Emergency Landing Saves Stroke Patient

Lucky outcomes all around:

CLEVELAND — Surviving a stroke is no easy task, and timing is crucial: A stroke victim must get the right medicine right away.

So, imagine how serious it would be to have a stroke on an airplane, in the middle of a cross-country flight.

NewsChannel5’s Alicia Booth reported on one local woman who experienced this ordeal and how she is recovering from it.

As a highly successful 40-year-old attorney and mother of two, Jean Robertson didn’t have time to be sick — she had a plane to catch.

“I started to feel a headache come on but I suffer from migraine headaches, so I immediately rationalized it as a migraine,” Robertson said.


Robertson said she chatted for quite a while with the businessman next to her.

“He kind of looked at me and said, ‘Excuse me?’ And apparently at some point in our conversation I stopped making sense,” she said. “I go like this to touch my face intuitively and I realize my entire head is numb.”

Fortunately, there was a doctor on the plane who helped convince the pilot and the airline that an emergency landing was necessary to save Robertson’s life.

I’m supposing this patient got TPA for her stroke from the way the article is worded, but I’m having trouble with the timeline if that’s the case.  In any event, good for everyone involved!


Comments

  1. I would think HA + neurologic deficits = bleed or complex migraine. I can’t recall an acute-phase ischemic stroke causing much of a headache. It was interesting how she neglected her symptoms even when they were fairly severe. That is often the case with strokes. Someone else notices the speech deficits if the right side is involved, but left sided deficits may not present until a couple of days later, unless the deficits are particularly severe.

  2. Often when you look a little deeper into these types of stories, one’s assumptions (got tpa, etc) are way off. The usual journalism MO is simplify, then exaggerate.

  3. Goatwhacker says:

    Yeah, I’m with scalpel. This doesn’t sound like an ischemic event but a bleed or migraine. Someone’s got some splainin’ to do. Maybe the medicine she had to get right away was Demerol.

    The doc on the plane probably did the right thing though, he most likely thought she was having a hemorrhage.

  4. The demerol comment is a little low… Say she didn’t have a stroke and had a hemiplegic or basilar migraine…does that mean that people have those just to get demerol quickly? I couldn’t have faked my basilar migraine attack if I tried – just happened to occur while I was doing a clinical shift in the ER. I’ve spoken with several people who suffer from hemiplegic migraine, and the resulting effect on one’s life can be devastating. Doesn’t sound like the woman had a history of migraine with neuro deficits anyhow, since she wouldn’t say, “I suffer from migraine headaches” if she had a history of hemiplegic or basilar migraine. She’d probably say she suffered from migraine with symptoms that mimic stroke, or something to that effect – and when others got concerned regarding the deficits, she’d probably assure them that this is typical to her history. Although migraine with neurological deficits is cause for urgent treatment.

    And then there’s the fact that young women with migraine (ok so the woman in the article probably wouldn’t fall into the ‘young’ part of this critera, as I suspect young means teens and twenties) are at greater risk for CADASIL…and what can CADASIL lead to? Strokes…

    Here’s an article on A Multivariate study of headache associated with ischemic stroke although it is from 1995.

    Here’s another one (this one from 2005): Headache at Stroke Onset in 2196 Patients With Ischemic Stroke or Transient Ischemic Attack and even states that, “Headache is a common symptom in acute ischemic and hemorrhagic stroke, but many aspects of its association with other clinical factors are controversial.” What I briefly got out of skimming through a bit of this is that female gender and a history of migraine are a couple of the commonalities noted in those who are more likely to have a headache with an ischemic stroke.

    Sorry – not trying to be the headache police, here. Scalpel…don’t start flamin. ;) And maybe I’m not seeing the whole picture in these articles because I haven’t really read them all the way through, but they seemed to be points of interest….

    Migrainous stroke is not very common, but it is speculated to be underreported, but we’re not really referring to migrainous stroke here anyway – more likely to be stroke associated with headache as it hasn’t been determined (from what I read) that migraine was the predisposing factor for the stroke itself…

    Anyway….carry on with your headache bashing… ;) (I know you’re not all headache bashing, but I can see where this might go!)

    Take care,
    Carrie :)

  5. OK, let’s review: a 40 year-old female (BTW, that IS young when we’re talking about strokes) with a history of migraines, has a bad headache and neurologic symptoms. Overwhelmingly, the most likely diagnosis is a hemiplegic migraine. Does anyone believe she had a sroke on the basis of atherosclerosis?

    Another (unlikely) possibility is a vertebral artery dissection, which can sometimes be mistaken for a subarachnoid hemorrhage. Did the stroke center “experts” just treat a VAD with heparin??

    I must agree with my esteemed colleagues – there’s more to this story.

  6. Goatwhacker says:

    Hey Carrie, no offense meant with the Demerol comment, it’s just that the story doesn’t sound right. The first paragraph makes it sound like the patient had to get “the right medicine right away”. The implication would be she had to get TPA since that’s about the only medicine you have to give “right away” for a stroke.

