Treatment, rehab at Scripps hospitals set course for successful recovery

Encinitas CA— A year after surviving a life-threatening stroke, Oceanside police officer Angela Guerra has returned to work, is paddle boarding again and recently won a gold medal in cross-country skiing at the World Police and Fire Games.
As caregivers and survivors across the country mark National Stroke Awareness Month in May, Guerra is reflecting on the swift treatment she received from a multi-discipline team at the Comprehensive Stroke Center at Scripps Memorial Hospital La Jolla and the crucial therapy she underwent at the outpatient physical rehabilitation program at Scripps Memorial Hospital Encinitas
“I never in a million years thought that I would have a stroke,” said Guerra, 42. “After almost dying, I dealt with the fight to recover, something many other people who have this stroke don’t get to do because they don’t survive. It’s made me grateful every day for waking up, walking, talking and breathing.”
Guerra suffered what’s known as a hemorrhagic stroke one morning in April 2016 while climbing the stairs that lead from the beach where she surfs. Only 30 percent of people who have a hemorrhagic stroke survive it. Guerra’s stroke was caused by a previously undetected aneurysm on her brain stem, which ruptured and leaked blood throughout the back of her brain, causing a sudden paralyzing headache.
“I remember standing there, holding my head and not being able to move because of the pain. It was so bad I felt like I was going to be sick,” Guerra recalled.
Fortunately, she remained conscious and was able to tell a friend what was happening. He knew severe headaches could be a sign of something serious and made the pivotal decision to call 9-1-1.
Guerra was quickly transported to Scripps Memorial Hospital Encinitas where doctors determined her condition and stabilized her before transferring her to Scripps Memorial Hospital La Jolla, home to one of the country’s first nationally certified Comprehensive Stroke Centers, which provide the highest, most sophisticated level of care to stroke patients.

Within hours, interventional neuroradiologist Giuseppe Ammirati, M.D., had stopped the bleeding in Guerra’s brain with endovascular aneurysm coiling, a procedure that uses a catheter to place a small platinum coil into the aneurysm. The coil acts like grout to fill a hole, triggering blood clotting and stopping bleeding, Dr. Ammirati said.
“As a comprehensive stroke center, we have an experienced team of experts who review every case and collectively decide the approach to treatment that will offer the best results with the least risk,” he said. “Angela’s case was difficult to treat because the aneurysm was located in a sensitive area of the brain that controls movement and function. When the team looked at the radiological images, it was determined that an endovascular approach was best.”
Studies have shown that for a hemorrhagic stroke, survival rates with endovascular treatment are 20 percent higher, Dr. Ammirati said.
“Angela was fortunate that she was in very good shape with no comorbidities and her friend knew that an unusually severe headache warranted a call to 9-1-1, so she got treatment from an experienced team before the stroke became too advanced,” he said.
American Stroke Month is a good time for people to familiarize themselves with the signs of stroke and the appropriate actions, Dr. Ammirati said. Quick thinking and awareness, like that shown by Guerra’s friend, can help to save a life.

• Hemorrhagic stroke often occurs in someone with a previously undetected brain aneurysm. Sudden onset of a headache of a severity never experienced before could be a sign of an aneurysm. Often the person loses consciousness before he or she can receive treatment.
• An ischemic stroke is caused by a blockage of blood flow to the brain and can cause weakness, numbness and paralysis in the arm, leg or face; slurred or garbled speech; dizziness or loss of coordination; and blindness or blurriness in one eye.

As a Comprehensive Stroke Center, Scripps provides minimally invasive stroke care not available at many other hospitals. Criteria for Comprehensive Stoke Center designation includes participation in research, access to advanced imaging and performing a minimum number of procedures, as well as treating a minimum number of conditions annually. The certification recognizes the significant differences in resources, staffing and training that are necessary for the treatment of complex stroke cases.
Guerra spent almost a month in the hospital recovering and several more months receiving physical therapy to regain the strength and dexterity that a can be sapped from a patient by such a traumatic health event. In November, angiogram images of the arteriesnd blood vessels in her brain showed that she was well enough to return to the police force, where she has worked for nine years.
A month later, Guerra competed in several races at the World Police and Fire Games in Mammoth, California, taking home the gold in cross-country skiing.
“I feel great. I’m thankful to be back at work, full-duty. I realize that I’m very lucky and fortunate to have received the great care that I did at Scripps, and I am continuing to push myself to train and increase my strength and endurance even more,” Guerra said.