Ms. Salamanca’s case highlights the critical importance of early stroke recognition, the delicate nature of brain interventions, and the value of having access to a specialized neuroscience team.

A Six-Year-Old’s Quick Thinking

The situation began on an ordinary afternoon. Ms. Salamanca was spending time with her six-year-old granddaughter when things suddenly took a frightening turn. Ms. Salamanca became dizzy, fell to the floor, and stopped speaking. Her gaze became fixed to the right, and the entire left side of her body went weak.

“It was a normal day at home, except that my granddaughter hadn't gone to school that day and she turned out to be my guardian angel,” recalls Ms. Salamanca.

Recognizing that something was terribly wrong, theyoung girl immediately called her mother using FaceTime.

 

“I collapsed to the floor, unable to get back up on my own,” said Ms. Salamanca. “I asked my granddaughter, who is always right by my side, to hand me my phone so I could call one of my daughters. I couldn't focus my eyes well enough to dial, so I asked her to fetch her tablet and call her mom — my daughter— to let her know that I had fallen. She did exactly that.”

Through the video call, Ms. Salamanca’s daughter observed the classic, undeniable signs of a stroke. She quickly called emergency medical services (EMS), setting a life-saving chain of events into motion.

“On two previous occasions, I had experienced mild bouts of dizziness, but I never associated them with a stroke,” said Ms. Salamanca. “Even now, I don't know if those earlier dizzy spells were in any way related to this specific episode.”

When paramedics arrived, they assessed Ms. Salamanca using a stroke severity scale. They rushed her to the emergency department, where the medical team stood ready to evaluate the damage and determine the best course of action.

Arriving at the Hospital: The Initial Assessment

Peter A. Abdelmalik, M.D., Ph.D.

Upon arrival, an emergency physician confirmed that Ms. Salamanca was stable enough to undergo immediate brain imaging. Computed tomography (CT) scans are the standard for stroke assessment, as they allow doctors to look inside the brain and identify whether a stroke is caused by bleeding or a blockage.

Peter A. Abdelmalik, M.D., Ph.D., neurologist and director of inpatient general neurology at Baptist Health Brain & Spine Care, assessed the patient. Because Ms. Salamanca could not communicate well, the medical team had to rely heavily on physical signs and imaging.

"Her inability to speak made it difficult to diagnose," Dr. Abdelmalik explained. "Not being able to speak could be due to stroke, confusion, lethargy, other medications, etc. Typically, in that situation, you treat as if it’s a stroke until a stroke is ruled out."

The team quickly realized they needed to administer clot-busting medication.

A Rare Double Threat: Clot and Aneurysm

The medical team ordered an advanced imaging test called a CT angiography/perfusion scan (CTAP). This specific scan maps blood flow and identifies exactly where blood vessels are blocked. The imaging revealed a major blood vessel occlusion — a severe blockage in the right middle cerebral artery.

Robert Wicks, M.D.

However, the scan revealed an additional dangerous finding. Ms. Salamanca did not just have a blood clot; she also had an unruptured aneurysm right next to it.

Robert Wicks, M.D., co-director of cerebrovascular surgery and director of the Neuroendovascular Surgery Fellowship at Baptist Health Miami Neuroscience Institute, described the rare discovery.

"She had this brain aneurysm, which is like a weakness or an outpouching in the artery," Dr. Wicks explained. "And it was immediately next to the area where the artery was occluded or blocked with a blood clot. So, she had two separate things there."

This dual diagnosis turned a standard stroke protocol into a delicate balancing act. Treating a blood clot usually involves thinning the blood or physically removing the blockage. But doing so near a fragile aneurysm presents a massive risk.

"One of the risks is that you could go in and try to remove the blood clot,” explained Dr. Wicks. “But then you develop bleeding from the aneurysm, or a rupture of the aneurysm, which can be very severe, leading to a large hemorrhage, or a coma, or a death."

The Brain's Hidden Backup System

While the medical team carefully weighed the risks and benefits of intervening, Ms. Salamanca’s brain was fighting its own battle. The human brain has an incredible, built-in defense mechanism called collateral circulation. When a major artery gets blocked, smaller surrounding blood vessels attempt to reroute the blood flow to keep brain tissue alive.

