In an ischemic stroke, a blockage in a blood vessel stops essential oxygen and nutrients from reaching the brain.
- Este Osofsky-McGonigle had a stroke in 2009 at age 47
- Timing is the main factor in determining whether
someone survives a stroke
- Her doctor calls her recovery remarkable; she says it
- May is National Stroke Awareness Month
She was getting out of the car one autumn day
in 2009, about to have lunch with a colleague, when Este Osofsky-McGonigle felt
something pop in her neck.
"It was something so strong I
couldn't talk for a couple of minutes," recalls the New York school
psychologist. But it passed, and she regained her speech.
The rest of the day and night
elapsed normally, but at 9:30 the next morning, as Osofsky-McGonigle finished
up a meeting at work, her right arm went numb.
She went into her office and tried
to write a letter, "Dear So-and-So." But when she picked up the pen
and tried to write the letter "D," the pen just slid across the
Osofsky-McGonigle tried again, but
the same thing happened. "The 'D' went crazy," she said.
Fortunately, Osofsky-McGonigle could
still run -- and she did, running the whole length of the school building,
seeking a friend who sent her to the school nurse.
The nurse checked for a pulse in
Osofsky-McGonigle's right arm, but found none. By the time she reached the
hospital 15 minutes later, she could not lift her right arm or leg, speak or
Osofsky-McGonigle, at 47 and in
near-perfect health, was having a stroke.
The "pop" she felt in her
neck the day before was her carotid artery tearing, a rare event called a
carotid dissection. The carotid artery is the main artery supplying blood to
A blood clot formed after the
dissection, and a piece of it likely broke off and traveled into an artery in
her brain, blocking blood supply and resulting in an ischemic stroke, explained
Dr. Daniel Antoniello, the attending neurologist at Montefiore Medical Center
who treated Osofsky-McGonigle.
Ischemic stroke, which results from
a blocked blood vessel, is the most common type of stroke and represents about
87% of all strokes, according to the U.S. Centers for Disease Control and
Prevention. Hemorrhagic strokes, which involve
bleeds in the brain, make up the remainder.
Most of the 800,000 strokes that
occur in the United States each year occur among people age 65 and older, the
CDC says. Unfortunately, doctors are seeing more and more strokes in younger
people, partly because of the continuing epidemic of childhood obesity, early
onset diabetes and cholesterol and hypertension issues, said Antoniello.
No one knows why Osofsky-McGonigle's
artery tore, especially at such a young age. She had not suffered a recent
injury, nor did she have any traditional risk factors for vascular disease such
as high cholesterol or high blood pressure.
She may have simply been unlucky --
but after that, she was as lucky as any stroke survivor could be.
Timing is the main factor
determining whether a person lives or dies -- or lives with a severe disability
-- after a stroke. May is National Stroke Awareness Month.
Thanks to the alert school nurse,
Osofsky-McGonigle made it to the emergency room about an hour and 20 minutes
after her first symptoms. That left doctors plenty of time to administer the
only approved treatment for ischemic stroke -- a clot-busting drug known as
tissue plasminogen activator, or tPA.
Generally speaking, tPA is only
effective and only given within a 4.5-hour time window after stroke symptoms
appear, said Antoniello.
About an hour after that,
Osofsky-McGonigle underwent a procedure in which doctors threaded a catheter
through an artery in her groin all the way up into her brain. Once the catheter
reached the clot, doctors squirted more tPA directly into the clot.
Stroke victims don't call 911, delay crucial
"That dissolved the clot and
restored blood flow," Antoniello said.
Still, no one knew how well
Osofsky-McGonigle would recover. After the procedure, she was in intensive
The next day, she still couldn't
speak or understand anything. On the second day, when Antoniello asked her to
name some simple objects in her hospital room -- a pen, glasses, a watch -- she
could not utter the words.
"She would try, but a jumbled
mess would come out," he said.
Osofsky-McGonigle had aphasia, a
common outcome of stroke in which parts of the brain related to language,
including reading, writing and talking, are damaged.
Although some people experience a
full recovery from aphasia, others only get part of their previous abilities
back. How well a person recovers from stroke is highly variable and highly
individual, Antoniello said.
By the third day, though,
Osofsky-McGonigle, who was also starting to move her right arm and leg, could
name one or two simple items -- and her recovery took off from there.
She was moved to a rehabilitation
facility. At first, she made mistakes identifying family and friends, but soon
could state who everyone was.
"That was a big promotion for
me," she said.
As soon as she got home, she said,
she was bossing her husband, Ray, and son Zachary around.
"I said, 'Zachary, get the
radio off,' but it was the TV I was talking about, so he said, 'It's the TV,
not the radio.' I said, 'OK, get the TV off.'
Osofsky-McGonigle started driving
again and went back to work in early December 2009, a mere five weeks after her
By any standard, she experienced an
"It is absolutely remarkable
that someone like her had such a severe impairment and then went back to work
as a psychologist two months later," Antoniello said. "There are not
many people that make recoveries like her."
Once blood flow was restored, the
damaged parts of Osofsky-McGonigle's brain started to "come back on
board," he said. Later on, different parts of her brain may have rewired
for any areas that were permanently damaged. Today, she shows no evidence of speech
She attributes much of her recovery
"I couldn't afford to
deteriorate," she said. "I had a lot of things in my life lined up
and I couldn't afford to be in any way less than what I was."