- Octogenarian’s Heart Stopped Thrice and Stroke Struck Twice
Chennai, January 7th, 2020: A 80 year old man from Pondicherry successfully survives two strokes and three cardiac arrests, due to timely intervention of an expert team of doctors from Gleneagles Global Health City. The expert team managed to revive the individual from a severe rare stroke, cardiac arrest and sleep apnoea which gave a new lease of life to the survivor.
Stroke is a medical and neurological emergency. Every minute after stroke approximately 2 million nerve cells die. TIME IS BRAIN. Timely recognition, transportation, and management by a comprehensive stroke team are of utmost vital importance said, Dr S Dinesh Nayak, Director and Head of the Department of Neurology, Gleneagles Global Health City.
Mr Sudesh (Name Changed), a 80 year old man presented with symptoms of stroke on right side of the body with inability to speak. Since the patient came outside the window period of stroke, for an appropriate treatment he was admitted for conservative medical management. To study his condition, the patient went through a detailed brain MRI scan which revealed scattered left brain acute infarcts with only single left carotid blood flow with 90 percent narrowing, which was managed appropriately with dual antiplatelets and statins.
As he had a medical history of cardiac angioplasty done in the year 2008, it was essential to handle the case with utmost care. Mr Sudesh began to respond well to medical management and was later shifted to the ward. On the fourth day of his admission, he became unresponsive, with cardiac arrest due to cardiac arrhythmia. He was immediately moved to the Neuro ICU where he was showing signs of mild right sided stroke symptoms with speech disturbances.
To assess his condition, the neuro team did a full CT angiogram of neck and brain vessels which showed calcified atheromatous plaque in the origin of the right ICA, completely blocking the lumen. The team was anxious as the previous MRI scan did not show any new infarcts. Calcified atheromatous plaque was previously seen in the origin of the left ICA, blocking 70 – 80% of the lumen. However, the scan showed the right carotid was also completely blocked.
Dr S Dinesh Nayak Director and Head Department of Neurology, Gleneagles Global health city Chennai says “Since the patient was thriving with a single left sided carotid flow to the brain and the right carotid was completely blocked, the decision of stroke intervention, benefit and risk of major stroke including stent related complications like stoppage of blood flow to brain and death were explained to the attenders”
To relieve the block, the patient underwent a procedure called angioplasty of left carotid neck vessels and was also got stented to remove the blocked segment with a self-expanding carotid stent. Post procedure angiogram revealed adequate dilatation of the stenosed segment. The patient experienced a sudden drop in conscious level with cardiac arrhythmia and hence was reintubated immediately.
The patient was later extubated and was on high flow nasal oxygen. The patient became normal without any intervention, but he was suspected to have Obstructive Sleep Apnoea (OSA). The patient was given appropriate medication to fight against the problem as sleep Apnea itself per se can be a confounding factor for stroke.
Dr N Praveen Chander , Stroke Neurologist, GGHC says“ Sleep study showed Severe sleep Apnea and significant nocturnal drop in oxygen saturation along with cardiac rhythm disturbances. Recurrent disturbed sleep due to sleep Apnea itself per se can be a confounding factor for stroke.”
This case illustrates the clinical decision making in an elderly 80 years old male who was thriving on a single blood flow to left side of brain, severe cardiac arrhythmia, three episodes of cardiac arrest was managed with the comprehensive stroke team including stroke intervention, neuro-intensivist, cardiac and pulmonologist care in a timely and bravado manner resulted in a lifesaving outcome said, Dr V Sathish Kumar, Senior Consultant & Stroke Neurology at Gleneagles Global Health City.
Finally, he was discharged with no new stroke symptoms but with mild speech disturbances with almost near normal walking stage, but with home Bipap machine at night for snoring.