"When you have a blockage of one of the main arteries in the brain, a lot of times, other smaller arteries can compensate," Dr. Wicks said. "So, she had blockage of the main right middle cerebral artery, but some of her other blood vessels were compensating for a period of time."

This backup system buys crucial time, but it is not a permanent fix. Eventually, these smaller vessels tire out, and brain tissue begins to die. Recognizing that Ms. Salamanca's collateral vessels would not hold out forever, the medical team moved forward with treatment.

The First Line of Defense: Clot-Busting Medication

Because of the severe blockage, Ms. Salamanca was an ideal candidate for Tenecteplase (TNK), a powerful clot-busting medication used in acute stroke care. Administering this medication requires careful consideration, especially with an aneurysm present.

The decision-making process in modern medicine is highly collaborative. Doctors do not simply dictate treatments; they work closely with patients and their families.

Dr. Abdelmalik emphasized the importance of this partnership. "Most, if not all, physicians practice in a joint decision-making model where the patient or their advocate is typically the final decision maker, and we as medical professionals aid in that process as best as we can."

After a thorough discussion about the risks and benefits, Ms. Salamanca’s family provided consent, and the nursing staff safely administered the TNK.

“I remember them explaining what was happening to me,” recalls Ms. Salamanca. “But I simply placed my trust in the fact that I was receiving medical care and that they were going to help me. I was inside the operating room, while it was my children and my husband who were speaking with the surgeon performing my procedure, as well as with the head of the hospital's Stroke Unit.”

Advanced Intervention: The Thrombectomy

While the clot-busting medication began its work, Ms. Salamanca required a more definitive procedure. She was transferred to the Neurointerventional Radiology suite for a thrombectomy, a minimally invasive surgical procedure used to physically extract the clot from the brain.

Dr. Wicks and the specialized neurointerventional team prepared to carefully navigate catheters through Ms. Salamanca's blood vessels, bypassing the dangerous aneurysm to reach and remove the blockage.

"By restoring that blood flow, we prevented a stroke involving that whole right side of her brain," Dr. Wicks stated, highlighting the massive impact of the successful procedure. The careful extraction saved Ms. Salamanca from devastating, permanent neurological damage.

Ms. Salamanca said she feels “blessed” to have been cared for by such a “professional and highly qualified team.”

“Throughout the entire process — from the emergency admission to the day of my discharge —everyone who attended to me demonstrated true dedication and professionalism,” she adds. “I feel very fortunate to have been cared for by the entire staff at Baptist Hospital.”

Key Takeaways: Time, Awareness, and Specialized Care

Ms. Salamanca Salamanca’s story offers profound lessons for everyone. Strokes do not discriminate, and the ability to recognize symptoms quickly can mean the difference between full recovery and severe disability.

Dr. Abdelmalik points out that awareness is the most critical tool the public possesses.

"First and foremost is to seek medical attention with any neurological symptoms," Dr. Abdelmalik advised. "Everyone should be familiar with the FAST acronym; there is also the BE FAST acronym to include balance and eye deviation."

The BE FAST acronym stands for:

• Balance: Sudden loss of coordination or balance.
• Eyes: Sudden trouble seeing out of one or both eyes.
• Face: Facial drooping on one side.
• Arms: Weakness or numbness in one arm.
• Speech: Slurred speech or difficulty finding words.
• Time: Time to call 911 immediately.

Beyond quick recognition, the facility you choose for treatment matters immensely. Complex cases involving overlapping conditions require advanced medical infrastructure and highly trained specialists.

"This is a more complex case, so if possible, I think it's good to go to a center where they're experienced in both treating the stroke and aneurysms, to manage those complexities," advised Dr. Wicks.

Ms. Salamanca points out that she is undergoing “all my follow-up and monitoring appointments with various specialty departments at the hospital — such as cardiology, cardiovascular surgery, and neurology — and I experience the same level of care and dedication from each and every one of them.”

Ms. Salamanca’s recovery stand as a testament to her granddaughter’s sharp awareness, her family's swift action, and the advanced capabilities of modern neurovascular medicine.

“Thanks to God, to Dr. Wicks and his entire cerebrovascular surgery team, and to Baptist Hospital, I received professional and timely care for my condition,” she said. “Consequently, I have suffered no physical limitations as a result of having had a stroke.”