likes stents
and catheters and wires while the other
physician gets the catheter in to place. This allows the procedure to be done much more rapidly.
Working from the groin artery, we passed a catheter to the left common
carotid artery
This angiogram picture shows the carotid dissection.
Here it is again: viewed from ninety degrees.
The artery open nicely with stenting.
And immediately after the carotid artery was
stented, we took her to the operating room and removed her spleen.
Bonnie, any neurological problems since our work?
Not since the surgery.
The next day our rehabilitation specialist Dr. Steinle came to see Bonnie.
We were able to start therapy while she was in the ICU.
We addressed her orthopedic rehab needs as well as looked for any kind of subtle deficits
that she might have had from her carotid dissection. Once she was medically stabilized
she was admitted to our comprehensive rehabilitation program where she
remained in hospital for 3 weeks.
At that point we're able to discharge her to outpatient therapy
back in her home state.
Thank you Bonnie for telling your story. Complex cases require a crack team of
specialists.
I'm proud to be a member of the team at the Saint Luke's Marion Bloch
Neuroscience Institute.