Mayra Gonzalez-Almanzar was seven months pregnant with her second child in late 2015. Other than migraine headaches, the 28-year-old hadn’t experienced any pregnancy-related complications. Her first pregnancy, ten years prior, had been problem-free. When she felt a sudden and persistent numbness along the left side of her face, the Lawrence resident knew something was wrong. Alarmed, Mayra and her partner, Raulyn, headed for the emergency department at Lawrence General Hospital.
Once at Lawrence General, Mayra was met by her primary care physician who was on staff that night. She performed a neurological exam and detected abnormalities. Concerned about Mayra’s pregnancy and neurologic symptoms, her physician recommended an urgent referral. “You need to go into Boston,” she said. Mayra was transferred by ambulance to Tufts Medical Center.
Ischemic stroke diagnosis
Lester Y. Leung, MD, Director of the Comprehensive Stroke Center at Tufts MC, performed a series of tests and diagnosed Mayra with a brainstem ischemic stroke. Ischemic stroke—the most common type of stroke—happens when an artery that supplies oxygen-rich blood to a portion of the brain becomes blocked. A blood clot is often the reason for the blockage. Stroke is one of the leading causes of serious, long-term disability in the United States. There are approximately 795,000 stroke cases in the United States each year.
“Mayra was transferred to us in a highly unusual scenario,” said Dr. Leung who also founded and directs the Stroke and Young Adults (SAYA) Program. “Unlike a lot of stroke patients, she did not have any major disabilities post-stroke but because the stroke happened late in pregnancy, it generated a lot of concern.” Mayra remained at Tufts MC for one week, receiving care from Obstetrics and Gynecology’s Maternal Fetal Medicine and Neurology teams.
Protein S deficiency and migraines likely cause
Subsequent testing by Dr. Leung and his team revealed that Mayra had a transient protein S deficiency, a disorder that results in a low level of this anti-clotting factor in the blood. People with this condition have an increased risk of developing abnormal blood clots. Transient protein S deficiency is relatively common in pregnancy, but it usually doesn’t cause significant blood clotting unless it combines with other factors that increase blood clotting.
“Dr. Leung explained that being pregnant can produce blood clots as can having severe migraines. The combination of both is what likely brought about my stroke,” said Mayra. “Dr. Leung assured me that my baby and I would be OK. He was calm and kind and explained everything to me in a way I could understand. I felt secure knowing he was my neurologist.”
Mayra and Dr. Leung remained in close contact after her discharge from Tufts MC. “There were a lot of decisions to be made regarding Mayra’s stroke recovery and her pregnancy and delivery. We had to consider how medications and tests might affect the baby and whether Mayra could deliver naturally or by Cesarean section. A big part of my role was supporting Mayra through this high stress period,” Dr. Leung said.
Penelope, a healthy baby girl, was born January 2017. Mayra said her labor and natural delivery went smoothly with no complications. “The nurses and doctors were amazing. I know they were doing their jobs but they seemed to take an extra step with me. I could tell how much they cared,” said Mayra of the Labor and Delivery staff.
Following Penelope’s birth, Mayra was filled with love and relief that her daughter was healthy, but other frightening feelings began to overwhelm her. “I couldn’t stay still. I’d get panicky and break out in a sweat. My body would shake. It was uncomfortable and upsetting,” said Mayra. Because the stroke impaired the left side of her body, Mayra worried that her lack of strength would cause her to drop Penelope. “I didn’t hold her as much as I’d like to,” she said.
Managing motherhood and stroke recovery
For stroke prevention, Mayra was prescribed a low-dose aspirin. She also wore a heart rhythm monitor 24-hours-a-day for one month to rule out atrial fibrillation as an alternative cause of stroke. “I was so scared I’d have another stroke. I was overwhelmed worrying about stroke and knowing I have two children to take care of,” admitted Mayra.
Dr. Leung said depression and anxiety are common for young people who have had a stroke. “Stroke is a shock for younger adults, something they never expected and often have difficulty accepting. It cuts them short as they are reaching up to achieve life goals. Older stroke patients tend to find more peace after stroke while younger people really struggle. I walk our young stroke patients through their concerns. I give them reassurance when I can and try to help them understand what has happened and why it occurred. I talk to them early on about getting medical treatment and encourage them to see therapists and attend the SAYA Social Support Group,” he said.
Moving forward with Tufts MC and family support
Since the stroke and Penelope’s birth, Mayra has not returned to work. The pressures of being a stay-at-home mom of two children in a one-income household is sometimes daunting. Mayra knows she needs to do everything possible to live a healthy lifestyle and reduce stroke risk but the needs of her family often come first.
“I try to cook organic foods and exercise three times a week,” said Mayra who suffers from vertigo while driving. The dizziness makes the prospect of travel unnerving which contributes to feelings of isolation when she’s housebound. Dr. Leung prescribed a medication to help with the vertigo and reduce the frequency of migraines.
“My parents and my partner have been a huge support,” said Mayra. “My sister works in the health care field and helps me to understand my medical situation better. Lately, I’ve been having trouble concentrating and I tend to forget things easily. I’m not sure if this related to the stroke or just my new normal as a tired mom.”
Mayra plans to discuss her symptoms and the possibility of expanding her family at her next visit with Dr. Leung. He has made a promise to Mayra – as he has with all of his young stroke patients – to remain in their lives as long as needed. “I care deeply about my patients on a personal level. I want to be a resource for them wherever they live, whatever stage of life they are in. My goal is to help young stroke patients rise again.”
Learn more about stroke, its causes and risk factors, symptoms and diagnosis.
If you have experienced a stroke and are concerned about after-effects, check out our Late Complications of Stroke questionnaire. Print a copy of the questionnaire, answer the questions and bring it with you to your next visit with your neurologist.