By Kory Herrick, M.D.
When 64-year-old David DeNoma awoke to a loud ringing in his head, he knew something was wrong. He tried to get out of bed, but the room was spinning so violently that he had difficulty maintaining his balance and could barely support himself sitting on the edge of the bed. By the time paramedics had brought him to Asante Rogue Regional Medical Center in Medford, he was having double vision and difficulty speaking.
His emergency room physician, Michael McCaskill, M.D., immediately suspected a stroke and called OHSU to request a telemedicine consultation. A few minutes later, using a telemedicine robot equipped with two-way video communications technology, I was able to speak with Mr. DeNoma about his symptoms, medical history and medications, and then perform a careful neurologic examination – despite being 275 miles away.
Mr. DeNoma’s symptoms and exam findings suggested that a blood clot had blocked his basilar artery, the major artery supplying blood to the brain stem. Strokes caused by basilar artery occlusions carry a particularly poor prognosis and usually result in death. Many of the patients who survive are left in a “locked-in” state, wherein they retain awareness but are almost completely paralyzed from head to toe and unable to communicate verbally. I discussed the case with his emergency room physician in Medford. We decided that Mr. DeNoma’s best chance of survival was to receive t-PA, a potent clot-busting medication, and then be flown to OHSU to attempt to have the blood clot removed by a procedure known as mechanical thrombectomy. A few hours later the clot was successfully removed, and Mr. DeNoma was recovering in OHSU’s neurosciences intensive care unit. Within 48 hours, his stroke symptoms vanished and he went home. Two months later, he was vacationing in Hawaii.
Mr. DeNoma’s case stands out as a poignant reminder of how indispensable telemedicine is in providing emergent specialty care to patients living in areas without specialist support. When patients arrive in an emergency room with symptoms of an acute stroke, the earlier an accurate diagnosis is made and treatment initiated, the better the outcome. The OHSU Telemedicine Network enables our stroke neurologists to arrive at a patient’s bedside in minutes, meet with the patient and family, perform a detailed physical examination, make a diagnosis and formulate a treatment strategy best suited to the patient’s particularneeds.
Since its inception in April 2010, OHSU has provided acute telestroke care to more than 420 patients like Mr. DeNoma. As this technology continues to evolve, and as the number of sites using it grows, we will provide immediate, quality care to an even larger number of Oregonians when and where they need us.
Learn more about how telemedicine helped Mr. DeNoma make a remarkable recovery. Check out this story on KTVL Channel 10 in Medford.