June 24th, 2019 my husband had a stroke. It started with a funny headache around his left eye. He also had ringing in the ears and pain in his upper molar. He decided it was eye strain and took a nap to try to shake it. When he awoke an hour or so later, he was having trouble with his arm and he felt “funny”. The headache, while not bad, was different from anything he had experienced before.
Normally I recommend ibuprofen for a headache. I get periodic headaches with aura that last about three days. Aspirin and Tylenol don’t do a thing for those but 200mg of ibuprofen works like magic. For some reason, a little alarm bell went off in my head and I told him to take two regular aspirin. (325mg each meaning 650mg total.) It was while he was pouring the water to swallow the aspirin that I could clearly see his arm wasn’t working properly. He was overshooting and knocking stuff over. As he swallowed the aspirin I first began thinking maybe we should go to the hospital because it might be a stroke.
The drive to our nearest local hospital is typically one hour and fifteen minutes. I made it in under fifty. I was speeding. At the hospital, they said I should have called 911 and waited for an ambulance. If I had done that, the paramedics could have started the stroke protocol immediately and my husband could have been in a CT machine about an hour and fifteen minutes after paramedics arrived on scene. I felt horrible. I felt crushed. However, talking to the local folks here since we got home, many have told me that paramedics take at minimum forty minutes to arrive at our small rural town. And that forty minutes is on a good day with nice weather and only if the nearest ambulance is not busy with another call. Sometimes in an urgent emergency like a stroke of heart attack, it can take an hour and half to two hours for the nearest ambulance to arrive. They would also have had to then make the same drive I did.
It is possible we would not have had to go through the one hour delay to CT involved in a transfer from the small hospital I went to first. That hospital had no CT machine. They had to arrange the transfer to the large teaching hospital for the CT. There are two local smaller community hospitals that have CTs. They are slightly further than the one I went to in different directions. They usually have staff on hand to do a CT. However neither one are equipped for acute care beyond contacting a neurologist at the major centre, administering clot busting drugs and then transferring to the large teaching hospital we ended up at anyway.
The neurologist told me to stop fretting about it. It does no good to blame myself. I did the right thing and the outcome was excellent. He told us that since my husband’s symptoms were resolving on their own and had largely resolved by the time he had the CT and the symptoms were so very mild, he would not have been eligible for the clot buster drug anyway. The clot busting drug is high risk resulting in 6% of patients dying. Compared to a catastrophic brain injury its well worth the risk but that was not what we were dealing with. His kind words took a huge load off my mind and eased my conscious considerably. Analysis of events to improve future response is one thing. Second guessing and regret is another and it is a waste.
In retrospect, I should have called 911 and then took off and met an ambulance somewhere on the trip in to one of the hospitals. The 911 people would have known where the nearest hospital open to do a CT was. Also when we arrived at the local hospital, my husband’s systolic blood pressure was over 220. They treated that while arranging the CT and transfer. The paramedics could have started that treatment sooner. Given their travel time, however, that meant only ten minutes sooner. I risked him having a major medical crash after a catastrophic stroke affecting his breathing and heart during those extra ten minutes. They would have been better equipped to handle that event.
The symptoms of arm weakness and headache my husband was experiencing dropped to about half by the time we hit the first town near us, a 38km (23miles) drive away. It was twenty minutes after he took the aspirin. While he was in the CT machine, the last of the symptoms went away. His arm was still a bit weak but it was working properly and the head ache was gone. The diagnosis was inner carotid artery dissection clearly visible on CT. At that point they weren’t sure if he’d had a full stroke or a transient ischaemic attack (TIA). They had not yet determined if he had thrown a clot that had traveled and lodged somewhere deeper in the brain or if the relatively small area of carotid artery had partial closed due to the dissection and reopened. Later, the neurologist would tell us it was a mild but full stroke and a clot had traveled and lodged in the area of the brain that controls arm movement and it has done a small amount of damage. (That damage will remain but the slight weakness should disappear as the brain heals and rewires itself around the stroke site.)
