Second Chapter at Life for Young Stroke Patient at Mount Sinai

Areti Boukas, a 28-year-old teacher in Queens, was teaching a math lesson when she noticed her students were looking at her funny. That’s when she realized she was slurring her words, and she couldn’t pronounce “numerator.” She started to feel dizzy, and it wasn’t like anything she had felt before.

Luckily, Areti was able to receive swift, lifesaving care at Mount Sinai Queens, which is home to the Cerebrovascular Stroke Center, one of the most advanced stroke centers in the country. And it led to Areti’s desire to share an important message: Anyone—even a young person—can suffer from stroke, and if you experience stroke-like symptoms, it’s critical to get help fast.

Areti’s colleagues did react quickly. There was a paraprofessional in her classroom, and she motioned him over and told him that she was feeling very strange. He ran to get the school nurse, who immediately called the principal’s office, telling them to notify 911. By this time, the entire left side of Areti’s body was numb, and her slurring was getting worse.

“I was trying to wiggle my fingers and toes, and there was nothing. And that's when I really got scared,” Areti says. “I had no idea what was going on. I mean, I know what a stroke is, but it never occurred to me that someone young and healthy could have one.”

“The EMTs arrived within minutes, and they carried me down from the second floor in a wheelchair. And I’m so grateful to the assistant principal who rode with me in the ambulance and kept reassuring me that it’s okay, we’re almost there, and you’re going to the best place for this.”

Areti was brought to Mount Sinai Queens, a renowned stroke center that luckily was close to her school. “Everyone was waiting for me—they were all suited up. They brought me right in on the stretcher and started doing neurological tests right away.”

Shahram Majidi, MD, the neurointerventional surgeon who first treated Areti, explains, “Here at Mount Sinai Queens Stroke Center, we have a state-of-the-art hybrid Angio-CT suite—the first in the nation—which enables us to obtain diagnostic imaging, identify stroke and the location of vessel blockage in the brain, and to perform minimally invasive surgery to remove the clot, all in one room and on the same table. We get pre-notification from EMS that there is a potential stroke from a large vessel occlusion coming in. So our team gets ready and clears the Angio-CT suite. By the time the patient gets here, there is no time lost. Everything is built into a single unit, and if we need to operate, we do it right there. Time is of the essence when it comes to stroke. If you save time, you’re saving brain.”

The CT scan did reveal a large vessel occlusion—a clot blocking one of the major blood vessels to the brain. To remove it, Dr. Majidi performed a minimally invasive procedure called endovascular thrombectomy. “We access the vessel through the groin or wrist and then navigate through the blood vessels with a small catheter up to the brain. When we reach the site of blockage in the target vessel in the brain, we use certain technologies to remove the clot and to restore the blood flow to the brain.” Dr. Majidi explains.

“I was awake through the whole procedure,” Areti says. “I could hear them talking to each other. Every now and then, I’d ask what was going on. And they would say, ‘Oh my gosh, you’re doing so great.’ And I remember the moment I could start to feel my fingers again. And they were so excited for me!”

Areti’s case wasn’t simple. Dr. Allison Selby, co-director of Cardiac Imaging at Mount Sinai Queens, did some tests that revealed she had a small hole in her heart called a patent foramen ovale or PFO. “Many people have a PFO, approximately 30 percent,” Areti says. “But most people never know it, and it usually never causes a problem. But I found out that it often is the cause of stroke in young people.” Patent forman ovale is a relatively common congenital opening within the wall between the left and right atrium of the heart. In young and otherwise healthy patients who had a stroke, PFO could be a contributing factor, and its closure is recommended, Dr. Majidi says.

Areti was transferred to The Mount Sinai Hospital in Manhattan for the heart procedure. “I was there for 10 days. I would have been there for less time, but I got COVID in between both procedures. I was flipping out, thinking that’s it. Goodbye world. And I’d been so careful over the past couple of years.”

One of the infectious disease specialists, Eric P. Neibart, MD, sat with Areti and reassured her. “I was separated in a COVID room, and I felt so alone. Dr. Neibart came in, and all I could see were his eyes because of his mask and protective gear. I was crying, and he held my hands, and I could see in his eyes how much he was listening to me and empathizing. And he said, ‘You’re going to get through this and have a long life ahead of you. You’re going to go to your favorite restaurant and celebrate. And you get to have a second chapter in your life. And not everyone gets that.’”

When Areti was cleared for surgery, Sahil Khera, MD, MPH, Interventional Director of the Structural Heart Program, performed a minimally invasive procedure to close the hole in her heart. Soon Areti was back home recuperating. “Young patients with stroke should always undergo cardiovascular testing. Patent foramen ovale can be pathogenic in certain instances and should be closed to prevent recurrent catastrophic strokes,” Dr. Khera says.

“Every day, I repeat what my doctors said to me, that this is chapter two for me. I’m incredibly grateful to everyone at Mount Sinai. They were like my cheerleaders. Also, I want people to know that a stroke can happen to anyone. It can happen to young, healthy people. Don’t brush off the symptoms. It’s better to get it checked out quickly because timing is everything. Better to be safe than sorry.”

Here is more information about recognizing the signs of stroke.