Stroke is Unpredictable

A Regular Morning

May 18 should have been a regular day for Wenping Kuo, a 48-year-old vegetarian, who practices Buddhism, doesn't drink or smoke, and meditates daily. But an ischemic stroke changed her path.

Despite her balanced lifestyle, Wenping Kuo had a stroke this year. In a quarter of cases, strokes occur with no known cause. Thanks to the Comprehensive Stroke Center at Cedars-Sinai, she has regained her footing and is looking forward to a life of wellbeing.

That morning she meditated, drove to the GP DEVA gallery where she was an assistant manager, and walked up the street for a tofu wrap. That's when she felt dizzy.

As she stepped into the crosswalk of Bedford Drive, she lost her balance and the left side of her body went limp before she hit the ground.

"I remember closing my eyes as I felt my head hit the ground. It hit the ground so hard it bounced back," she said. "I tried to get up using my right hand to push up but I couldn't. I had no idea the left side of my body was paralyzed. Everything was so heavy."

Strangers sprung into motion and helped – she remembers a woman in a red sweater and a man with white hair carried her away from the busy intersection, while a man in a suit called 911. Kuo was rushed to Cedars-Sinai where the multidisciplinary stroke team gave her the clot-busting drug tissue plasminogen activator (tPA), while an endovascular surgeon went to work removing the clot from her neck.

"In Wenping's case tPA acted like Drano, where it helped breakup the surface of the clot but you still need a snake or something a plumber has that can mechanically get the bigger clots out," said Shlee S. Song, MD, associate director of Cedars-Sinai's Stroke Program.

"And that's exactly what Michael J. Alexander, MD, and the team of neurointerventionalists did for Wenping when they performed the thrombectomy procedure."

Michael Alexander, MD, director of the Neurovascular Center, performed a thrombectomy to pull the clot from Kuo's

Song said the hospital was notified at 10:56 a.m. of an incoming stroke patient and by 11:03 a.m. Kuo was in the Cedars-Sinai emergency room, where the hospital's stroke team was waiting for her.

Song said, by 11:23 a.m., the tPA had been injected with the goal of breaking up the clot. With the knowledge that tPA alone couldn't do the trick, Alexander and his team were ready to go with a catheter that would be threaded up from Kuo's groin to her neck.

By 12:29 p.m. Kuo was clot free, with blood fully restored and flowing to her brain.

As a Comprehensive Stroke Center, Cedars-Sinai is equipped to handle the most severe circumstances of acute stroke cases, and offers minimally invasive treatment options.

"When Wenping came in she was slurring her speech. She was considered a Jane Doe because we couldn't understand her," Song said. "She was able to give us the phone number to her work and from there our stroke nurses were basically playing detectives trying to find out who she was so they could reach her family members."

Phone calls to the gallery, then the gallery manager and Kuo's sister in Taiwan, circled back to Los Angeles where Kuo's mother lives.

One of the people who helped her when she fell had recognized the amber prayer bead bracelets Kuo was wearing. The woman in the red sweater made the connection to Buddhism and GP DEVA, and walked into the gallery hoping to find the identity of the "thin Asian woman who doesn't speak English and had a stroke," said Kuo.

"But I speak English and am healthy, so the employees didn't think it was me who had the stroke," Kuo said.

Stroke Team in Action

Thanks to rapid intervention by stroke specialists Konrad H. Schlick, MD, and Shlee S. Song, MD, Kuo is continuing her recovery.

In addition to paralysis on her left side and slurred speech, Kuo also experienced a common stroke symptom and phenomenon called neglect.

"Patients with neglect no longer have the perception of the left side of the world. It's not just a matter of them not being able to see it; they can't understand it and there is no such thing," said neurologist Konrad Schlick, MD, who was part of Cedars-Sinai's team caring for Kuo.

Schlick said patients with a severe form of neglect would only eat the food on the right side of the plate and complete ignore the left, until the plate is turned 180 degrees. And often don't know they're experiencing the symptom.

"Luckily for Wenping this would have been a very disabling stroke if she hadn't received all the right treatments within the right time," Schlick said.

Kuo's successful outcome is due in large part to bystanders recognizing the symptoms of stroke and calling 911 immediately. And, Song said, because the whole hospital was able to move quickly, working together to give Kuo her very best chance at recovery.

Positive outlook

Kuo is continuing her faithful lifestyle, with a dedication to health and Buddhism that keeps her centered.

Kuo's healthy medical history had Cedars-Sinai neurologists searching for answers as to why she experienced the stroke. Schlick said about 1 in 4 strokes happen with no known cause – in the medical world, this is called a cryptogenic stroke. The good news is these types of patients are less likely to have another stroke down the line.

By the next morning Kuo was sitting up, drinking tea. Hospital staff nicknamed her "Ms. Miracle."

While she no longer works at the gallery, Kuo has started meditating again and has continued with her healthy and religious lifestyle, while recognizing the importance of Western medicine.

"I had not seen a doctor in 20 years, not since my son was born. And I have not had a cold in years," Kuo said. "But with this stroke I am so grateful I was in the hands of Cedars-Sinai. They did an amazing job taking care of me and curing me of the stroke."