Health at Home Nurse Lisa Lucero, R.N., offers Delfina Duran encouragement during recovery.

When Delfina Duran, 41, of Fairfield, reached the NorthBay Medical Center Emergency Department (ED) on Friday, May 17, it had been 10 hours since she had suffered a stroke.

The mother of two didn’t know the warning signs of stroke, so when her symptoms began the evening before, she attributed them to muscle spasms. “She tried to pick up the telephone, but she dropped it,” remembers Cindy, 11, her daughter. “Her face had also changed and I told her we should go to the emergency room.”

Delfina says she had no feeling in her arm or hand, but decided to go to bed, hoping to be better in the morning. Instead, when she awoke she couldn’t speak and her right side was weak. Alarmed, her husband Apolinar and the entire family rushed her to the hospital. The triage nurse immediately admitted her to the ED.

“When we first saw Delfina, she was very anxious about what was happening to her,” remembers Rosalie Toloumu, R.N., who cared for her in the ED.

Delfina’s initial examination included a neurological assessment. It revealed she couldn’t hold her right arm up and her grip strength was weak. And she still couldn’t speak.

ED physician Caesar Djavaherian, M.D., called a Stroke Alert, which immediately marshaled an array of hospital resources to help Delfina. This cleared the way for a CT scan of her brain, as well as lab work and an IV.

The first step in treatment for Delfina was determining just what type of stroke she had experienced.There are two types of stroke, ischemic and hemorrhagic. Ischemic stroke occurs as a result of an obstruction within a blood vessel supplying blood to the brain. It accounts for 87 percent of all stroke cases. Hemorrhagic stroke results when a weakened blood vessel ruptures and bleeds into the surrounding brain. Although less common, it often requires immediate intervention.

Delfina was sent for a CT scan, which is a quick and easy way to detect bleeding inside the brain. Fortunately, NorthBay Medical Center is home to a powerful, $2 million Phillips 256-slice scanner which produces extremely high-resolution images with reduced radiation exposure. The scan revealed that Delfina did not have bleeding in her brain, ruling out a hemorrhagic stroke.

“After the CT, the doctor came to us and said ‘I think we know what’s wrong—your mother has had a stroke,’” Cindy remembers.

Because Delfina had not reached the Emergency Department within three hours of the start of her stroke symptoms, she was not eligible to receive the clot-busting drug tPA. Instead, she was admitted to the hospital’s intensive care unit.

In the first few hours and days following a stroke, the patient is at risk of having a second stroke. They also are susceptible to serious complications that can include seizures, brain swelling and infections such as pneumonia.

Once she was in the ICU, Intensivist Sreenivasa Ravuri, M.D., ordered a Magnetic Resonance Imaging or MRI. It is one of the most helpful tests in the examination of a stroke. By this time Delfina said she was feeling ill and had a big headache. With her stroke identified, she began an intensive course of medical management.

Delfina’s blood pressure was unusually low, which meant less blood, and therefore less oxygen, was reaching her brain. Drs. Ravuri and Rehman placed her on medication to raise her blood pressure to get more oxygen to the damaged left lobe of her brain. Their goal, said Julian Gallegos, the stroke clinical practice manager and nurse practitioner on the case, “was to minimize any deficits Delfina may have.”

“I’ll always remember this case, because her young daughter, Cindy, sought us out and asked what was happening with her mom,” Gallegos says. “How do you tell a child that her mother may never speak again? It was a very poignant moment that reminded me that it is not only the patient we are caring for but also the family.”

Looking back, Cindy remembers that it was very hard to communicate with her mom. “She couldn’t write with her left hand, so we had to use hand signals.”

By Sunday, Delfina could speak. She spent a total of six days in the hospital, including four in the ICU. She gradually regained her strength and began moving her arm. A physical therapist taught her how to exercise her arm and a speech therapist coached her on speaking.

By the time she was discharged, Delfina was still weak, but well on the road to recovery. NorthBay Health at Home nurse Lisa Lucero, R.N., monitored her blood pressure and kept an eye on her progress once she was home.

“Today, she feels much better, although sometimes she knows what she wants to say but can’t find the words,” Cindy says. “We are so very thankful for the people who helped her.” “Delfina had the best possible outcome,” Gallegos adds.