June 15, 2017 | Justin Treas is a busy man. The 29-year-old has a Ph.D. in environmental toxicology and has worked in cancer research. He’s married with three children and just earned his medical degree from the UAMS College of Medicine. On March 28, 2017, Treas had a stroke that his doctors believe would have killed him if those around him hadn’t acted quickly and efficiently.
“I remember being with other students. The professors were teaching us about geriatrics,” Treas said. “I remember going outside because I wasn’t feeling well. Some friends came to check on me and quickly called Dr. Mendiratta. She took me to the clinic. They checked my glucose and other vitals. I was doing very poorly so they took me to the emergency department.”
Benedict Tan, M.D., listened as Treas recounted the events of that day.
“The fact that you can recall that much is very impressive,” Tan told his patient. “Once you see your CT scans, you’ll be impressed, too. Your clot was massive.”
Tan is the director of neurocritical care at UAMS, treating the most serious brain and spine cases in emergency and intensive care. He is the only neurointensivist in Arkansas.
“The stroke pager was activated, and we were called to the emergency room,” Tan said. “As soon as the CT scan was complete you could see the clot. That’s very unusual because it was probably the biggest clot I have seen without using further imaging techniques. We knew right away that he needed treatment immediately.”
Mehmet Akdol, M.D., an interventional neuroradiologist and assistant professor in the UAMS College of Medicine’s Department of Radiology, removed the clot after Treas received tPA. The tissue plasminogen activator is a clot-busting agent used to quickly improve blood flow to the brain. Tan says since the onset of the stroke was clear and verified by multiple witnesses, he felt confident to give him the clot-busting drug. Clot-busting medication is the first line of medication for stroke patients but must be used in the first three hours after onset of symptoms. Treas received tPA 19 minutes after he entered the emergency department.
“We used a microcatheter to grab the clot and pull it down like a cork screw, resuming blood flow to the brain,” Akdol said. “We have several cases that received this kind of treatment. What is unique in this case is the timing and aggressive treatment with no delay, which brought an excellent neurological result.”
“The staff, physicians and nurses were amazing,” said Debra Johnson, R.N., stroke nurse coordinator and outreach nurse for the AR SAVES program. “He was ranked a 26 on the National Institutes of Health (NIH) Stroke Scale. Twenty-four hours later, he was at a two.”
The NIH stroke scale increases with severity. The lower the score the less severe it is; anything above 20 is extremely severe.. Three nurses and a resident physician were recognized for their distinct aptitude in treating Treas by receiving an “I Saved a Brain” pin: Stacy Bennett, R.N; Emily Boyd, R.N.; Erin Sanders, R.N., and Heather McLemore, M.D.
It is uncommon for a person as young as Treas to have a stroke except in the case of traumatic injury. The size of the clot prompted Tan to examine Treas for signs of trauma around his neck.
“We later found out that the stroke was caused from a carotid artery dissection,” Tan said.
Carotid artery dissection is a tear in one of the two main arteries in the neck. It’s almost exclusively caused by trauma. Over time, the tear can get bigger and a clot will form around it, cutting blood flow to the brain. Tan says the trauma doesn’t have to come from an assault or something very severe. He says there have been examples of carotid artery tears caused from being hit too quickly, falling, whiplash, dancing violently or riding a roller coaster. Treas’ physicians believe a roller coaster may have caused his tear. He’d visited an amusement park two weeks prior.
“Rides like that can cause a tear because of the abrupt changes in gravity,” Tan said. “That creates a reversal in blood flow and in some degree can cause stress on the vessel itself. If the vessels obtain stress, they can tear and over time cause a clot.”
Akdol says Treas’ ability to make a complete recovery is because of swift reaction from those around him. “There was no waste of time. We have implemented a system here at UAMS that allows us to deal with these cases very quickly. This is why we want people to know the symptoms and remember the acronym FAST.”
F – Face Drooping.
A – Arm Weakness.
S – Slurred Speech.
T – Time to call 911.
Since the stroke, Treas has been recovering and says he’s been improving daily. He and his wife have a baby, Lillie Belle, born April 20. He graduated from UAMS on May 20 and he soon starts his internal medicine residency with hopes to eventually be an oncologist or cardiologist.
By Katrina Dupins | June 15th, 2017 |