Lucky Stroke Survivor Was in the Right Place at the Right Time

There is never a good time to suffer a massive stroke but for 35-year-old Meisha McIntosh, R.N., it couldn’t have happened in a better place. It was Wednesday, January 3^rd and the registered nurse was checking on patients in the stroke unit at Baptist Health Baptist Hospital, known as “Four Hope” because of its location on the fourth floor of the hospital’s Hope Tower.

“Someone had come to tell me that one of my patients was trying to get out of bed and I went to their room to assess the situation,” recalls Ms. McIntosh, who lives in Miramar with her mother, a nurse practitioner, and her grandmother. “The next thing I know, I woke up on the floor surrounded by my colleagues. I was extremely confused. I had no idea what was going on. People were asking me a lot of questions. I remember I wasn’t able to respond.”

(Watch now: There is never a good time to suffer a massive stroke but for 35-year-old Meisha McIntosh, R.N., it couldn’t have happened in a better place. See how her Baptist Hospital colleagues acted fast to save her life. Video by Gort Productions.)

Fortunately for Ms. McIntosh, her colleagues on Four Hope recognized right away that she was having a stroke, a “brain attack” that occurs when a blood vessel that supplies blood to the brain is blocked by a blood clot or when a weakened blood vessel in the brain bursts.

According to the National Institutes of Health (NIH), stroke is the third leading cause of death and a leading cause of adult disability in the United States and worldwide. On average, someone in the U.S. has a stroke every 40 seconds and someone dies from a stroke every three to four minutes.

Ms. McIntosh was immediately transported to the emergency department, where a stroke alert was initiated. This action starts the clock on a rapid-fire series of assessments, scans and interventions from Baptist’s specially trained team of doctors, nurses, radiologists and technologists.

Baptist Hospital is certified by The Joint Commission as a comprehensive stroke center, the nation’s highest level of stroke accreditation. To earn the designation, hospitals must provide a full spectrum of quality stroke care – including diagnosis, treatment and rehabilitation – and be able to treat any stroke or complication 24 hours a day, seven days a week.

Why strokes need to be diagnosed and treated quickly

What happens in the minutes and hours following a stroke can mean the difference between facing a lifetime of disability or walking out of the hospital on your own two feet. Neurologists refer to the period of time when a stroke can still be treated before the brain suffers lasting injury – usually less than three to four hours – as the “golden window.” At a comprehensive stroke center like Baptist Hospital’s, everyone understands that time is of the essence.

Ms. McIntosh says she doesn’t recall much of what happened but colleagues helped fill in the blanks in her memory of that day. “I knew I had a right-sided weakness and I wasn’t able to speak. Being a nurse here, you understand what that means,” she says. One of Ms. McIntosh’s colleagues who assisted with her initial evaluation was Monique Sanchez, R.N., a nurse on the B.E.S.T. (Baptist Emergency Response Team) stroke response team.

Monique Sanchez, R.N., a nurse on the B.E.S.T. (Baptist Emergency Response Team) stroke response team, helped assess her colleague, Meisha McIntish, R.N., who suffered a stroke while on duty

“I immediately assessed her and from what I could see she was having a stroke. She had right-side facial droop and her colleagues were propping her up in the wheelchair because she was leaning over to one side more,” recalls Ms. Sanchez. “I was extremely concerned about her condition, as strokes can be life threatening and life altering, and I wanted her to get the immediate medical attention and appropriate care she needed.”

Ms. Sanchez called in Interventional neuroradiologist Guilherme Dabus, M.D., co-director of interventional neuroradiology and vice-chief of neuroscience at Baptist Health Miami Neuroscience Institute.“When I saw Meisha, she was suffering an acute, potentially devastating stroke known as a large vessel occlusion in the left side of her brain,” says Dr. Dabus. “This was affecting her speech and the entire right side of her body.”

Different options for treating acute ischemic strokes

Dr. Dabus says that it’s rare for someone Ms. McIntosh’s age to suffer such a devastating, massive stroke. “It’s usually something that happens in older patients, particularly patients with heart problems. However, sometimes it can also happen in young patients.”

                                                                                                                                                                                                               Guilherme Dabus, M.D., co-director of interventional neuroradiology and vice-chief of neuroscience at Baptist Health Miami Neuroscience Institute

Ms. McIntosh was given an injection of the clot-busting thrombolytic medication tenecteplase (TNK) but Dr. Dabus says such medications don’t always work as well with these types of strokes because the clot is simply too big.

“With an acute ischemic stroke such as Meisha’s in which the brain is blocked, a lot of times thrombolytics will not work very well. The patient’s best chance is for us to do a catheter-based procedure called a mechanical thrombectomy,” he says. The procedure is used to treat some patients with ischemic stroke which, according to the Stroke Association, is the most common type of stroke caused by a blood clot cutting off blood flow to part of the brain.

Dr. Dabus calls mechanical thrombectomy a “very powerful” treatment. “We use a specially designed clot-removal device that we insert via a catheter in the patient’s groin and navigate to the part of the brain where the vessel is blocked,” he explains. “We then extract the clot and insert a tiny stent to restore blood flow and get that part of the brain starting to work normally again.”

