A stroke of luck saves New London patient

When Jeanne Munnelly went for a swim at a high school in East Lyme one August morning, she could not have known she was about to have a stroke—and make medical history in Connecticut.

At about 8:15, as she swam in the school’s pool, Munnelly became weak on her right side and unable to speak. Lifeguards pulled her out and emergency personnel based at the fire station across the street arrived within five minutes. She reached New London’s Lawrence and Memorial Hospital in just 15 minutes.

That’s when Munnelly, 67, became the first patient to benefit from the Yale-New Haven TeleStroke Network, a program modeled on a similar initiative at Massachusetts General Hospital. The TeleStroke Network allows area hospitals to call upon Yale neurologists’ expertise in assessing stroke victims. Using high-speed network videoconferencing and image-sharing technology, neurologist Joseph Schindler, M.D., evaluated Munnelly via computer from Yale-New Haven Hospital (YNHH), then gave the “green light” to physicians in New London to use the clot-busting drug tissue plasminogen activator (tPA). Munnelly received the drug only 37 minutes after reaching the hospital—much more quickly than if she had been transported to YNHH first.

Schindler said the process of evaluating a stroke patient via TeleStroke is the same as when he sees a patient in YNHH’s emergency department. “It’s no different; it’s just the use of technology to do it remotely,” he said.

Speed and decisiveness are critically important in treating stroke victims. Most blood clots that cause ischemic strokes can be dissolved by tPA, a thrombolytic agent. But this medication can also cause bleeding in the brain, and that risk increases beyond three hours after the onset of symptoms. To meet that three-hour deadline and try to prevent this complication, doctors must ensure that a patient is an appropriate candidate for tPA. Yet in most hospitals, neurologists are not always available to assist emergency physicians with the evaluation and treatment decision. As a result, many patients who might benefit from tPA do not receive it.

With telemedical technology, a neurologist need not be physically present. While seated at a computer 50 miles away from the patient, Schindler, the clinical director of the Yale-New Haven Stroke Center, used a high-speed Internet connection to speak with the patient, family and clinical staff and review Munnelly’s medical history, blood tests and CT scan. He also examined her using a camera with a zoom feature. She was, he determined, a good candidate to receive tPA. Shortly after receiving the drug, Munnelly regained the use of her right leg as well as some ability to speak.

Schindler, who is optimistic that Munnelly’s condition will continue to improve, was pleased not only that the technology worked but also that he and the team in New London could act so quickly. “We’ve done it at Yale when the entire team was already in the ED; we [assessed and treated the patient] in a similar time. But to have that done remotely, it’s wonderful.” (See related story, “A viper’s venom and stroke.”)