OU Health's Telestroke Services Provide Fast Treatment to Man in Rural Oklahoma

A day of shopping and running errands in McAlester, Oklahoma, started out well for Michiel and Steffanee Edwards. However, a couple of hours into the day Michiel started to feel a bit off. He had some chest pain which was concerning, given his history of cardiac arrythmias and his pacemaker. Michiel was reluctant to seek medical help until the left side of his face, arm and leg started to tingle and feel weak. As a family practice nurse practitioner, Steffanee recognized the symptoms of a stroke and took Michiel to the closest emergency room.

In the emergency room Michiel was started on IV fluids, and blood was drawn.

“A few minutes later the doctor wheeled in a large screen television and placed it at the foot of Michiel’s bed,” said Steffanee. “On the screen in real-time was a neurologist from OU Health University of Oklahoma Medical Center.”

The neurologist asked Michiel some questions and directed the emergency room staff to perform various tests. The neurologist noticed that the left side of Michiel’s face was starting to droop so he instructed the doctor to treat him for a stroke, and administer a thrombolytic, commonly known as a “clot-buster”.

A thrombolytic is used to dissolve the clot blocking or disrupting blood flow to the brain, helping to restore normal circulation to the affected area. After administration of the clot-buster, Michiel would need close monitoring in the intensive care unit (ICU). However, the small rural hospital didn’t have the staff available to care for Michiel in the ICU, so a transfer was recommended.

“We were asked where we wanted to go and we chose OU Health University of Oklahoma Medical Center,” said Michiel. “My brother works there, and I knew I’d be cared for by a neurologist and receive the clot-buster under their supervision.”

Treatment for Stroke

Michiel is a United States Army veteran who worked as a fire fighter and then as a federal fire inspector at the McAlester Army Ammunition Plant for 17 years in rural Oklahoma. In 1998 he was diagnosed with supraventricular tachycardia, a heart condition. After an ablation failed to treat his arrythmia, he had a pacemaker placed in 2010. After a stroke in 2019, Michiel was diagnosed with atrial fibrillation and was medically retired from work. He has been on blood thinners since then, which he was supposed to take every day.

“Michiel has been on blood thinners since he was diagnosed with atrial fibrillation,” explained Steffanee, “but he’d forgotten to take them for a few days prior to this incident. I knew that his symptoms needed to be checked out.”

At the University of Oklahoma Medical Center Michiel was treated by a team of specialists. One of the neurologists treating him was Dr. Jorge Ortiz-Garcia, M.D., assistant professor in the Department of Neurology, and Chief of the Section of Critical Care Neurology at the University of Oklahoma College of Medicine.

Michiel was given thrombolytic medicine and treated for stroke; however, an MRI scan told a different story.

Same Symptoms, Different Diagnosis

After reviewing Michiel’s history and MRI imaging, the neurologists determined that he did not have a stroke and diagnosed him with a hemiplegic migraine.

A hemiplegic migraine is a type of migraine headache that not only causes typical migraine symptoms but also leads to muscle weakness on one side of the body. This muscle weakness usually begins during the aura phase of a migraine, right before or during the headache attack. It may also be accompanied by changes in sensation, vision, or speech.

Types of Hemiplegic Migraines

There are two types of hemiplegic migraines, and they both cause similar symptoms:

Familial Hemiplegic Migraines: This type has a genetic link within your biological family history. There are three subtypes, each caused by a different gene change. If a healthcare provider can’t identify a known genetic change, they may refer to it as familial type 4.

Sporadic Hemiplegic Migraine: This type occurs randomly in individuals with no family history of migraines.

While migraines affect 15 to 20% of people, hemiplegic migraines are rare, affecting only 0.01%. A Danish study found that sporadic hemiplegic migraines affect 0.002% of people, and familial hemiplegic migraines affect 0.003%.

“If you or a loved one experiences sudden weakness or paralysis, especially with a history of migraines, seek medical attention to rule out stroke,” said Dr. Ortiz-Garcia. “It is crucial to recognize the difference, as both conditions require prompt but distinct care.”

The symptoms of hemiplegic migraines are similar to stroke and include face drooping, arm weakness, and speech difficulty. Without an MRI there is no way to diagnose a hemiplegic migraine from a stroke. Michiel’s history of stroke and atrial fibrillation put him at a higher risk of stroke and prompt treatment is necessary to reduce serious damage.

Telestroke Services at OU Health

Many people living in rural parts of Oklahoma do not have access to stroke care experts and rely on their closest hospital for emergency care.

About 40% of people in Oklahoma live in rural areas and they often must travel long distances to get healthcare, which can lead to worse outcomes for serious conditions like strokes. On average, rural residents live three years less than those in cities. They also have higher death rates from stroke and heart disease. Oklahoma is 42nd in the nation for stroke prevalence among adults and 45th for hospitalizations due to ischemic stroke.

OU Health offers a telemedicine cart at participating rural hospitals with 24/7 support that allows local teams treating stroke patients to connect with OU Health specialists in minutes. Patients are assessed on a videocall which speeds up diagnosis and the delivery of clot-dissolving medications and other treatments. If patients need to be transferred to a higher level of care, it can happen quickly.

Steffanee said that having the OU Health neurologists on a video call as they assess the patients provides doctors in rural hospitals a sense of confidence.

“Having the oversight and expertise of a neurologist who sees stroke patients day in, day out and knows what's going on, to make a call about stroke treatment is a sense of security for ER doctors,” Steffanee said. “They have the confidence that the treatment they are providing is the right treatment.”

Michiel is fully recovered from the hemiplegic migraine and is enjoying the recent birth of his ninth grandchild. He is diligent in taking his blood thinner medication every day to help prevent a stroke.

“The telestroke service is going to save lives in the rural areas where we don't have access to a neurologist in the ER,” said Michiel. “Time matters — minutes count when it comes to brain tissue, and to bring the level of OU Health neurology expertise to rural hospitals is a major win. It’s absolutely going to save lives.”

“Telestroke services are a game changer in the management of stroke, particularly in rural areas where access to specialized stroke care may be limited,” said Dr. Ortiz-Garcia. “By utilizing telestroke services, even rural hospitals without an on-site neurologist can offer the same life-saving care available in larger, urban stroke centers. Increasing awareness of this service can empower rural communities to act fast and ensure patients receive optimal stroke care no matter their location.”

OU Health is revolutionizing stroke care across Oklahoma — bringing expert, life-saving treatment to even the most rural areas through our 24/7/365 telestroke services by connecting patients with stroke care specialists in minutes, reducing treatment times, and improving outcomes.

Learn more about our stroke services or view our OU Health locations and providers to find a stroke specialist that works best for you.