The Stroke Association says that, when used with other medical treatments available from a comprehensive stroke center, “evidence shows thrombectomy can significantly reduce the severity of disability a stroke can cause.” It is able to remove clots which are too big to be broken down by clot-busting drugs and is therefore effective in preventing and reducing long-term disability in people with severe strokes.”

The Association goes on to say that, as with clot-busting drugs, “thrombectomy is most effective the faster it is used following a stroke and it is normally only performed up to six hours after symptoms start.”

A scan of Meisha McIntosh's brain shows the clot that led to her acute ischemic stroke earlier this year

Immediate improvement following mechanical thrombectomy

Many stroke patients who undergo a mechanical thrombectomy will have some function restored instantly. For Ms. McIntosh, the result was dramatic. “As soon as the vessel was open again, she was able to move her right side and follow commands,” Dr. Dabus says. “And as soon as the tube was removed for her mouth, she was basically talking normally again.”

Following her procedure, Ms. McIntosh remained in the hospital for about a week. She remembers waking up in the ICU with a tube in her throat. Her mother, a nurse herself, was there at her bedside and told her what had happened.

“I remember immediately wanting the tube out because I had so many questions,” she recalls. “My mother started doing a mini clinical assessment on me, asking me to do a series of tasks: ‘Lift your arm. Lift your leg. Squeeze my fingers.’ Even though I couldn’t speak because of the tube, she wanted to make sure I was able to move.”

Just two months later, Ms. McIntosh was already back at work on Four Hope. “It took me a couple of months to fully recover but I don’t have any limitations or deficits now. I’m back to work and I think I’m 100 percent,” says the nurse, noting that she has a family history of hypertension, or high blood pressure, which is a risk factor for stroke.

Being in the right place at the right time when she suffered her stroke, Ms. McIntosh considers herself a very lucky person. “I think my whole unit was pretty much stunned at what happened but working in a comprehensive stroke center pretty much saved my life,” she says. “If I worked somewhere where I had coworkers who didn’t recognize my symptoms, things would have been completely different,” she says.

Dr. Dabus says Ms. McIntosh is “truly a success story” and agrees that she was very lucky. “When you have that type of stroke, with the type of severe blockage that she had, a lot of patients unfortunately still don’t do well. Even if everything is done quickly and the treatment is performed successfully, roughly half of all stroke patients still will either die or be severely disabled.”

How to reduce your risk of stroke

In addition, Dr. Dabus says, 30 percent of all patients who survive a stroke don’t ever get a final diagnosis as to what caused it. Although the exact cause of Ms. McIntosh’s stroke is as yet undetermined, he says she now is being followed for secondary stroke prevention.

Noting that more than 90 percent of the global stroke burden can be traced to the modifiable risk factors of blood pressure, diet, physical inactivity, smoking, and abdominal obesity, both the American Heart Association and American Stroke Association published updated guidelines for preventing recurrent ischemic stroke, focusing on overall cardiovascular risk reduction and targeted secondary prevention.

Post-procedure care following a stroke is important

Dr. Dabus credits Baptist Hospital’s B.E.S.T. stroke nurses, such as Monique Sanchez, for expediting Ms. McIntosh’s care.

“When a stroke patient comes to the hospital, our nurses are trained specifically to take care of them and navigate them as quickly as possible to the right treatment, all while communicating with the neurologist and many other people on the team,” Dr. Dabus says. “What they do is truly amazing. They’re a critical part of what we do and I think it’s a big part of why our patients do so well.”

Dr. Dabus points to the post-procedure care offered by Baptist Hospital as another factor for the number of patients at the hospital who have successful outcomes following a stroke. “Post-procedure care is extremely important and one of the criteria that sets Baptist apart as a comprehensive stroke center,” he says.

Ms. McIntosh says she is so thankful for Baptist Hospital and calls the care she received there “absolutely amazing.” She credits her colleagues and Dr. Dabus for giving her a chance to lead a normal life.

“Dr. Dabus was great. He’s remarkable, really. You can tell that he truly cares about his patients,” she says. “Knowing all the people who were taking care of me was definitely a relief because I knew that they were good at what they do. I think within 30 minutes of them recognizing my symptoms, I was getting the intervention I needed.”

How to recognize the symptoms of stroke

As both a stroke nurse and a patient, Ms. McIntosh says that knowing the signs and symptoms of stroke is important so you can get help quickly – even if you’re not lucky enough to be working in a stroke unit.

Stroke symptoms vary and can include severe headaches and fainting or loss of consciousness, as in her case. But according to Ms. McIntosh, F.A.S.T. is an easy way to remember the most common signs of stroke:

F: Face drooping. One side of the face is drooping or numb, or the smile is uneven.

A: Arm weakness. One arm is weak or numb. One arm may drift downward when both are lifted at the same time.

S: Speech difficulty. Slurred speech, difficulty speaking, inability to repeat a simple sentence correctly when asked.

T: Time to call 911. Call 911 immediately if you or a loved one experiences the above symptoms. If possible, write down when the symptoms first appeared so you can share this information with doctors.

As for Monique Sanchez, who was among the first to assess Ms. McIntosh following her stroke, she feels fortunate to be working in a setting where she can have a positive impact on someone’s life.

“When I go home, I feel like I’ve made a difference, as little as it may seem,” says Ms. Sanchez. “Meisha may not remember her time with me when she first came in, but she does remember the impact that I made, because of her being able to walk out of here after one week and make the progress that she’s made.”