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.