Conquering stroke … and motherhood

Stroke team saves young, pregnant woman through fast action, collaboration
February 3rd, 2016

One day Suzannah Preisendorf’s daughter will learn of the amazing obstacles her mother overcame to be able to hold her firstborn.

“I am so thankful to have this special, healthy baby,” the 26-year-old Preisendorf said as she picked her daughter up off the floor and gave her a kiss — a simple mothering task, yet one that Preisendorf could have missed if it weren’t for the fast-acting Primary Stroke Center team at UCHealth Northern Colorado’s Medical Center of the Rockies in Loveland.

“It started with a horrible headache, dizziness and complete numbness on my right side,” she remembered of that August 2015 day.

mom lifting baby
Thanks to the fast-acting stroke team at Medical Center of the Rockies, Preisendorf has recovered from her stroke and can now hold her firstborn. Photo by Joel Blocker, for UCHealth.

Four days past her due date, Preisendorf was fortunate to have her husband, Scott, by her side.“When I grabbed ahold of her, Suzannah’s legs just buckled,” he recalled.

The couple rushed to MCR, a nationally recognized Primary Stroke Center, where the stroke team, including neurologist Dr. Brian Kaiser, emergency physician Dr. Marc Breen and obstetrician Dr. Eric Yeh, sprang to work to save Preisendorf and her baby.

Though hard to believe for someone so young, Preisendorf was suffering from an ischemic stroke, a brain MRI confirmed. An artery supplying oxygen-rich blood to her brain was blocked by a blood clot.

That stunning discovery posed a difficult question: Could a full-term pregnant patient be given the clot-busting drug that doctors knew could break her clot?

Tissue plasminogen activator, or tPA, is given through an arm IV and restores blood flow quickly to the brain to minimize permanent disability. Complications include bleeding, but most studies on the effects of the drug weren’t conducted on pregnant women, according to Kaiser.

“I couldn’t find any other cases where they treated somebody [with tPA] at 40-plus weeks [pregnant],” he said. “My chief concern was if Suzannah went into labor after receiving the tPA, would bleeding complications occur?”

Kaiser consulted further with fellow neurologist Dr. Pearce Korb of UCHealth Metro Denver and decided that Preisendorf was indeed a good candidate for tPA, so they administered the drug. MCR Stroke Program Medical Director Dr. Gerald McIntosh joined the treatment team the next morning to assist in the continued care of the young, soon-to-be mother.

“This was pretty rare,” McIntosh said. “We found nothing in the international literature like this case.”

The team of UCHealth specialists continued through the next day researching and discussing the best next steps for the patient, including the risks involved with her pending delivery.

Suzannah, Scott and Maisy Preisendorf
Suzannah, Scott and Maisy Preisendorf at their home in Windsor. Photo by Joel Blocker, for UCHealth.

That around-the-clock vigilance was incredibly reassuring, Preisendorf said.

“Doctors were always in the hallway discussing what needed to be done from the moment I was in the emergency room,” she added. “They were phenomenal. Each puzzle piece that fell into place helped us make the final decision.”

“I think they were personally invested in our story, which made us feel better,” Scott said.

Because of Preisendorf’s potential risk of bleeding, doctors felt a vaginal delivery wasn’t a good option because of the increased intracranial pressure that would be caused by pushing. The health care team concluded that it would be safer for both the patient and baby if doctors delivered via cesarean section.

“We were all rooting for this family,” said Leigh Anne Creighton, stroke coordinator for UCHealth Northern Colorado. “As a Primary Stroke Center, we have the expertise and resources to provide the collaborative care required to treat patients with strokes. And this collaboration that touched the lives of this young mother and her child was incredible. It involved neurology, OB, anesthesia, pharmacy, lactation nurses, a rehabilitation team, ICU nurses and case managers. We were committed to having a whole team behind this patient.”

Thirty-six hours after receiving tPA, Preisendorf delivered her beautiful baby girl, Maisy, without complications.

But Preisendorf’s fight wasn’t over. Although tPA broke up her clot, deficits caused by the stroke needed time to resolve. Preisendorf could not sit, stand or walk on her own, and she wasn’t able to hold, bathe or feed Maisy with her weakened right arm.

“I was driven by wanting to take care of Maisy. She is pure joy,” Preisendorf said while bouncing Maisy on her knee. “I started going to physical therapy and occupational therapy rehab on an outpatient basis, and I do exercises at home. It was a huge motivator for me to know that if I worked hard I could finally hold her. If that doesn’t motivate you, I don’t know what will.”

Their experience also has motivated the Preisendorfs to use their story to raise stroke awareness and the importance of acting fast when you suspect a loved one is having a stroke.

“Even young, pregnant women can have strokes,” Scott said. “Suzannah is 26; we had an appointment that morning and all the tests were perfect. It can happen to anyone.”

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If you suspect someone is experiencing a stroke, call 911 immediately. Paramedics are trained to recognize stroke symptoms and can notify the emergency room so that the stroke team is ready when the patient arrives. Immediate evaluation of patients with stroke symptoms by the stroke team is critical to providing the best chance of reducing permanent disabilities and death.

Medical Center of the Rockies and Poudre Valley Hospital are nationally accredited primary stroke centers, meaning they have a stroke team of physicians and nurses committed to rapid evaluation and treatment of stroke 24/7, 365 days of the year. Research shows that patients who arrive at the ER within four and a half hours of their first symptom are eligible to be treated with tPA. UCHealth focuses on a 45-minute window for treating stroke patients so that patients like Preisendorf can return home to their families.

Time is Brain.
QUICKLY IDENTIFY A STROKE USING THE ‘FAST’ TEST:
F – FACE: Ask the person to smile. Does one side of the face droop?
A – ARMS: Ask the person to raise both arms. Does one arm drift downward?
S – SPEECH: Ask the person to repeat a simple phrase. Is the speech slurred or strange?
T – TIME: If you observe any of these signs, write down the time and call 9-1-1 immediately.