‘Amazing’ care for hemorrhagic stroke
In the spring of 2018, Adrienne Pechy experienced a headache unlike any she had ever had. “It felt like my head was going to explode,” recalls the Coatesville resident, who was 51 at the time.
Puzzled as she was by the intensity of her headache, Pechy was also vomiting. She had just eaten dinner, so she supposed she might have food poisoning or even a stomach bug. She decided to ride things out at home.
Twenty-four hours later, Pechy asked her mother to drive her to urgent care at the Main Line Health Exton Square. There, after a flu test came back negative, Pechy was advised to go to the emergency room. At Paoli Hospital, part of Main Line Health, a CT scan of her brain showed that she had suffered a hemorrhagic stroke.
No time to lose
Pechy’s stroke was caused by an aneurysm, a bulging weak spot in the wall of an artery, which had burst and bled into the space surrounding her brain. This type of stroke is known as a subarachnoid hemorrhage. The blood pooling around the brain increases pressure on the brain and damages brain cells. Without prompt treatment, a subarachnoid hemorrhage can cause permanent disability or death.
“Fifty percent of patients having a subarachnoid hemorrhage do not make it to the hospital,” says Michelle J. Smith, MD, FAANS, system chief of neurosurgery and medical co-director of the neuroscience service line at Main Line Health. “Of those who do, one-third will survive with a good outcome, one-third will have a disability and one-third will die.”
Pechy needed treatment to relieve the pressure on her brain and prevent the aneurysm from bleeding again. She was rushed by ambulance to Bryn Mawr Hospital, part of Main Line Health, where Dr. Smith placed a temporary device inside her head to alleviate the pressure. Neuro-interventionalist Nabeel Heriel, MD, MPH, then performed a minimally invasive procedure called endovascular coiling to block blood flow to the aneurysm.
But Pechy was not out of danger yet. She soon developed additional brain bleeding causing significant brain swelling and needed more invasive surgery.
Dr. Smith performed a hemicraniectomy, removing part of Pechy’s skull so she could remove the blood and enable Pechy’s brain to safely expand. A few weeks later, she performed a second surgery to secure the bone back into position. Dr. Smith also removed the device, draining the excess fluid around Pechy’s brain and implanting a shunt, which moves the fluid to another part of the body where it can be absorbed.
Rehabilitation for memory, balance
Pechy spent three weeks in Bryn Mawr Hospital’s intensive care unit. She was then transferred to Main Line Health’s Bryn Mawr Rehabilitation Hospital, where she received inpatient physical, occupational and speech therapy.
“Adrienne came in functioning at a fairly high level,” says speech therapist Jessica Wardell, MS, CCC-SLP. “She had mild cognitive deficits in the areas of memory, problem-solving and speed of information processing. She needed help walking and also received therapy to improve her balance and coordination and regain daily living skills. She was definitely motivated, and she made quick progress.”
Getting her life back
Pechy continued to improve during eight more weeks of outpatient rehabilitation. Four months after her stroke, she began transitioning back to her job as a project manager for a cancer research biotech company. Now 53, she’s doing great and staying active with her 13-year-old daughter, Hannah.
“I’m very fortunate—I’m alive,” Pechy says. “This could have gone a completely different way. I’m here and doing well because of the great care, support and positive reinforcement I received from my doctors, nurses and therapists. Everyone who helped me along the way has been amazing.”
Stroke: Know the risks and symptoms
Some risk factors for stroke can’t be changed. But up to 80 percent of strokes could be prevented with healthy lifestyle changes—eating well, exercising regularly and quitting smoking. Another key is working with your doctor to control health conditions such as diabetes, heart disease and hypertension.
It’s important to know the signs of a stroke and get help immediately. Treatment is most effective when started right away.
Bryn Mawr Hospital was recently certified by the Joint Commission as a thrombectomy-capable facility. The Joint Commission, in collaboration with the American Heart Association/American Stroke Association, now provides an advanced stroke certification for Thrombectomy-Capable Stroke Centers in response to the need to identify hospitals that meet rigorous standards for performing endovascular thrombectomy.