Vicky Chryssanthakopoulos with stroke nurse practitioner candidate Bronwyn Coulton

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In the stroke of time

Austin Hospital is a major metropolitan stroke centre in Melbourne. A specialist stroke team is ready at the hospital to assess and treat patients as soon as they arrive.

It was strange for Vicky to feel lethargic and dizzy. A fit, healthy and active 48 year-old primary school teacher, she thought perhaps she was just coming down with something. In hindsight, these were warning signs; a precursor to the tingling in her fingers and the slurred speech that she would more confidently identify as stroke.

Vicky remembers calling her husband, a lifestyle coach training a client on a local oval nearby. He immediately called an ambulance.

"I really thought I was going to die. I thought I was coherently telling my husband I loved him but he told me later my words weren't making any sense," says Vicky.

Vicky had suffered a dissection (a tear) in one of the arteries in the back of her neck - the vertebral artery. It was a spontaneous dissection - something that will never be fully explained. What is known though is that when a small tear occurs in the inside lining of the artery, the body tries to heal itself by forming clots. Sometimes the clots can break off, get swept away and lodge in the brain.

Austin Hospital is a major metropolitan stroke centre in Melbourne so when paramedics arrived at Vicky's house in Preston and identified stroke, they knew exactly where to take her. Time counts with stroke - for every minute that passes, 1.9 million neurons can be lost.

The paramedics notified the hospital and the triage nurse activated an acute stroke call to ensure a specialist stroke team was ready at the Emergency Department to assess Vicky, undertake imaging and make decisions about her treatment.

Neurologists had to decide whether Vicky would benefit from a treatment called thrombolysis - a substance injected into a patient's blood stream which dissolves stroke-causing clots. Even when doctors are very confident that thrombolysis will work, there are always risks.

Stroke nurse practitioner candidate, Bronwyn Coulton says that in Vicky's case it was the best option. "We could see there was an abnormality of the vessel and we knew the clots travelling further up were causing all the trouble. We had to re-establish blood flow to the back of the brain and the clot busting drug was our best chance."

All stroke patients who receive thrombolysis are connected to a heart monitor before treatment (and for at least 24 hours afterwards) and are closely cared for by highly skilled stroke nurses who look for changes in heart rates and rhythms, neurological deterioration and bleeding complications.

Nurse Jessica Moss was in charge of Vicky after thrombolysis was administered and during a critical moment when it is believed a clot travelled to the part of her brain responsible for breathing and heart rate, causing Vicky's lungs to fail and her heart to stop. Without hesitation, Ms Moss called a code blue and provided CPR before Vicky was transferred to the Intensive Care Unit.

When Vicky eventually returned to the ward and met the nurse responsible for watching over her, she was overwhelmed.

"I gave her the biggest hug. It is an emotional moment to meet the person who saved your life. If it weren't for her, I would have probably died but all the nurses were wonderful. Bronwyn looked after me on the ward and as an outpatient. I talked to her about any concerns. She explained why the stroke happened, how the clot formed and how to recover. It was what I needed. She was the person to turn to, my mentor in a way."

After a few more days investigating her heart and the arteries in her neck, clinicians discharged Vicky. Physiotherapy at home and ongoing management as an outpatient have been important to her recovery.

"The physiotherapists showed me functional exercises to help with vertigo," says Vicky. "They also helped me improve my fine motor skills undertaking basic tasks like picking up a 5 cent coin from a table."

Vicky returned to part-time work within eight weeks but Ms Coulton says most people need more time to recover. "While people can look okay they can be suffering fatigue or trauma from the shock of stroke. They need a lot support."

On the day of her discharge, Vicky's husband drove her to Studley Park Boathouse, her favourite place. "I have started to appreciate things more intensely. Being here is a miracle. Embrace it because things can change in the blink of an eye."