As Julie Milanese Jensen was shooting off her last e-mail before going home from work at the end of the day, she looked down at her left arm and didn't recognize it as her own. "It was around Halloween," remembers Jensen, "and I thought my co-workers were playing a trick on me and had put a fake rubber arm next to mine."
But it was no joke: Jensen, then 26-years-old, was experiencing dissociation — a rare symptom of stroke in which a person experiences a sudden mental detachment from themselves. Although unaware of it, she was also slurring her words. Her co-workers immediately called 911.
"When the paramedics arrived, I said, 'Thanks guys,' but I still had no idea why they were there," says Jensen.
Numbness in one arm or leg, as well as speech or vision problems, may signal a stroke. These symptoms occur because the blood supply to the brain is temporarily reduced, leading to an ischemic stroke. If the blood flow to the brain is not restored in a timely manner, there is great risk of permanent damage to the brain resulting in severe neurological damage.
"At UCSF's Stroke Center we have 24-7 neurologist coverage, newer imaging technology and trained doctors who use cutting edge therapy for the treatment of stroke," says Dr. Vineeta Singh, a critical care neurologist at UCSF who treated Jensen. "The key step in successfully treating acute stroke is rapid diagnosis. Not all hospitals have full-time staff who are trained in recognizing the various stroke signs and symptoms."
Within 15 minutes at UCSF, Jensen was diagnosed with a severe ischemic embolic stroke caused by a blood clot, or embolism, which was blocking the blood supply to her brain. This prevents oxygen and nutrients from reaching brain cells, sometimes causing permanent brain damage or even death.
"Getting treatment fast is also an essential part of improving chances for recovery in acute stroke," says Singh. "Had Julie not received treatment right away, her odds of having a severe neurological disability or death would have been higher."
Fortunately, Jensen's paramedics determined that she was having a stroke, and took her to UCSF's Neurovascular Disease and Stroke Center, the first hospital in San Francisco certified by the national Joint Commission on Accreditation of Healthcare Organizations (JCAHO) as a primary stroke center.
Jensen had to make some quick decisions about her care. She signed a consent form to receive a thrombolytic drug — a "clot bluster" that would help dissolve the blood clot lodged in her brain. She was told that it came with serious risks, such as bleeding to death.
"I was transferred to the ICU and by the end of the day I was able to slightly lift my left arm and barely close my left fingers to wave goodbye to my family," says Jensen. "By the next day, I was trying to get used to my left side again."
The treatment saved Jensen's life, but now doctors were trying to determine what had caused a healthy, athletic 26-year-old to have a stroke. Although surprisingly, stroke is not uncommon in people aged 15-45 years of age. It is also the second leading cause of death among women worldwide.
Among other tests, Jensen had an echocardiogram, which uses sound waves to produce detailed, moving images of the heart.
Doctors discovered that Jensen had a condition called a patent foramen ovale (PFO), which is a small hole located between the upper two chambers of the heart. Normally, this hole closes after birth, but remains open in 25 percent of people.
Although most people with a PFO never experience any problems, it is the greatest risk factor for strokes in adults. If an adult with a PFO has a blood clot in the veins in their legs, the clot can travel through the PFO from the right to left side of the heart and into the brain, where it can become stuck, thus blocking normal blood flow to the brain and causing a stroke.
"I was shocked and couldn't believe I had a hole in my heart," says Jensen, who has completed a marathon and five triathlons. "Though when I would exercise, it felt as though my heart was going to jump out of my chest."
Her doctors told Jensen that they would have to repair the PFO. In the past, Jensen's condition required open-heart surgery and a long recovery time. However, now heart specialists successfully close PFOs with a non-surgical procedure that involves cardiac catheterization and a special device that acts as a patch to cover the hole between the right and left atrium.
Jensen's PFO closure was conducted at UCSF's Cardiac Catheterization Laboratory where experts perform more than 425 catheterization procedures for heart defects. Milanese's procedure took approximately two and a half hours to complete. Two days later, she was released from the hospital.
"When you have a patient like Julie who comes into the hospital with a devastating stroke and only in a matter of days leaves the hospital walking, then you know that a system like ours is working and that stroke doesn't have to be debilitating," says Singh.
Within three months after her stroke and PFO procedure, Jensen was back at work and planning her wedding. Now 28-years-old, Jensen is married and the director at Fox Interactive Media. She says she's back to being herself — though with a few major improvements.
"My experience has totally changed my outlook on life," says Jensen. "I think of it as a wake-up call. Now I try to be more balanced and realize that life is very precious and something can happen in a blink of an eye. I spend a lot more time with family and friends, rather than in the office."
Story written in March 2006.
Abby Sinnott is a freelance writer based in San Francisco.