It can happen to anybody

Tom Chivington and his wife Georgie were always the picture of excellent health. "I've always been very healthy and in shape. My vocation was as a men's tennis coach at Foothill College," says Tom. "We ski, we go to the gym. I jog, ride bicycles, all of it. I wasn't a candidate. I had a very good cholesterol count, very normal blood pressure, not high at all. I guess what I'm saying is – it can happen to anybody."

Frequent travelers and avid sports enthusiasts, the couple had been taking advantage of their retirement years with time spent in Molokai, Tahoe, Burma and elsewhere. One day in January of 2005, Tom was alone at the couple's Woodside home. "I was downstairs at a file cabinet and had some dizziness," Tom recalls. "I couldn't walk and my balance was off; I just felt uncoordinated. So I called 911. I knew to do that because a week before I'd had a minor incident, a TIA."

A TIA, or transient ischemic attack, is caused by a temporary interruption in the blood supply to the brain. These "mini-strokes" are accompanied by the same symptoms as a stroke—sudden dizziness, numbness or lack of coordination. The symptoms occur rapidly and last a relatively short time, usually from a few minutes to several hours, always with complete recovery within 24 hours. Even though the symptoms do not last, TIAs can be a warning sign for an impending stroke and should be evaluated on an urgent basis.

"Urgent evaluation of TIA symptoms is extremely important. It is estimated that 20% of patients suffering a TIA will go on to have a stroke within 90 days, and one half of those will have a stroke within the first 24-48 hours," explains Connie Wolford, TIA Nurse Coordinator for the Stroke Clinic at Stanford Hospital. "A timely and complete medical evaluation of a TIA provides an opportunity to identify the cause of the interruption in blood flow and initiate treatments before a debilitating or fatal stroke occurs."

Is it a stroke?

A stroke (also called a cerebrovascular accident or CVA) occurs when blood vessels carrying oxygen and other nutrients to a specific part of the brain suddenly burst or become blocked. When blood fails to get through to the affected parts of the brain, the oxygen supply is cut off, and brain cells begin to die. Blood supply to the brain is very important. Brain cells must have a continuous supply of oxygen and other nutrients from the blood in order to function. When the blood supply is disrupted, a stroke results. Clinicians at Stanford Hospital's Stroke Clinic are working to reduce the long-term affects of stroke.

The Stanford Stroke Center's TIA Clinic is one of the newest lines of defense for people at risk for stroke. Officially established in 2006, the TIA Clinic has developed an innovative approach to patient assessment and treatment that provides personalized care for TIA patients judged to be at low risk for an imminent stroke. Patients arriving in the Stanford Hospital Emergency Room with symptoms of TIA or stroke receive an initial assessment by a Stroke Center physician. Approximately 60% of TIA patients can now avoid hospitalization and have urgent follow-up care provided in the TIA Clinic. "Being treated at our Emergency Room for a stroke can make the difference between full recovery and permanent disability," says SHC President and CEO Martha Marsh.

Knowing the signs

Tom's knowledge of the warning signs of stroke quite possibly saved his life – and his swift action increased his chances of recovery. Sings of a stroke include sudden weakness, numbness or paralysis of the face, arm or leg (especially on one side of the body); sudden difficulty talking or understanding others; sudden loss of vision; sudden, severe headache with no apparent cause or unexplained dizziness, loss of balance or coordination.

Unfortunately, patients often do not seek help for a day or more after the first symptoms appear. By that time, it is usually too late for treatments to be effective. Recognizing and responding to the warning signs of stroke—as soon as they appear—offers the best chance for an optimal recovery.

Timing is everything

Every second the brain survives without blood flow, damage is occurring. When paramedics arrived at Tom's house, they began treating him right away. Calling an ambulance, rather than having someone close by take him to the hospital, also saved precious time when Tom arrived at the Stanford Hospital Emergency Department.

"They called me at the gym down in Menlo Park, so I actually got there before he did,"says Georgie Chivington, who was not at home when her husband first experienced stroke symptoms. "Dr. Albers and the team, they were there already, waiting for him. He actually had the stroke in the hospital."

"Tom and Georgie did what we wish everyone who experiences stroke symptoms would do – they called 911", says Dr. Greg Albers, the Director of the Stanford Stroke Center. "Tom received clot-busting medication in the emergency room followed by additional therapy administered by a catheter directly into the blood clot that was causing his stroke. Tom's stroke was one of the most dangerous types and very difficult to treat; he had a clot blocking the blood flow to his brainstem."

"I had the major part of it in the hospital," says Tom. "I had all these symptoms. At first, you just have dizziness, something that maybe if you weren't really aware you would wait and wait and wait. Then all of a sudden I got into the emergency room and I started experiencing the double vision and the slurred speech and the paralysis started to set in. The paralysis started on my left side and then went to the right side."

"We were so lucky that we were here and had access to the best care," says Georgie. "We had been skiing, we'd just come home. Last January we were off the southern coast of Burma. How lucky can you get? We feel so good that we're close to Stanford and the Stroke Center there."

"The fact that he arrived early and the stroke progressed while he was already in the hospital allowed us to use treatments that would not have been safe to employ if he had not arrived so quickly," agrees Dr. Albers.

Treatment and recovery

The Stanford Stroke Center is one of the first comprehensive, multidisciplinary centers of its kind. Established in 1992 to develop new approaches to diagnose and treat stroke, the Stroke Center is comprised of neurologists, neurosurgeons, neuroradiologists, nurse specialists, basic scientists, and clinical researchers. The Stanford Stroke Center team works to significantly improve the chances that a patient can prevent, or recover optimally, from a stroke. They work closely with the occupational therapists at Stanford Hospital to provide full rehabilitation services to stroke survivors.

"The best thing that Greg Albers ever did for me, was what he told me. Not long after the stroke, he leaned down and said to me 'you know, you can recover from this.' And at that point I was wondering if I ever could" says Tom. "There's more to it than the physical care, which is outstanding, obviously. Hope was given and that made a tremendous difference."

It took a year for Tom to fully recover from his stroke. With the dark days behind him, he and Georgie have gotten back to life as usual, resuming their travel schedule and staying active. An avid fisherman, Tom is able to take his boat out again. "I know how lucky I am, to have fully recovered," Tom admits with a smile. "I do everything I want to do, and you probably wouldn't ever tell I had a stroke. Having a positive attitude is a real key."

It took a year for Tom to fully recover from his stroke. With the dark days behind him, he and Georgie have gotten back to life as usual, resuming their travel schedule and staying active. An avid fisherman, Tom is able to take his boat out again. "I know how lucky I am, to have fully recovered," Tom admits with a smile. "I do everything I want to do, and you probably wouldn't ever tell I had a stroke. Having a positive attitude is a real key."