By Henry L. Davis
The Buffalo News
BUFFALO, N.Y. — When Molly Schmand crumpled to the floor, she wasn’t thinking brain attack.
To the 18-year-old from Buffalo, strokes were something that happened to old people.
Not so, she learned.
Less than an hour after the episode she was in a hospital, where doctors threaded a tiny catheter into her brain to examine a clot that threatened to leave her crippled or dead.
The longer blood flow to the brain is cut off, the greater the damage. So every minute counts with stroke. And, in this case, quick action by Schmand’s parents, a neighbor and her dog made a big difference.
Indeed, it’s likely Annie, a mixed coonhound from the SPCA Serving Erie County, will never lack for affection or dog biscuits because of the role she played.
“Teenagers act as though they’re invincible. They would never think this is going to happen to them,” said Schmand, whose life is starting to return to normal since she suffered the stroke in April and underwent surgery in June.
Stroke in children and young adults is not as common as in the elderly, but it’s more common than physicians once thought.
Improving delays in treatment
The causes and symptoms can be different, too, all of which has led to misdiagnosis and delays in treatment, according to studies.
Therefore, stroke in young people is getting more attention from the medical community.
Among other things, the American Heart Association/American Stroke Association in 2008 issued its first scientific statement on the treatment of stroke in children.
A 2009 study in California found that the rate of stroke in children may be twice as high as current estimates, and a paper presented earlier this year at the International Stroke Conference offered the first hard numbers on what looks like a rising number of stroke cases among younger adults in the U.S.
“If our data is useful for anything, it raises awareness. People need to know that stroke is possible in the young,” said Dr. Brett Kissela, the University of Cincinnati neurologist who led the study.
Schmand knew stroke was possible in the young.
One of her neighbors is a close relative of Nick Giangreco, who was partially disabled at age 14 after suffering a near-fatal stroke on the bench at a St. Joseph’s Collegiate Institute football game in 2006.
She just never thought it could happen to her.
A teenager’s account of her stroke
It was April 1, her first day home for spring break from Canisius College, where she lived on campus. Her parents, Liz, a nurse practitioner, and Michael, executive director of Buffalo Place, were at work.
Schmand — an athlete who played soccer, basketball and softball when she attended high school at Sacred Heart Academy — headed to the basement to work out with a punching bag. As she walked by Annie, who was snoozing on Schmand’s bed, she remembers jokingly calling out, “You are such a bum.”
Soon after Schmand started punching the bag, everything went dark. She had passed out.
Her next memory was of waking up to Annie licking her face, something Annie was not known to do.
“I think she revived me,” said Schmand.
It was clear something was wrong. The right side of Schmand’s body felt numb, and her head throbbed. She couldn’t see out of her right eye, and her left eye had trouble making out objects in the room.
Schmand was scared but didn’t panic. She climbed the stairs to the first floor but isn’t sure how she did it. She couldn’t identify a telephone, yet remembered one of them was lime green, so she searched for the color and somehow made a call to her mom.
A ‘finely tuned machine’
“I knew it was a stroke immediately, and I knew we only had minutes to react,” said Liz Schmand, who called a neighbor to stay by her daughter’s side until an ambulance arrived.
After word got to Michael Schmand, they both rushed home, waited for the ambulance, called about its whereabouts, waited a little longer, and then took matters into their own hands.
They carried Molly to their car and raced to Millard Fillmore Hospital, a state-designated stroke center that also specializes in minimally invasive procedures to treat and prevent the condition.
Stroke centers organize teams that train to respond to cases as quickly as possible.
“I remember being rushed from test to test. People were running. It was like out of a movie,” said Schmand.
Her mother described what she witnessed as “a finely tuned machine.”
A stroke occurs when a blood vessel that brings oxygen and nutrients to the brain bursts in a hemorrhagic stroke or is clogged by a blood clot in an ischemic stroke. Each year about 795,000 people experience a stroke, making it the third-leading cause of death in the U.S. and a leading cause of disability.
When time is everything
Starved for oxygen, brain tissue will eventually die, so the more quickly blood flow returns to normal, the better the outcome for patients.
Highly detailed images of Schmand’s blood vessels revealed a clot in an artery in the base of her brain. Doctors decided against a procedure to remove the clot, noticing that her vision was starting to improve and fearing it might release debris that would penetrate farther into the brain.
Instead, they put her on medications aimed at dissolving the clot, and the treatment worked.
Doctors would eventually trace the origin of Schmand’s stroke to a condition known as patent foramen ovale.
As babies grow in the womb, there is an opening between the upper chambers of the heart that naturally closes soon after birth. But the hole remains, usually undetected, in about 25 percent of the population. It’s linked to stroke in about 1 percent of those with the condition, especially in patients under age 55.
Schmand had the hole surgically repaired with a patch made of Gore-Tex.
The right side of her body still feels numb, and she struggles with focusing her mind and remembering things she has read. But life is starting to return to the way it was. She even recently went for a run.
“It could take two years to get over most of this. I’m just so glad to have my vision back,” she said.
Children and adults younger than 45 account for 5 percent to 10 percent of all stroke cases, according to experts.
But Kissela’s research suggests the incidence of stroke is rising among individuals under 45. He attributes the increase in stroke to increasing rates of obesity and diabetes from poor diet and lack of exercise.
“The lifestyle decisions we make early in life have consequences,” he said.
A tough diagnosis
On average, it takes 12 to 24 hours for adults to get to the hospital after recognizing the first symptom of stroke, but much longer for children and young adults, mainly because symptoms can go unrecognized or be attributed to something else, according to the National Stroke Association.
“Diagnosing stroke can be a challenge. In a third of cases, you never find a cause, and it can be misdiagnosed because there are other conditions that have similar symptoms,” said Dr. Catalina Ionita, director of neurocritical care at the Catholic Health System.
Doctors know much more about how stroke affects individuals differently, depending on their age, race and gender. Evidence indicates that young patients make ideal candidates for procedures that open clogged arteries and other aggressive therapies.
“If any population is good it is the young patient. The anatomy of a young person is more robust and, because of their age, a successful intervention has a huge impact on their lives,” said Dr. Elad Levy, one of the leaders of the neurosurgical team at Millard Fillmore.
After her experience, Schmand agreed to participate in a hospital advertising campaign about stroke care. She wants to share her experience, hopeful it will raise awareness among others her age.
“What gets me now, is how your life can take a completely different turn in just one second,” she said.
Copyright 2010 The Buffalo News