When Julie Knichel, R.N., awoke suddenly at 3 a.m. on February 2, she knew something was terribly wrong. She had a headache, but not just any headache. It was the worst, most intense pain in her life. And it was accompanied by nausea. She quickly called 9-1-1.

(Watch now: When Julie Knichel, R.N., awoke suddenly with the worst headache of her life, the Marcus Neuroscience Institute neuro ICU nurse called 911. She was having a stroke like the one that killed her mother at age 47.)

Her instincts — on especially high alert thanks to her experience as a neuro ICU nurse and her family history — saved her life. “I knew I had to get to the hospital,” says Ms. Knichel, who works at Marcus Neuroscience Institute, part of Baptist Health, at Boca Raton Regional Hospital.

Ms. Knichel, 57, had suffered a hemorrhagic stroke caused by a ruptured brain aneurysm. Her mother had died at age 47 from the same kind of stroke. “This is a life-threatening type of stroke,” explains neurosurgeon Brian Snelling, M.D., director of cerebrovascular and endovascular neurosurgery and director of the stroke program at Marcus Neuroscience Institute. “When a brain aneurysm ruptures, blood escapes and travels around the brain and can cause a lot of damage and even death.”

The basics on stroke

Nearly 800,000 people in the U.S. have a stroke each year. About 20 percent of them die, and many survivors are severely disabled, according to the U.S. Centers for Disease Control and Prevention. And while stroke treatment has advanced dramatically in recent years, it’s still receiving care immediately that is most crucial.

“Getting appropriate diagnosis and treatment at a comprehensive stroke center such as Marcus Neuroscience Institute is critical to having a good outcome,” Dr. Snelling says.

Stroke is really an umbrella term. “The most common type of stroke is what we call an ischemic stroke, where an artery that delivers blood to the brain is blocked. That comprises about four-fifths of all types,” he says. “The remaining one-fifth fall into the category of bleeding in the brain, such as a brain aneurysm rupture or traumatic brain injury or other types of strokes.”

Unique stroke services

Ms. Knichel’s care at Marcus Neuroscience Institute began before she even reached the emergency room. A stroke team was at the ready on her arrival, and not just because Ms. Knichel was a colleague.

“We receive a push notification on our phones when there is a patient with a brain bleed or possible stroke,” Dr. Snelling said. “Julie’s been an ICU nurse since before I arrived here in 2018. She’s a member of our family. But the way I was trained as a neurosurgeon was to treat each patient as if they were my brother or sister or my mother or father.”

Rushed for a brain scan, Ms. Knichel benefitted from a unique artificial intelligence (AI) technology at Marcus Neuroscience Institute. The AI program reviews the scan faster than a radiologist or emergency room physician can and notifies the team immediately if it identifies a brain bleed.

Speed is important when it comes to stroke treatment because the longer an aneurysm bleeds into the brain — or the longer the blood flow to the brain is blocked as in an ischemic stroke —the more damage that can occur. “About one in 20 brain aneurysms will bleed again in the first 24 hours, increasing the risk of death and disability,” Dr. Snelling said.

Ms. Knichel was quickly taken to the interventional radiology suite, where she underwent a minimally invasive catheter-based procedure. With no need to open the skull, doctors threaded a small catheter through her femoral artery up to the brain, where they inserted tiny metal coils into the aneurysm to stop the blood flow.

She stayed in the hospital about three weeks, some of those days in the very same neuro ICU unit where she works. “It was very comforting because I know their level of knowledge and competence. I felt very reassured,” she said.

Colleagues who care

Not only did her colleagues care for her in the hospital, but they also looked after her precious 16-year-old puggle. “Daisy Duke is pretty much all I talk about during our off time,” Ms. Knichel says. “They knew how important she was to me. They gave her her medication and lots of attention.” While Daisy Duke recently passed away, Ms. Knichel says her co-workers kept the dog happy and healthy during her recovery.

Carol McAfee, R.N., who works in the neuro ICU with Ms. Knichel, has known her for 25 years. “Our team is phenomenal. Co-workers and friends took turns going by her house and taking care of her dog and we settled her in when she came home from the hospital. One cleaned her house. Another got groceries.”

Sarah Thames, R.N., met Ms. Knichel at the Institute when they began working together five and a half years ago. “Julie and I are very close and the dynamics and camaraderie here, it’s special,” she says. “Everyone here is very compassionate and believes in what they do. We see this every day at work.”

A gratified Ms. Knichel says she can’t praise her work family enough. The experience has also changed her relationship with patients. “I have more of a bond with my patients after this,” she says. “I can explain it in the terms that they can understand better. I can share my experience and they can see my recovery.”

Ms. Knichel is happy to have returned to work full time and to her previous activities, including gardening and do-it-yourself and home remodeling projects. She also stays on top of her health and will have cerebral angiograms every six months for the near future.

When to seek help

Dr. Snelling says that everyone needs to know the risk factors and signs of stroke so that they can increase their odds of preventing a stroke, as well as obtain emergency care right away if they suspect they are having a stroke.

Among the risk factors are smoking, hypertension, leading an inactive life, being overweight, and health problems such as diabetes and heart disease. In some cases, such as Ms. Knichel’s, there can be a family link.

The acronym BE FAST is the best way to remember the most common symptoms of stroke. Get medical care immediately if you experience any of the following:

·      B: Balance. Problems with balance or coordination.

·      E: Eyes. Double or blurry vision in one or both eyes.

·      F: Face drooping. One side of the face is drooping or numb, or the smile is uneven.

·      A: Arm weakness. One arm is weak or numb. One arm may drift downward when both are lifted at the same time.

·      S: Speech difficulty. Slurred speech, difficulty speaking, inability to repeat a simple sentence correctly.

·      T: Time to call 911. 

For more information about Marcus Neuroscience Institute, click here.