Young, Healthy, and a Stroke Survivor: Ramit Malhotra’s Story

There isn’t much that Ramit Malhotra remembers about the morning of April 17, 2018, but it was a day that would change his outlook on life forever.

While driving along the Long Island Expressway in Queens, New York, Ramit suddenly felt a shooting pain in his neck, which turned into a loss of function on his right side. His first instinct was to video call his then-fiancee, Sumiti, but the call dropped. Despite starting to lose control of half his body, Ramit managed to pull off the expressway and into a bank parking lot.

After that, his memory gets fuzzy. He later found out that a bank customer noticed him in the parking lot, realized something was wrong, and alerted the security guard, who called 911. Ramit’s next vivid memory is of waking up in a hospital bed in the intensive care unit at NewYork-Presbyterian Queens. “I remember waking up with a tube controlling my breathing, and seeing my sister, who had flown in from California,” he says. “When I saw her, I knew it had to be serious.”

A Race Against Time

Ramit would soon learn that, despite being a healthy, fit 28-year-old, he had suffered a stroke. While he drifted in and out of consciousness, Dr. Jay Yasen, attending neurologist at NewYork-Presbyterian Queens, was evaluating him and saw some of the telltale signs: slurred speech, loss of coordination in his right arm, trouble maintaining his gaze toward the right, and a smaller right pupil than left, among other symptoms. “These were clues that not only was he having a stroke, but he was having a stroke involving the brain stem and right cerebellum,” says Dr. Yasen, who is also an assistant professor of clinical neurology at Weill Cornell Medicine.

The care team had to act quickly. First was a CT scan to rule out the possibility of bleeding in his head, of which there was none. Next came a CT angiogram, a type of imaging that uses an iodine contrast administered through an IV to evaluate the blood vessels. The CT angiogram uncovered the cause of the stroke: a right vertebral artery dissection, which is a tear in the tissue layers of the vertebral artery that runs along the back of the neck. All this happened within 40 minutes of Ramit’s being admitted to the emergency room.

In Ramit’s case, Dr. Yasen suspected that a blood clot had formed at the site of the tear in his neck. He gave Ramit tPA, a medication used to dissolve blood clots that must be administered within a 4 ½-hour window of the onset of a stroke. Ramit initially showed signs of improvement right after receiving the medication. But 1 ½ hours later, his head and neck pain intensified, his blood pressure shot up, he lost all movement on his right side, and he became more confused.

“At that point, I suspected the clot may have traveled from the vicinity of the dissection in the neck up to another artery within the brain,” says Dr. Yasen. He consulted with Dr. Ning Lin and Dr. Srikanth Boddu, neurosurgeons and interventional stroke specialists at NewYork-Presbyterian Queens, to discuss the possibility of performing a thrombectomy, which is a surgical procedure used to physically remove a clot from a blood vessel.

Ramit underwent another CT scan just to confirm that there was still no bleeding in his brain, followed by a traditional angiogram, in which a catheter is inserted into an artery to administer the iodine contrast that helps determine the location of the blood clot.

The angiogram, however, showed no signs of a blockage — which meant Ramit didn’t have to undergo the thrombectomy after all. Dr. Yasen says it’s possible that it just took time for the medication to kick in and clear the clot, or the mere act of inserting the catheter and injecting the iodine contrast had created enough pressure to push the clot through and open up the artery.

Either way, Ramit now appeared to be in the clear. He was taken to the intensive care unit, where his care team quickly performed an MRI of his brain. It revealed that he’d had not just one stroke, but two additional ones — fortunately, those had been small. “Based on both the MRI and how he looked when I examined him later that day in the ICU, I knew that he was going to do quite well,” says Dr. Yasen.

A Speedy Recovery Before Saying ‘I Do’

After speaking with Ramit, Dr. Yasen discovered the likely cause of the vertebral dissection: About a month prior, Ramit had been lifting weights at the gym and experienced an intense pain in his neck followed by dizziness. He thought he had just strained a muscle, but a few weeks after noticed a slight droop to his face. He visited an urgent care center, but they dismissed his concerns. Two weeks later, he had the stroke.

Fortunately, Ramit’s recovery was rapid. He was in the hospital for three nights total and only needed physical therapy for about two months following his release. Other than forgoing lifting heavy weights in his exercise routine, he didn’t need to change much about his lifestyle. And most important of all, he was able to marry Sumiti at the end of June, just like they had planned, a mere two months after his stroke.

“I never suspected this would happen to me. As a 28-year-old millennial, you feel like you can do anything,” says Ramit. “But what I’ve learned is that you just don’t take time for granted. Soak in every moment — and don’t take your body for granted, either.”

That’s a sentiment that will stick with him forever, he says, because he can’t forget the feelings of fear and uncertainty that plagued him and his family when he was at his weakest, physically and emotionally.

“I’ve gathered stories from my family and learned what condition I was in when I arrived at NewYork-Presbyterian Queens,” Ramit says. “Learning I’d had a stroke and that I could be a very different person if I made it out of the stroke alive was a very difficult message for my family, and especially for my wife, to digest. It was unfathomable and unexpected, and the weight of the message was really heavy.”

But he recalls how the care team’s attentiveness helped them get through the ordeal. They patiently explained what had caused the stroke and what they were doing to stabilize his situation. Dr. Yasen answered his family’s many questions at every point of his recovery. And when Ramit felt uncomfortable, helpless, or sad, a nurse would hold his hand and give him strength. “Each conversation with my doctors and nurses was a form of support during my darkest hours,” he says.

As a show of thanks, a few weeks before his wedding, Ramit hosted a dinner at his family’s restaurant for his care team, inviting the doctors, a physician’s assistant, nurses, and others who treated him at NewYork-Presbyterian Queens. He even toasted them with a speech.

“I really wanted the care team to feel proud of what they do on a daily basis,” Ramit says. “I walked away from my NewYork-Presbyterian experience extremely grateful for the compassion and intellect these professionals bring to their work. I thought they should know that what they do is truly special.”

Dr. Jay E. Yasen is an attending neurologist at NewYork-Presbyterian Queens specializing in vascular neurology and neurocritical care and an assistant professor of clinical neurology at Weill Cornell Medicine. He is a member of the American Academy of Neurology, American Heart Association, The Stroke Council, and the North American Neuro-Ophthalmology Society.