A stroke at age 28

Emily Miller, right, with stroke neurologist Dr. Erik Tarula.
Emily Miller, right, with stroke neurologist Dr. Erik Tarula.

If you were shocked that Hollywood star Luke Perry could have a fatal stroke at age 52, meet Emily Miller, who was just 28 years old when she suffered a stroke.

She's part of a growing number of younger people who have suffered an ischemic stroke, which happens when a blood clot travels to the brain and blocks the blood flow. About 10 percent of stroke patients are under 50. Some of them share the same risk factors that cause stroke in older people: type 1 diabetes, obesity, smoking, physical inactivity and high blood pressure.

Others, like Emily, have rarer conditions that can cause an ischemic stroke. In Emily's case, an undiagnosed hole in her heart allowed a blood clot to travel to her brain.

But none of that was known when Emily suddenly developed a terrible headache while working in the box office at the Coronado Performing Arts Center in Rockford, Ill. When she started to lose consciousness, her co-workers saved her life by calling 911.

She was taken by ambulance to SwedishAmerican Hospital, where a CAT scan showed the problem and Emily received a dose of the clot-dissolving drug tPA (tissue Plasminogen activator).

When her parents, Kevin and Cathy McDermott, arrived at the emergency department, Emily was still unresponsive. Cathy remembers being taken to a closed room, and a doctor showing her a scan and telling her that her newly married daughter had suffered a major stroke.

"It was the worst moment of my life, it was so scary," she said. "Emily had her head struck to the left, her eyes weren't responsive, she couldn't speak and the whole right side of her body was paralyzed."

Doctors decided to airlift Emily to University Hospital in Madison in anticipation that she may need neurosurgery. When she arrived, however, surgery was no longer needed, the tPA had restored blood flow. She began her recovery in the Neuro ICU, where her parents and husband Austin soon joined her.

"It was incredible," her mother said. "Within a few days, she was up and walking. Her doctor was amazed."

Her stroke neurologist, Dr. Erik Tarula, explained that the degree of injury demonstrated by the MRI was much more extensive than her symptoms would have suggested.

"Emily is an example of how we treat the person, not the image," he says. "She was very lucky to recover from a stroke this serious."

Emily would move to the intermediate care ward of the hospital, and then on to the UW Health Rehabilitation Hospital, where her workout partners could have been her grandparents. In addition to speech therapy, she walked every day, worked out at a gym, planted a huge garden with her husband, Austin, and threw a surprise engagement party for her sister. Her mom is in awe of how hard Emily worked to get better from "this greatest challenge of her young life."

"She faced each day of her recovery with determination to do what she needed to get better," Cathy McDermott says. "Her positive attitude, along with the care of excellent doctors, and prayers and support from friends and family, all contributed to her recovery."

Emily returned to University Hospital last summer, so that cardiologist Dr. Amish Raval could repair her heart. Dr. Raval says the condition is called a patent foramen ovale (PFO), a hole between the upper chambers of the heart. This hole exists in everyone while in utero, but in about 75 percent of people, the hole closes soon after birth.

An ischemic stroke can occur if a clot develops in a vein, a fragment breaks off, travels up to the heart, across the hole and up to the brain. If there were no hole, the clot would only travel to the lungs, where a small clot would be unnoticed. However, a small clot in the brain results in a stroke.

To reduce the risk of future strokes, Ravel threaded a small device through a catheter into the heart. This "double umbrella, PFO-closure device" sealed the hole, reducing Emily's chances of a future stroke.

Dr. Tarula adds that not every hole in the heart needs to be sealed. Since this type of hole in the heart is present in one out of every five people, he says, we cannot simply assume that this is the problem. A complete workup looking for other stroke causes along with a detailed look at the architecture of the heart is needed before referring someone for a procedure. The goal is to make sure the right people get the right intervention.

As Emily began to recover, she wanted to give back and help other families, like hers, who suddenly find themselves spending days and nights at the Neuro ICU.

She asked for donations from friends and family instead of Christmas gifts, and used the donations to assemble "comfort kits" for other patient families.

On the anniversary of her stroke, she, Austin and her parents arrived at the hospital with 48 kits, filled with tissues, toothbrushes, toothpaste, a blanket, coloring books, notepads, crayons and snacks. Things to make life a little easier for others.

She made the rounds, chatting with other families who were in the same scary situation as her family was a year before.

"It's so great that she can give hope to other families and show them what is possible after a stroke," says Dr. Tarula. "The kits are also a wonderful way to give back and help others."