How I survived a massive stroke
KATHLEEN Roche lifts her baby son, Archie, high into the air, triggering a wave of giggles.
It's a heart-warming scene made all the more poignant given that four weeks after Archie's birth, the first-time Mum suffered a massive stroke which left her unable to speak and paralysed down her right side.
She had a centimetre-long clot blocking her middle cerebral artery, preventing blood flow to a large area of her brain. Without quick diagnosis and treatment, her little boy could have tragically been left to grow up without his Mum.
But almost nine months later, Ms Roche has fully recovered, thanks to major advances in stroke care.
Doctors at the Royal Brisbane and Women's Hospital say if her stroke had occurred only five years ago, she may have died and would certainly have been left with life-long disabilities, struggling to communicate, to work and to care for her son.
Instead, the 31-year-old has returned to a normal life, revelling in the joys of motherhood.
Ms Roche, of Albany Creek, on Brisbane's northside, also had some luck on her side when she fell ill on the last Saturday in January this year.
Her husband, Richard, was home from work and her in-laws, Dianne and Neville Ferguson, were visiting from New Zealand to meet their new grandchild.
Mrs Ferguson is an occupational therapist and suspected Ms Roche may be having a stroke after her daughter-in-law sat down, her right arm hanging uselessly by her side, and was unable to respond to questions.
"While I could see my hand, it had flopped down to the side and I could see my foot but it didn't feel like it was part of me anymore," Ms Roche recalled. "It was a very strange feeling."
Her frantic husband called triple-0 and on the way to the RBWH, paramedics phoned ahead telling emergency department staff they had a suspected stroke patient.
Director of the RBWH's Emergency and Trauma Centre Sean Rothwell said the hospital's "Code Stroke" protocol was activated, a system which fast-tracks patients with suspected strokes into the ED's CT scanner.
"They don't go to triage and then get checked in, we put them straight onto the scanner and check them in there," Dr Rothwell explained.
Time is critical for stroke patients. The "Code Stroke" protocol is designed to ensure they are diagnosed and treated as soon as possible, giving them the best chances of survival and recovery.
If the latest state-of-the-art images show a patient has a blockage in a large artery, and the blood-starved area of their brain is still alive - which is the case in about 10 per cent of stroke cases - doctors will remove the clot.
In a minimally invasive procedure, RBWH interventional neuro-radiologist Kate Mahady said doctors thread a catheter from a tiny cut in a patient's groin through major blood vessels to the site of the clot, guided by an angiogram, a type of real-time X-ray.
A small metal device called a "stentriever" is then inserted inside the clot and opened. The clot sticks to a tiny mesh basket on the end, and removed, allowing blood to flow freely again throughout the brain.
Without clot retrieval, which has only been introduced in the past few years after international clinical trials showed its benefits, Dr Mahady said that as the stroke starved key parts of Ms Roche's brain of oxygen - causing cell death and swelling - she may have required major neurosurgery.
To save her life, surgeons may have had to remove part of her skull to allow the brain to swell. Dr Mahady said Ms Roche would then have needed intensive rehabilitation and would still have been left with severe disabilities.
Instead, by the time Ms Roche's family saw her in hospital after the clot retrieval procedure, she was talking again.
"She had tubes hanging out everywhere, but she was talking away and smiling," her Dad Dennis Roche said. "We knew then that she was going to be okay. Kathleen loves talking."
RBWH director of neurology and stroke services Andrew Wong said some stroke patients would also receive clot-busting drugs, but these were not available to Ms Roche because of her recent caesarean surgery and the risk of causing a bleed.
"Five years ago, this would have been a life-threatening, disabling stroke, without a doubt," Associate Professor Wong said. "It's been very impressive to see the results of this treatment. This is a really good example of research leading to big clinical benefits. Stroke is my specialty of interest. I've been watching the research unfold over a decade and this is the biggest change that we've ever seen in the management of stroke."
The RBWH treated 110 stroke patients using clot retrieval in the 12 months to June this year. Other Queensland Health facilities offering the treatment include the Princess Alexandra Hospital and the Gold Coast University Hospital.
The State-wide Stroke Clinical Network is working on a system designed to transport eligible stroke patients from other areas of the state to hospitals offering clot retrieval. Clot retrieval can only be performed up to 24 hours after a stroke.
Professor Wong said Ms Roche's stroke was probably the result of what doctors refer to as a "dissection" - a small tear in the wall of a blood vessel, resulting in the formation of a clot.
Other stroke risk factors include an irregular pulse, high blood pressure, high cholesterol, smoking, alcohol intake, poor diet, lack of exercise and diabetes.
In 2017, more than 10,000 Queenslanders were diagnosed with a stroke. About 2200 died from the condition.
"I feel extremely lucky," Ms Roche said, cuddling her baby son.
FAST TEST TO RECOGNISE STROKE SIGNS
* Face: Check the person's face; has their mouth dropped?
• Arms: Can they lift both arms?
• Speech: Is their speech slurred? Do they understand you?
• Time: Time is critical. If you see any of these signs, call triple-0 straight away.