The morning of October 29, 2019 started like any other for Victoria Devorak. She was diapering her month-old baby, Vaughn, then started seeing double and finally couldn’t see at all. She shouted for husband, Billy, and he helped her lie down.
Her entire right side became limp and she slumped onto the bed. Billy called 911 and an ambulance rushed the then 30-year-old home health nurse to the local emergency room where Devorak learned she had had a stroke.
“It’s just baffling,” Devorak, 31, of Mount Holly, New Jersey, told TODAY. “This stroke was coming out of left field.”
From healthy birth to stroke
Devorak gave birth to her third son, Vaughn, on September 26, 2019 after an uneventful pregnancy. Her second son was born via emergency cesarean section but her doctor cleared her for a vaginal birth after cesarean (VBAC) for her third baby.
“Her words to me from the beginning to the end were, ‘You’re a very good candidate,’” Devorak recalled. “’You’re healthy, you didn’t have any issues (with pregnancy).’”
She maintains good habits, such as exercising and eating well (with the occasional sweet). And, she rarely imbibes and doesn’t smoke. Like with her two other sons, this pregnancy and delivery seemed uneventful and normal. That’s why she was stunned when she had a stroke. But experts know that during pregnancy and up to three months postpartum, women are at increased risk.
“Doctors are concerned about what’s called hypercoagulation — your blood is a little bit more pro-clotting and the blood may be a little thicker,” Dr. Kristy Yuan, an assistant professor of clinical neurology at Penn Medicine in Philadelphia, and one of Devorak’s doctors, told TODAY. “Her only risk factor was just this postpartum period and immobility.”
Like many new mothers, Devorak spent many hours nursing her baby, sometimes sleeping upright in bed after a late-night feeding (lots of sitting and immobility can lead to more clots forming).
What’s more, she didn’t know that she had a heart defect that increased her chance of having a stroke. After she arrived at the Comprehensive Stroke Center at the Hospital of the University of Pennsylvania, doctors performed tests and noticed that her patent foramen ovale, a flap between the two upper parts of the heart, had not closed. Babies are born with it open, but it normally grows shut. When it doesn’t, the defect can damage the heart, lungs or cause a stroke. Like other adults with it, Devorak had no idea she had it.
“Because my blood was thicker during the period and I had formed a clot, which they said was pretty substantial in size,” she explained. "The flap of my PFO opened up and that’s when it shot right up to my brain.”
Yuan added that while this sounds scary it is not considered a typical risk factor for stroke.
“I want to put a very large caveat on this … Most of the patients I see, PFO is not really a contributor to stroke,” Yuan said. “You have other traditional risk factors like hypertension, cholesterol, diabetes, plaque build up in your vessels. Most of those are much greater contributors to stroke.”
It's important to note that postpartum strokes are rare: A recent study reported that pregnancy-associated stroke occurs approximately 34 per 100,000 deliveries. Additional risk factors include if a woman is or experiences:
- Advanced maternal age (35 years and older)
- African-American race
- Preeclampsia, eclampsia or gestational hypertension
- Migraine headaches
- Hyperemesis gravidarum
- Postpartum hemorrhage
Yuan stressed that Devorak’s husband did the right thing by calling 911 immediately. When it comes to identifying a stroke, experts use the acronym BE FAST, which stands for:
E: Eyes, doubled, blurred vision or inability to see
F: Face droop on one side
A: Arm or leg weakness
S: Slurred speech or inability to speak
T: Time to call for help. The faster you get help, the better.
“My face never drooped,” Devorak said. “When I had slumped over, that’s when Billy knew we were in trouble and that it was probably a stroke.”
While doctors gave her a clot-busting drug that broke it up, they needed to remove pieces of the clot with a minimally invasive procedure. By the time she returned home on November 1, she was able to move around using a walker and she now walks unassisted, though she still has some weakness. The stroke also impacted her vision and she can’t see from the upper quadrants of her eyes.
“I don’t see a black hole. It’s almost as if my brain stretches the vision that I do have to cover (it),” she said. “I do still have a little bit of double vision from time to time.”
Raising awareness while recovering
Devorak's feeling much better and hopes to have her PFO fixed soon (the COVID-19 pandemic postponed her surgery). She’s sharing her story to encourage others to act quickly if they suspect a loved one is having a stroke.
“My husband saved my life," she said. "If he wasn’t home, I don’t know what would have happened."
And Devorak hopes to raise awareness about stroke in pregnant and postpartum women.
“None of the conversations from my first pregnancy, my second or this one has anybody approached me and told me that there could be complications, such as stroke,” she said. “Even somebody who is in very good health can have (a stroke).”