We went through four days in hospital of careful monitoring, 24 hour heparin drip, a barrage of drugs and lots of fighting his blood pressure. (It needs to be up to get blood into compromised areas but not high enough to encourage another clot of break off and travel. The doctors fretted and administered drugs every time the systolic number went over 180.) Students came and went along with the many doctors and one thing I kept hearing over and over again was how lucky my husband was and how mild the event was. This was invariably followed by a lowering of the voice, heads coming closer and then in a near awe-struck tone someone would say, “He took aspirin.” This would be followed by knowledgable head nods and as if that explained it all. At the time it made no sense to me. I fretted that maybe I had made things worse by telling him to take two aspirin instead of an ibuprofen. I even asked if the aspirin made it worse. “Oh no, not at all,” everyone assured me. No one mentioned it might have been absolutely best thing to do.
I have since put things together in my mind. In ScienceDaily, 18 May 2016, there was commentary on how taking aspirin as soon as you have symptoms of a stroke, especially if you are far from medical help, reduced the chances of a major stroke by 70-80%.
The authors concluded ‘Our findings confirm the effectiveness of urgent treatment after TIA and minor stroke — and show that aspirin is the most important component. Immediate treatment with aspirin can substantially reduce the risk and severity of early recurrent stroke. This finding has implications for doctors, who should give aspirin immediately if a TIA or minor stroke is suspected, rather than waiting for specialist assessment and investigations.’
Furthermore: ‘The findings suggest that anyone who has stroke symptoms, which are improving while they are awaiting urgent medical attention can, if they are able, take one dose of 300 mg aspirin.’ [Note I gave him 625mg which may have been too much but then again….]
I am an avid follower and reader of science news consolidators such as Science Daily. I often then go back and read the entire article they reference. In retrospect, I think I must have read that article about stroke and aspirin and it sat in my subconscious. I now also think the dramatic improvement we saw in twenty minutes was due to the aspirin starting to dissolve the clot. The fact that the symptoms pretty much vanished even as he had the CT was when the clot was fully dissolved. All the other stuff the doctors did, like keeping his blood pressure in a range that allowed more blood to get to the brain but not so much as to cause the delicate healing process of the carotid artery dissection to break open, those anti-inflammatory drugs to stop the brain from overreacting to the damage, and the blood thinners, all prevented something much worse from coming afterward.
Am I recommending taking an aspirin if you have symptoms of stroke? I can’t do that. I am not a doctor. (Okay, I am a doctor but the PhD kind not the medical kind.) There are two kinds of stroke. One kind (about 30%) is caused by blood vessels rupturing and bleeding into the brain causing damage. The other kind, the 70% kind like the one my husband had, is due to a blockage, usually but not always by a clot. Aspirin could make the bleeding kind worse. That’s why doctors don’t just give you clot busters if they think you are having a stroke. They do the CT first to make sure they don’t make a bleeder worse. I also don’t know if it will help all kinds of blockage. There are also people who should not take aspirin because of other reasons. So no, I can’t recommend you take aspirin if you are having stroke symptoms.
I recommend instead that everyone read up on the symptoms of stroke so you know if it happens to you or someone you love. Understand your best options for getting to medical care quickly before you need it. Talk to your own doctor about it and read up on taking aspirin. Weigh the risks. Make your own decision once you are fully informed and do it before you need to deal with an emergency. If you live next door to a major teaching hospital you can afford to wait to treat. If you live 250km from the nearest hospital, like we do, you have to play different odds. Aspirin might be your answer. Maybe.
We got lucky. As Louis Pasteur said, “Luck favours the prepared mind.” We were also prepared with knowledge even though I did not recall from where during the emergency. We had aspirin on hand. I distinctly remember buying that aspirin even though we never use it, in order to have it in the house, just in case. [My husband has been on the low dose aspirin for decades which he takes with a multivitamin which is why we don’t use it randomly for other things.] I don’t recall just in case of what. The aspirin bottle has an expiration date of this year. That means I likely bought it around the time I read that article in 2016. It doesn’t have the vinegar smell of spoiled aspirin and aspirin lasts a lot longer than the three years or so written on the bottle. Even so, I will be buying a new bottle next trip to town. I might even buy a half dozen or so and keep aspirin in my truck, my RV and a couple in my purse.
We got lucky. Luck favours the prepared mind. Be prepared.