March 8, 2019

UAMS Stroke Team Provides ‘Miracle’ for DeWitt Man

Salah Keyrouz, M.D., David Bullock and Eren Erdem, M.D.

David Bullock (center) recently enjoyed a visit with the two UAMS doctors who saved his life following a severe stroke: Salah Keyrouz, M.D., and Eren Erdem, M.D. (l-r)

Shannon Bullock rushed to her husband, David, when she saw him fall on the steps of their family crop dusting business in DeWitt.

What happened next speaks to the life-saving power of timely, appropriate treatment that is now available across Arkansas when someone has a stroke.

Shannon, an EMT, took the first critical steps: She recognized her husband’s stroke symptoms – right-side paralysis and inability to speak – and immediately called 911.

An ambulance arrived in less than 10 minutes and took Bullock to the DeWitt Hospital, which had the communications equipment needed to connect with UAMS stroke neurologist Salah Keyrouz, M.D. The equipment was provided through AR SAVES (Arkansas Stroke Assistance through Virtual Emergency Support), a UAMS-led program that since November 2008 has continued adding rural hospitals to its network.

With the live two-way audio/video, and with assistance from DeWitt Hospital staff, Keyrouz could see Bullock’s right-side weakness, loss of peripheral vision on the right, and inability to speak, understand spoken language, and feel touch or a pinprick on that side.

“What I was able to see through telemedicine made me aware that we were dealing with a large, severe stroke,” Keyrouz said. “I couldn’t do that as well if we were relying just on the telephone.”

After confirming that the stroke was caused by a blood clot in the brain rather than by a ruptured blood vessel, Keyrouz was able to recommend the use of t-PA, a clot-dissolving drug. The t-PA (tissue plasminogen activator) was given intravenously in DeWitt.

Prospects for a full recovery from stroke improve significantly when patients receive t-PA, the powerful clot-dissolving drug, but it must be given within 4.5 hours of the first signs of a stroke.

Stroke Pathway

For a stroke as large as Bullock’s, t-PA isn’t enough, so Keyrouz urged his immediate air transport to UAMS and simultaneously activated UAMS’ “stroke pathway,” which ensures that UAMS subspecialists and staff, imaging devices and procedure room are ready when the patient arrives.

“The minute he hit the door, all I had to do was lay an eye on him to know if he was better or not,” Keyrouz said. “I wasn’t starting from scratch, so there was no time wasted, and that’s tremendously helpful.”

Bullock, who arrived at UAMS within about two hours of his stroke, needed aggressive, acute endovascular therapy that could be provided only by one of UAMS’ interventional neuroradiologists – in this case, Eren Erdem, M.D., who is internationally known for his advanced catheter-based treatments.

Bullock’s clot was affecting two-thirds of the left side of his brain, and he had four seizures while at UAMS. In spite of those complications, Erdem was able to open the vessel and restore blood flow before extensive damage occurred. Erdem used one of the latest devices for retrieving blood clots that works by fragmenting and sucking out the clot.

“The device was very important to the outcome, but just as important was the ability to make the right decision and act very fast, which couldn’t have been done without a team of highly experienced doctors, the stroke team and the AR SAVES program,” Erdem said.

Following his emergency treatment, Bullock was taken to the neurointensive care unit where his care was overseen by Keyrouz, one of just two neurointensivists in Arkansas, both at UAMS.

Two days later, Bullock amazed all involved in his care by walking out of UAMS with no stroke-related disabilities.

“One of the doctors said it was a miracle,” Bullock said.

“Everything went perfectly,” Keyrouz said. “You can’t hope for better outcome.”

AR SAVES is a partnership that includes the UAMS Center for Distance Health, Arkansas Department of Human Services, Arkansas Department of Health and Sparks Regional Health System in Fort Smith. So far, AR SAVES has 27 community hospital partners, which become part of the program after extensive training by the UAMS Center for Distance Health and stroke certification by the National Institutes of Health.

Since the program began, more than 500 patients have received stroke consults through AR SAVES, and more than 130 patients have received t-PA.