Mrs. Frances Jalet-Miller awoke at 5:00 a.m. on Sunday, February 23, 2014, and went to the kitchen for a glass of water. As she got back into bed, she felt a strange sensation in her head. Now in her 60s, Mrs. Jalet-Miller had been living with migraines since her teenage years. However, this was not a typical headache. She described it this way: “The headache seemed to occur so suddenly, like a gunshot.”
In addition to the sudden pain in the front of her head, Mrs. Jalet-Miller was also having trouble reading the labels on her pill bottles – she was unable to put the right and left halves of the words together. She decided to go back to sleep hoping the headache would simply go away. That she might be having a stroke never crossed her mind.
When Mrs. Jalet-Miller awoke two hours later, the headache was still there. She decided to get out of bed and begin her day. She sat down at the computer to check her email and discovered that she was having trouble reading the words on the screen.
Mrs. Jalet-Miller phoned her primary care physician’s office and was told to go to the Mount Sinai Urgent Care Center on the Upper West Side. On arrival, she described her symptoms, and, after a quick exam, the doctors informed her that based on her head pain and visual symptoms, she needed to be seen immediately at the Mount Sinai Emergency Department because she might be experiencing a stroke.
“When I first took a pill that morning for the headache, I had no suspicion whatsoever that I might be having a stroke. It never entered my mind. Why? I guess because I have none of the typical risk factors: I am not overweight, I exercise, I never have smoked, and I do not drink.”
The Mount Sinai Stroke Team: Mobilized and Ready
Mrs. Jalet-Miller and her husband arrived at the Mount Sinai Emergency Department where the Stroke Team was mobilized and ready. After a series of tests, including an MRI (magnetic resonance imaging of the brain), the doctors told Mrs. Jalet-Miller that she indeed had experienced a very mild stroke. She was admitted to the Mount Sinai Stroke Unit for observation and further testing.
The Mount Sinai Stroke Center: Comprehensive Care and Finding the Cause of Stroke
The Mount Sinai Stroke Center provides comprehensive, interdisciplinary care. As one of the first stroke centers in New York City, the Stroke Center has pioneered major advances in medical therapies and neurosurgical techniques to treat strokes. For Mrs. Jalet-Miller, this meant that the Mount Sinai Stroke Team was determined to find the possible cause of her stroke. Stanley Tuhrim, MD, the Director of The Mount Sinai Stroke Center explained it this way: “There’s more to stroke care than just treating the stroke. We need to find the cause – which may be complex – so we can prevent it from happening again.”
The doctors explained to Mrs. Jalet-Miller that her stroke was an “ischemic stroke,” caused by an embolism (blood clot) lodging in the vessels of her brain. Extensive tests, including an echocardiogram (ultrasound of the heart), revealed a patent foramen ovale (PFO), or a “hole in the heart.” Before birth, hearts have communication passages between the two upper chambers. This passageway closes after birth, but, in a small percentage of people, it remains open. In addition, small growths were found on her heart valve. Either one of these abnormalities may be a source of emboli (blood clots or bits of tissue). These emboli may travel up to the brain and cause a stroke. In the final analysis, the Mount Sinai Stroke Team informed Mrs. Jalet-Miller that the cause of her stroke remains unclear.
Life After Stroke: Knowledge is Power
Mrs. Jalet-Miller’s post-stroke care is focused on the prevention of a second stroke. According to Dr. Tuhrim, “Ninety-five percent of stroke prevention is in the patient’s hands.” In addition to Dr. Tuhrim, Mrs. Jalet-Miller’s team at Mount Sinai consists of cardiologists and a headache specialist (neurologist) who will help her determine the best path forward. While Mrs. Jalet-Miller is taking an oral medication that helps prevent future blood clots, she is also determined to reduce the stress in her life. She believes that, “Knowledge is power and having a compassionate team of physicians that is willing to help me make informed decisions is so important to me.”
After her stay at the Mount Sinai Stroke Unit, Ms. Jalet-Miller took the time to send a letter praising the care she received, including from two especially “approachable, warm, and helpful” neurology residents.
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