A daughter recounts the moment her mother suffered a brain blood clot, causing weakness in her arms and legs, and slurred speech, putting her at risk of slipping into a coma.
“If you have any unusual symptoms, please see a doctor within 6 hours, if possible.”
The health of seniors is something family members must observe closely. Because some symptoms signify abnormal brain and blood vessel function. If not rushed to the hospital in time, it can lead to brain death, stroke, paralysis, or bedridden.
This issue of Patient Story tells the heartrending story of Ms.Kunlathep Thanasiriyothin, a patient who suffered a blood clot in her brain and needed urgent treatment before her brain sustained irrecoverable damage. We are grateful to Ms. Pannarat, the patient's daughter, for sharing her story with us in ...Patient Story.
Stiff tongue, incoherent speech: Warning signs of stroke
Ms. Pannarat mentioned that her mother used to engage in demanding work. The family currently runs their own business. With her children pitching in, her overall workload has significantly lightened. However, her physical well-being is not that robust.
“My mother is nearing 58 years of age and contends with several health conditions, including rheumatoid arthritis, diabetes, hyperthyroidism, and a leaky heart valve, with the latter being the most severe. She has been undergoing continuous treatment for approximately three years. While she no longer shoulders strenuous work, I cannot rule out the possibility of previous stressors preceding the incident.”
In late December of 2023, Punnarath began noticing that her mother had incoherent speech, stiff tongue, and dizziness.
“When I initially noticed the unusual symptoms, I speculated that it could be related to fluid in her ears or possibly an outcome of the bone surgery. My mother had bone surgery in the past and experienced frequent dizziness afterward, which would intermittently occur. Additionally, there was an instance when she walked into a door and developed drooping of the mouth. I am uncertain if it is due to neuritis, but it has been over a decade.”
The symptoms that manifested caused a great deal of concern. However, before long, an unexpected event unfolded. While Khun Kullathep was lounging on the front porch of the house and the maid was walking to fetch something, in a mere split second when she looked away...
“My mother slowly fell from the bed. Fortunately, my father was present and promptly rushed her to Mahachai Hospital. During that time, my mother was semi-conscious; her tongue was twisted and stiff; her left arm and leg were limp and unresponsive, and her right side was experiencing constant twitching and shaking. We reassured her, saying, 'I'm here, Mom.' She looked at us and acknowledged.”
“When my mother arrived at the hospital, the doctor quickly performed an X-ray and suspected the presence of a blood clot or blood vessel narrowing in the brain. Consequently, they requested an additional MRI for a more detailed assessment. The doctor explained that if you have symptoms or have been suspected of having a stroke within the last 3 months, you will not be able to receive blood thinners to dissolve the blood clot. Because such medication could potentially result in a brain hemorrhage, impacting the brain stem and posing a risk of fatality.”
Obstructed cerebral artery causes brain tissue to die
Khun Panarat inquired about the treatment approach, and the doctor suggested the removal of the blood clot in the brain. However, due to the need for sophisticated specialized equipment, the hospital advised referring the patient to a larger facility, such as Siriraj Hospital or Chulalongkorn Hospital.
Recognizing the dire situation, Khun Panarat expressed concern about the time it might take at a public hospital. The critical window for her mother's treatment was best within two hours but not more than six hours for her brain to recover and function normally. Acting on the doctor's recommendation, the family opted for MedPark Hospital after conducting swift online research. They were confident in the medical team and the sophistication of the medical equipment, prompting them to bring her mother to the facility.
The emergency medical team of Mahachai 2 Hospital promptly transported the patient in an ambulance, covering a distance of approximately one hour amid heavy traffic. Despite the challenging road conditions, the time spent on the journey proved worthwhile. During the patient transfer, there was constant communication with the medical team at MedPark Hospital. At that time, the coordinating physician was Dr Udom Sutthipanphasal, an interventional neurologist.
“The hospitals collaborated seamlessly. The doctor called and informed us that everything was well prepared. Upon arrival, the patient would be whisked off directly to the hybrid operating room to ensure no wasted time. The treatment process involved executing specific steps, which the doctor explained thoroughly. Upon reaching the emergency room of MedPark Hospital, the emergency department team and nurses quickly received my mother, changed her clothes, and escorted her to the hybrid operating room. The treatment process commenced swiftly. We only had to wait for about two hours.”
