96-year-old stroke survivor proves the benefits of swift treatment

In October 2023, Doris Carlson stood up from the sofa in her living room and fell forward, flat on her face.

She doesn’t remember anything, but her husband Winston called 911 and their daughter Sue. Sue rushed over to find several emergency responders in her parents’ house. The right side of Doris’ face was drooping, and she was having trouble speaking. These are signs of stroke and meant Doris needed to get to the emergency department quickly. An ischemic stroke occurs when the blood supply to part of the brain is blocked by a blood clot. It prevents oxygen and nutrients from reaching the blocked part of the brain and brain cells begin to die within a few minutes. Doris’ symptoms were caused by a large blood clot on the left side of her brain.

Sue remembers her mother being uncharacteristically resistant. But she got her mom in the ambulance. Sue specifically requested that they go to M Health Fairview Southdale Hospital because of the successful stroke care another family member received there.

At Southdale, Christopher Streib, MD, MS, a vascular neurologist, and his team quickly assessed Doris. They gave her a medication that dissolves blood clots and called the endovascular surgical neuroradiology team that performed minimally invasive surgery to remove the blood clot that remained. Streib is also an associate professor with the University of Minnesota Medical School and is the cerebrovascular director for M Health Fairview.

“With stroke treatment, everything has to be fast because injury to the brain will become permanent,” Streib said. “We’re going as quickly as we can. People are running the medication to the patient while the surgical team is getting set up to take her immediately for treatment. It’s impressive how fast everything happens.”

Each patient is an individual

For some patients, a clot-busting medication is enough to restore blood flow in the brain. In Doris’ case, she would also need a surgical procedure, called a thrombectomy, to remove the clot. The surgical team made a small incision in Doris' wrist and maneuvered a catheter up to the brain through her blood vessels to remove the clot.

It can be tough to know if the risks involved with the procedure outweigh the benefits in older patients – which makes some healthcare providers reluctant to treat older stroke patients. Risks include tearing a blood vessel, excessive bleeding, and a brain hemorrhage, which is bleeding in the brain.

For nonagenarian patients who already have a diminished quality of life or severe cognitive decline, surgical treatment to remove the clot might not be appropriate. But Doris proves that treatment shouldn’t be discouraged based on age alone. Streib expressed pride in his team for not focusing on Doris’ age and caring for her as an individual. Research shows that the elderly, women, and racial minorities are less likely to receive stroke treatment like the clot-buster medication or thrombectomy.

“It’s important for us to be as aggressive as we can with each stroke patient as long as it is reasonable and aligns with their goals of care,” Streib said, “All we can do is give everyone the best opportunity to recover by removing the clot as fast as possible without discriminating by age, sex, race, or anything else."

The stroke intervention team believed that Doris was a good candidate for thrombectomy. When she had her stroke, Doris was mentally sharp and cared for her husband of 77 years, who has since passed away. For Doris, it was important to get back home to her husband. Without swift treatment, she would not have survived.

After the procedure, Doris couldn’t speak or move the right side of her body. She was also agitated and disoriented from the sedating medication. This can be difficult for families because their loved one might look worse than when they arrived at the hospital.

Streib was able to reassure the family that she could recover. “We knew the clot was out, we knew it had come out quickly, and we were confident that nearly all her brain tissue was saved,” Streib said.

A remarkable recovery

The following day, Doris’ strength and language skills had improved. She woke up to find her granddaughter and great-grandchildren in the hospital room with her.

“I couldn’t understand why I was in a bed and all our family was there,” she said. “Then I looked at my right hand and it didn't look like my hand. I couldn’t move it like my left hand. I thought to myself, ‘you better get that hand moving.’”

Perhaps Doris’ determination helped speed her recovery. Sue remembers her mom declaring from her hospital bed, “well, I have places to go and people to see. I don’t have time to be sick here.” She was in the hospital for about three days, then spent a couple of days in a rehabilitation facility before going home.

“That’s fast, even for a 50- or 60-year-old,” Streib said. “It’s very remarkable for a 96-year-old.”

Six months later, Doris was laughing at her kitchen table after lunch. If she wasn’t telling the story of her stroke, you wouldn’t have guessed she’d had one. She expressed her gratitude for the healthcare team that treated her, so she could return home with no lasting effects from a major stroke.

“I just want to say thank you to everybody that helped me those couple days because I had no idea what was going on,” Doris said.