Emergency response systems and hospital care in the Department of Neurology, the UCLA Stroke Service and UCLA Health are optimized for rapid treatment. However, the moment of action in stroke can demand an even faster response. UCLA Neurology partnered with Henry and Arlene Gluck to capture that extra element of time. This recent case shows how such a system works.
A 40-year-old woman was at the dentist office for a minor procedure. While there, her right eyelid began to droop. Dental office staff immediately called 911. After hearing the symptoms, the LA County Fire Dispatcher was concerned that this could be a sign of stroke and dispatched the Henry and Arlene Gluck Mobile Stroke Unit. Upon arrival, the team was able to begin assessment and treatment from the Mobile Stroke Unit, right outside the dental office. The paramedics determined that the patient’s symptoms could be related to the dental anesthesia and procedure. The UCLA neurologist in the Mobile Stroke Unit, Dr. May Nour, was concerned that this might instead be the first sign of a larger stroke. She examined the patient and found subtle right arm weakness and left-sided face weakness – possible signs of the start of a progression to a larger stroke. Soon additional symptoms developed with new weakness in the right leg. Dr. Nour considered treatment to break the clot, however the patient noted that she may have had a diagnosis of a cerebral aneurysm in the past, but wasn’t sure. An aneurysm can bleed into the brain, and a clot-busting agent such as tPA (tissue plasminogen activator) cannot be given if an aneurysm is present. The technology in the Mobile Stroke Unit allowed the team to not have to take a risk -- the team imaged the patient’s brain blood vessels in the CT scanner of the Mobile Stroke Unit and saw that the patient did not have an aneurysm and could be treated with tPA. After being transported to a local hospital, she made a remarkable recovery, and literally walked out of the hospital as she was discharged home.
The concept of Chronos, the hourglass of time, drives the urgency of stroke treatment. But it is the concept of Kairos, the perfect moment to act, that guides a Mobile Stroke Unit.