A Stroke (and Another)
One evening in the fall of 2011, I was sitting at home on the couch while Rita took the kids to get takeout for dinner. Suddenly the room started spinning, and when I closed my eyes, I had a hard time keeping myself from tilting to the right. It was like ‘up’ was in a different direction, and to keep from tipping over on the couch, I needed to lean to the right. It was very odd. At first, I thought something had happened in my inner ear as my equilibrium was way off. I tried to stand up, but there was no way I could keep my balance. I then crawled over to the end table to get my phone and called Rita, who I suspect immediately called 911.
After I hung up the phone, I started to sweat more than I think I ever have. My hair and shirt were soaked in minutes. I also started to feel extremely nauseous and thought I was going to vomit. I think Rita arrived before the ambulance did. I really had no idea what was going on but was oddly not that worried about it. By the time the ambulance arrived, I felt a little better but still had to be wheeled out of the house into the ambulance. They took me to the E.R. at Mount Nittany Medical Center. By the time I arrived at the hospital, maybe 15 minutes later, I felt significantly better.
At the hospital, they did a scan to see if blood flow was constricted anywhere. At the time, I don’t even think I realized that they were checking to see if I had had a stroke. After the tests, they took me back to the E.R., and at that point, I was feeling pretty much normal. The doctor came in and said I’d had a vertebral artery dissection (which sounded to me a lot worse than it is) and a mini-stroke. I was shocked. I really had no idea what I’d experienced was as serious as a stroke.
I was taken to Geisinger Medical Center, a much larger medical facility, by ambulance. I spent about three days there under close observation as they were afraid another clot could form. They had me on strong blood thinners to try to prevent this. For about a week after I was released, I had to give myself shots of blood thinner that caused huge bruises around the injection site. I then took Coumadin for many months and had to get the levels checked to adjust the dose frequently.
An arterial dissection happens when the interior wall of the artery tears away, creating a flap of tissue. This will eventually heal, but a clot can form from the stagnant blood that gets trapped by the flap. When this clot breaks free, it can travel into the brain and eventually reach a blood vessel too small for it to pass. This cuts off blood flow to whatever region of the brain was supplied blood by this vessel.
People have vertebral arteries on each side of their neck that run alongside the carotid arteries and provide blood to the brain. As you can see in the illustration, the vertebral arteries snake around the vertebrae and this tortuous path can cause wear on the artery. The illustration makes it pretty clear that at the location pointed to by the top arrow, contorting your neck can put a lot of strain on this artery. It turns out vertebral artery dissections are actually not that uncommon. They are sometimes caused inadvertently by chiropractors and people “cracking” their necks. Painters are at risk for this because they often look up for extended periods as they paint ceilings. People that have connective tissue issues are also at much higher risk.
In the end, I learned that there was a second code provided to the insurance by the ambulance company. Apparently, this diagnosis was provided by an EMT in the ambulance. I have no idea why the insurance company would rely on this, but they did. In the first ambulance trip, the EMT had “diagnosed” me with a cerebral hemorrhage which I, fortunately, did not actually have. In the second case, the EMT “diagnosed” me with a headache. Argh!! Ultimately, I convinced the insurance that there was no way an E.R. doctor would send me by ambulance to a hospital 90 miles away for a headache.
I did not belong to any of these categories and had not been to a chiropractor recently. However, sometimes they simply happen for no apparent reason. I asked the neurologist I saw after getting out of the hospital if I should or should not do anything to prevent this from happening again. He basically said to avoid having chiropractors do anything to my neck and not “crack” it, which I never did anyway. Other than that, he said it was probably just a fluke thing and would likely never happen again.
Oddly enough, it happened again almost a year to the day after the first one. This time I was in my office at Penn State, and the symptoms were very different. Instead of being dizzy and disoriented, my left side went numb. I stumbled out of my office to get my assistant, who drove me to the local hospital. They again did the same tests and told me that I’d had another vertebral artery dissection and another mini-stroke. However, this time it was the artery on the other side of my neck. I was again taken by ambulance to Geisinger Medical Center for another three days of observation. Later, the neurologist said he’d never in 25 years of practice seen someone that had had two of these. He essentially said I was just extremely unlucky. I was really hoping I could learn what might have caused them, but I never did. Now, I simply take a baby aspirin each day to help prevent a clot if another dissection occurs. Fortunately, while I don’t know if I’ve had another dissection, I have not had another mini-stroke.