    But I would bet most docs would not give TPA to this patient. One contraindication to TPA is “symptoms consistent with subarachnoid hemorrhage” which essentially is a bad headache.

    Not to mention the 3 hour TPA time window which started on the plane or even prior to boarding if I read the article right. So in 3 hours you get on the plane, fly from Cleveland to KC, go to the hospital, get your CT, and even then the doc is probably scratching his head wondering if she has a bleed the CT missed. That’s cutting things pretty tight with a patient who does not have a classic presentation by any means.

    This is all speculation since the article doesn’t say what med was given. For all we know the author threw in the bit about immediately needing medicine on their own.

  7. Interestingly, the primary treatment for vertebral artery dissection is anticoagulation.

    http://www.emedicine.com/emerg/topic832.htm

  8. I’m a student @ a University in Omaha. I was doing a clinical shift in the ICU last week and we had a lady on a non-stop flight from LA to NY who started having crushing substernal chest pain at 35,000 feet. Luckily there was a cardiologist on the flight who ordered the pilot to land, the report from the medics states that she’d already had aspirin, plavix and nitro thanks to the plethora of pharmaceuticals that the passengers were packing. An ECG in the ER revealed textbook ST elevations along with reciprocal changes, and off she went to the cath lab. When I saw her in the ICU her ECG was NS without a Q wave in sight… Sometimes it all works out.

  9. Doug – I’m talking about “young” first of all, in terms of predisposition to CADASIL – not in terms of “young” to have a stroke. I agree – 40 years old is young to have a stroke. I wouldn’t necessarily jump to a conclusion of hemiplegic migraine if a woman has a history of migraine and is now having a headache with neurological symptoms. The reason I say this is because hemiplegic migraine is rare, is often genetic, and is difficult to diagnose the first time – and all other options of more serious, acute condition, such as stroke for example, need to be ruled out. It’s difficult to determine if it is hemiplegic migraine for the first time until the hemiplegia goes away and it becomes clear the connection. Here is the ICHD II diagnostic criteria for Familial Hemiplegic Migraine and the ICHD II diagnostic criteria for Sporadic Hemiplegic Migraine

    Now I’m not saying that you couldn’t suspect someone of having a hemiplegic migraine attack, even if this is their first ever. However, one still has to take the time to rule out a stroke, hemorrhage, etc.

    You’re right – there probably is more to the story, but still – either way it sounds like it needed emergency attention…

    Goatwhacker – No offense taken…It’s the sensitive defensive chip that rests on my shoulder when it comes to headaches, that’s all! haha I do know the time limit and criteria as well as contraindications for TPA, and I agree that this would sort of seem unlikely based on the description and time frame in the story. Maybe that’s why they didn’t post the actual treatment – the story would get more attention if folks like us were sitting here wondering what really happened! haha…

    Perhaps we’re reading this wrong…the line in the article says that a stroke victim must get the right medicine right away. What if medicine has nothing to do with medication….which is how we view it – but rather getting the right medicine right away refers to getting the right medical care right away? Now later on in the article, the woman does say that if she had been left untreated, she could have died or been severely disabled – so apparently something was done in a hurry – we just don’t know what that something was…

    Take care!
    Carrie :)

  10. John J. Coupal says:

    Bad Shift,

    You have identified the tactics of the journalist who decides that he/she is competent to write accurately about medical matters for the general public.

    ” I’m not a competent journalist, but I play one in real life !! “

  11. THis is directly from a PDF from St. Luke’s Medical Center where she was treated. I googled her name and “stroke” and it was on the 1st or 2nd page:

    “Stopping Strokes in Mid-air
    “It was a series of little miracles.” That’s how 40-year-old
    Ohio lawyer Jean Robertson described her airplane flight over
    Kansas City as she began having a stroke.
    Robertson—who had a history of migraines—started a flight
    from Cleveland to Phoenix with blurred vision and a headache,
    but she dismissed both. Settling in next to her seatmate, she
    began talking but made no sense.
    Then Robertson touched the left side of her face. No feeling.
    Then the side of her mouth began drooping as paralysis set in.
    Fortunately, another passenger—a pediatric emergency room
    doctor—suspected a stroke and asked the pilots to land. Closest
    airport? Kansas City—home of nationally recognized Saint
    Luke’s Mid America Brain and Stroke Institute.
    Neurologist Irene Bettinger, M.D., and interventional neuroradiologist
    Naveed Akhtar, M.D., were able to reverse the
    stroke by removing a blood clot caused by a tear in the lining of
    the carotid artery, which had prevented blood from getting to
    her brain.
    By that evening, Robertson’s prognosis was good. Today,
    she’s back at work—and her normal life.
    “Jean was in the right airspace at the right time,” said the
    patient’s husband, David Robertson. ?”

  12. Thanks! So, it was a neurointerventionalist that made the difference. That makes more sense than TPA.