VCU news

By Laura Rossacher

Tia Ingram was feeling weak and disoriented. She was 22 years old and 29 weeks pregnant, and went to bed on Aug. 10, 2017, convinced her body was taxed from a long day of work and taking care of her 3-year-old son, Mah’kari.

The next day, her boyfriend alerted her that the side of her face was drooping and her speech was slurring. Soon after that, she needed help walking. After suffering those symptoms overnight, Ingram was rushed to the emergency room at Virginia Commonwealth University Medical Center, where doctors diagnosed her as having a stroke. 

“I just started crying. I completely broke down,” she said.

Ingram was no stranger to the effects of a stroke. She had been working as a certified nursing assistant at an assisted living facility in Richmond, where she cared for seniors with limited mobility due to various health issues, including stroke. A stroke is caused by a sudden interruption in the blood supply to the brain, and though often associated with older adults, an estimated 10 percent of stroke patients are younger than 50.

Leading edge of stroke treatment and care

The team treating Ingram at VCU Medical Center determined her situation was serious enough to perform a thrombectomy, a surgery that removes a blood clot from inside an artery. The American Stroke Association has found thrombectomy to be appropriate up to 24 hours after stroke symptoms begin, an expanded timeframe newly adopted nationwide, but which has been used at VCU Medical Center for more than two years in carefully selected patients.

“Based on our collaborative team of emergency medicine doctors and nurses, neurology stroke specialists, and the experience of our two vascular neurosurgeons who specialize in the thrombectomy procedure, we were confident that we could provide the care Tia Ingram needed,” said Warren Felton, M.D., medical director of VCU Health’s stroke program.

The medical team worked quickly to stabilize Ingram and remove the blood clot. The same day she arrived at the hospital, Ingram had her procedure and was on her way to a full recovery. Today, Ingram is enjoying motherhood with her 9-month-old baby, Luis, and her 3-year-old and raising awareness about stroke and the importance of seeking care as soon as symptoms develop. She reflects on her experience at VCU Health with gratitude.

“It was a stressful time for me, being pregnant, going through that, being the age that I am — I just thank everybody for caring so much about me,” she said.

It was a stressful time for me, being pregnant, going through that, being the age that I am — I just thank everybody for caring so much about me.

Multidisciplinary approach to care

Although uncommon, pregnancy can provoke a stroke — the incidence occurs in 11 to 34 per 100,000 deliveries. Because Ingram was pregnant when she had her stroke, VCU Health obstetricians also were part of her care team. Edward Springel, M.D., an obstetrician-gynecologist and assistant professor in the School of Medicine, worked with the team at the stroke center to discuss and prepare for the procedure.

“Collaboration with the neurosurgery team was vital for Tia Ingram and her then unborn baby,” Springel said. “We discussed the relative safety of the planned thrombectomy to the baby with the neurosurgery team. Our team was available to help minimize fetal risks so that the neurosurgery team could continue with doing everything necessary to prevent her stroke from causing permanent damage.”

Springel later helped deliver Ingram’s baby boy on Sept. 27, almost seven weeks after her stroke. The neurosurgery team continued to serve as part of Ingram’s care team through her delivery.

“It is a multidisciplinary effort on a routine basis. And what allows us to be a Joint Commission-certified comprehensive stroke center is that we have all of these departments, as well as other departments which routinely collaborate in the care of these patients, such as cardiology, or in this case OB/GYN,” said Dennis Rivet, M.D., a neurosurgeon at the stroke center.

VCU Health consistently leads the way in implementing advances in stroke treatment in Virginia. In 2015, the medical center became the first in the state to earn advanced certification as a Comprehensive Stroke Center from the Joint Commission and the American Heart Association and American Stroke Association. VCU Health also is the first medical center in Virginia to incorporate multimodal neuroimaging in the emergency department. Multimodal neuroimaging brings together data from different types of tests and imaging, creating a more comprehensive picture of the brain and allowing for acute stroke diagnosis, regardless of severity.

The level of care provided draws patients from the Richmond area and beyond — more than one-third of VCU Medical Center stroke patients are transported from other hospitals throughout Virginia.

Collaboration with the neurosurgery team was vital for Tia Ingram and her then unborn baby.

Community outreach and education

About 92.1 million American adults are living with some form of cardiovascular disease or the after-effects of stroke, according to statistics from the American Heart Association and American Stroke Association. When considered separately from other cardiovascular diseases, stroke ranks fifth among all causes of death in the United States, killing nearly 133,000 people a year.

“Educating the community on how to prevent stroke is as much a part of the responsibility as treating patients,” said Kristina Gooch, a registered nurse with the stroke program.

“We’re very passionate about outreach and being out in the community,” she said. “We want to make sure people have the information they need so they can make the right choices, no matter what end of the health care spectrum they find themselves on.”