Out of danger, with a good recovery
From the initial expectation that it would take 3-4 hours, the experience with the medical team, including the doctors, and nurses, and the preparedness of medical technology equipment allowed for a swift treatment process, which brought much comfort and increased confidence.
“The doctor is very skilled. He explained the condition of my mother, showing images on the computer screen depicting how it was before and after treatment. Witnessing such advancements in medical technology was impressive, and what is even more delightful is that my mother is now safe. The next day, she could move her arms and legs, respond well, and speak clearly. Everyone is so happy.”
“What contributed to the mother's rapid recovery is the expertise of the doctor and the team and the innovative technology, such as the minimally invasive procedure in a hybrid operating room. There was only a small wound where the catheter was inserted, resulting in minimal blood loss.”
After the treatment through the neuro-interventional vascular procedure, the doctor performed brain imaging to assess the extent of damage. The patient was then moved from the ICU to a special room and proceeded to the next steps of physical rehabilitation.
“I want everyone to pay close attention to your close one. If there are any abnormal symptoms, such as dizziness, stiffening of the tongue, or loss of balance, I encourage you to consult a doctor within 6 hours, if possible. The sooner, the better, as it not only enhances safety but also increases the likelihood of restoring the brain to normal conditions.”
Stroke symptoms require immediate medical attention
Stroke is a disease that many people fear because it often occurs suddenly. If the blood vessels in the brain become narrowed, blocked, or ruptured and are left untreated for several hours, it will deprive the brain of blood and damage it to the point it cannot recover after treatment.
Therefore, if you notice someone close to you is starting to have unusual symptoms, such as a crooked face, weak limbs, or slurred speech, do not hesitate; you should rush them to see a doctor for diagnosis and treatment within 4.5 hours of the onset of symptoms.
Dr Udom Suthiponpaisan
Lt. Cdr. Dr. Udom Suthiponpaisan, a neurologist specializing in stroke and neuro-interventional radiology, treated Kullasup. The doctor said that it was an emergency case. Mahachai 2 Hospital had coordinated to send the films and MRI results, which clearly showed a blocked right-hemispheric blood vessel, causing the patient to have left hemiplegia.
The MRI images show a lack of blood supply and large cerebral artery stenosis on the right hemisphere of the brain
“The patient had a stroke, so we prepared the hybrid operating room and all the equipment and instruments for immediate neuro-interventional treatment. It was already afternoon at the time, and it would be evening by the time the patient would arrive. The sooner the treatment, the better. When the patient arrived, she was still conscious, but her left arm was weak, and she could not lift or move it at all. In medical terms, muscle strength grade ranges from 0-100, and her muscle strength was 0.”
In the hybrid operating room, after the patient received anesthesia, the doctor inserted a catheter into the main artery until it reached the blocked area in the cerebral blood vessel. The doctor then removed the problematic blood clot.
“When we injected the dye into the blood vessels, we found that the blood clot location had moved slightly from what was on the MRI. We then used a catheter to remove the blood clot. It was about 1 cm long. Upon the clot removal, blood flows to the part of the brain that was not getting enough blood, and the brain returned to normal.”
The angiogram on the left shows large artery stenosis on the right hemisphere of the brain, while the right angiogram shows normal blood flow after the removal of the blood clot.
The blood clot removed from Kullasup’s cerebral artery
“After the successful catheterization procedure, the patient was transferred to the ICU. She started to feel better, could lift her left arm much better, and spoke more clearly. The next day, the doctor followed up on her condition and found that she had normal strength, speech, and a good recall of what had happened. She was then transferred to a private room and underwent physical therapy for 2-3 days.”
The doctor concluded that the reason she recovered quickly was because of time. Once aware of the problem, do not let time pass idly by.
“Seek medical attention as soon as possible, preferably within 6 hours. If you take longer than that, the condition can get more complicated, requiring an additional test to determine the right treatment. In this case, the cause of cerebral artery occlusion might be heart valve disease and atrial fibrillation. Before discharging, the doctor prescribed anticoagulant to prevent blood clots and scheduled regular follow-up appointments to lower the risk of recurrent stroke.”
From left to right: Assoc. Prof. Dr Mungkorn Apirakkan, Dr Udom Suthiponpaisan, and Issarun Paibul, RN, an operating room nurse
