Lying on the couch after a long Monday might not be unusual for some, but it was for Richard Raposo. When his wife, Sandy, saw him fast asleep in the living room around 5 p.m. on May 23, she knew something was wrong.
“He was in a very deep sleep, which was unusual because he never naps,” Sandy recalled. “He woke up around 5:30 p.m. and didn’t look right. The right side of his face was drooping. He couldn’t talk.”
Sandy was certain Richard was having a stroke and called 911. The paramedics arrived and told her Richard would be taken to UF Health Jacksonville. “Richard came into the Emergency Department with right-side paralysis, facial droop and vomiting,” said Vicki Coppen, stroke program coordinator at the UF Health Neuroscience Institute – Jacksonville.
The staff in the ED knew they had limited time to stop the effects of the stroke or there might be irreversible damage. After lab work, a CT scan and additional radiographic imaging, Richard received a tissue plasminogen activator, or tPA, which is a concentrated dose of a protein used to naturally dissolve clots. It must be given within the first four-and-a-half hours after the onset of stroke symptoms.
“After he received a peripheral intravenous therapy tPA, he was admitted to the Neurosurgical Intensive Care Unit. He was then intubated for decreased mental status. After further evaluation, he was taken to the interventional suite for clot retrieval,” Coppen explained.
As the physicians worked, Sandy waited, hoping Richard would pull through. “I sat in the waiting room for a while when a doctor came out and told me there was brain swelling,” Sandy said. “They were waiting for the swelling to go down to determine the type of stoke he had.”
Richard was diagnosed with acute ischemic stroke. The following morning the physicians removed the clot in Richard’s brain. “He had the type of stroke that if left untreated, he would have been ‘locked in’ — meaning he would be unable to communicate,” Coppen said. “That’s when you know what you want to say and how to say it, but can’t get it out.”
This is common if stroke victims are not treated in time, and it’s one of the most frightening possibilities.
“I was terrified,” Sandy said. “I couldn’t believe it was happening. The doctor came out and showed me pictures. When I saw the before picture, I panicked. The clot was the size of the tip of your pinky. However, the after picture showed that the clot was the size of a pin top.”
After retrieving the clot, interventional radiologist James Cunningham, DO, told Sandy that Richard was able to squeeze his right hand. She knew then Richard would recover.
Coppen said that at his 30-day follow-up appointment, Richard met with neurologist Scott Silliman, MD, who noted he only had a slight change in his voice and an occasional gait change.
Now, only three months since the stroke, Richard has almost fully recovered. “When he first came home, he was weak and tired,” Sandy said. “Now he walks our 2-acre property down to the lake. He can do just about anything, but he has to consciously apply himself when doing things with his right side.”
Richard’s care is a great example of the multidisciplinary cooperation for stroke treatment that can only be found at an advanced, comprehensive stroke center.
“Richard’s stroke was very complex, and multiple medical disciplines were needed to manage his case,” said Wayne Hodges, a stroke educator at UF Health Jacksonville. “If you take everyone into consideration — EMS, Emergency Department staff, neurologists, neurointensivists, neuroradiologists and radiologists — there were probably 30 people working on his case within the first 24 hours.”
Richard and Sandy are extremely grateful for the care he received at UF Health Jacksonville. “It was outstanding,” Sandy said. “I would recommend UF Health to any stroke patient. As a nurse, it really impressed me that there was always someone from the neurology team with him through the entire process. They followed his progress every step of the way.”
Timing is critical when it comes to a stroke. During an ischemic stroke, blood flow to the brain becomes blocked and if left untreated will cause permanent damage. The UF Health Comprehensive Stroke Program provides inpatient and outpatient services for the diagnosis, management and rehabilitation of stroke patients. To learn more, visit UFHealthJax.org/stroke.
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Medical Director, Comprehensive Stroke Program; Program Director, Vascular Neurology Fellowship