| Poughkeepsie Journal
Jenna Viani-Pascale had trouble annunciating her words.
One of her fellow nurses in the Vassar Brothers Medical Center neonatal intensive care unit noticed the side of her face was drooping, and urged her to visit the emergency room.
They weren’t the first symptoms Viani-Pascale noticed. She had downplayed them for months, dutifully going to work each day at a time when hospital staff has been stretched thin.
Now, the gravity of the situation began to take hold. Tears filled her eyes and visions of her worst fears began playing out in her head.
“I think the biggest thing for me was my kids and my family and feeling the thought of how serious it was,” the mother of four said of that late November Sunday. “I was afraid.”
A comprehensive test revealed a complete blockage of Viani-Pascale’s middle cerebral artery — a major vessel that supplies the brain with blood, oxygen and nutrients. A blockage of that vessel can lead to a potentially fatal stroke.
Viani-Pascale was suffering mini-strokes. And, she survived.
Secondary blood vessels kicked in, providing her brain with blood and oxygen, which ultimately saved her life. Though doctors say it’s a natural form of compensation in the brain, they also said not everyone’s brain would be able to do so adequately.
►Holiday homecoming: 21 months after twins’ premature birth Hopewell family brings son home
►Villanova’s Siegrist, Lourdes product, describes ‘spiritual’ meeting
►Purdue commit Ava Learn staying ready, hopeful for Lourdes’ basketball season
She didn’t require surgery to repair the blockage, but was placed on various medications to clear it. Rest over a period of several months, and non-strenuous activity, is required for her recovery.
The experience took the 36-year-old Poughkeepsie resident by surprise, being a healthy former Division I basketball player at Villanova University and standout player at Our Lady of Lourdes High School, with no family history of stroke.
“Everything really went into slow motion for a while,” said her husband, Matt Pascale, the principal of Eugene Brooks Intermediate School in Amenia. “I was shocked, confused and I was very scared … I just felt at a complete loss. It was totally surreal. Her being a nurse, I’m thinking to myself, this is not only someone who’s in great shape, but she had helped save the lives of people. This is not how it’s supposed to work.”
But after five days in the hospital, she was able to come home. She was “extra thankful,” she said, spending the holidays with her family. Viani-Pascale mentioned how she and her kids spoke about how gifts meant little this year, and her health and presence was the greatest present the family could have received.
The family received more good news three days after Christmas. Viani-Pascale’s neurologist told her everything is “looking good.” She hasn’t experienced any more symptoms, and she will go back for another scan in the middle of February.
According to the National Stroke Association, 425,000 women suffer from strokes each year, roughly 50,000 more than those for men.
Viani-Pascale said her doctor told her the odds of a recurrence are low, and she isn’t overly concerned the blockage will cause more problems. She said her doctors believe the medicine she was prescribed, which includes Plavix, medication to her lower blood pressure and antihistamines, will heal and reopen the blocked vessel.
She is no stranger to injuries, having torn the anterior cruciate ligaments in both of her knees — the first during her freshman season playing basketball at Lourdes and the other during her junior year at Villanova. Both required hospital stays and surgery.
However, she said, those injuries paled in comparison to the blockage in her brain.
“Back then, basketball is your entire life. At the time, I had no kids, I wasn’t married. When you look at it now, you have a family and four children. They were so scared, they weren’t sure I was going to come home,” Viani-Pascale said. “You see the reality of how life can change so fast. The experience was different than the knee injuries.”
The episode came at the end of what Viani-Pascale called “an interesting year,” being a nurse working in a hospital during the pandemic. The neonatal unit, she said, is “exclusive” and she doesn’t encounter many COVID-19 patients. As such, her fears over coronavirus weren’t great, though she recognized others may not have been as content.
“Thankfully, I don’t work in an area that is dealing with the really sick patients for COVID,” she said. “I’m not one to be nervous about things, because of my faith. But everybody has a different comfort level, in trying to make sure everyone is safe and comfortable with their situation.”
Problems pushed off
The first sign of danger came over the summer.
Viani-Pascale in August began experiencing migraines, which lasted two weeks. She consulted with a neurologist, who conducted CT scans. The results were negative, but a month later, another spell occurred.
While driving after exercising, the entire right side of Viani-Pascale’s body went numb for 4 minutes.
“I had worked out earlier in the day. At the time, I didn’t think it was anything, I thought it was an injury from working out,” she said. “As a typical healthcare worker, I ‘poo-poo’d’ it. There was nothing else going along with it; it stopped and I had no other symptoms. I said, ‘If something happens again, I’ll call.’ But nothing ever happened.”
That was, until Nov. 28, the Saturday after Thanksgiving, during a family gathering.
She felt a “slight dullness,” she described, in her right hand and foot, and she began to jumble her words when speaking. Her mother noticed the right side of her face was drooping and insisted that she seek help. Viani-Pascale promised her family, if it persisted, she would call the doctor.
“Because it happened to be the holiday weekend,” she explained, “I said, ‘Listen, I’m working on Sunday. On Monday I’ll call the doctor if I’m still feeling weird and still having slurred speech.’”
Viani-Pascale went to work at Vassar Brothers the following day, but her symptoms remained.
As she walked to the emergency unit on her own a “code stroke” was ordered by staff, meaning hospital personnel begin diagnosis and treatment of a potential stroke as soon as the patient arrives.
She underwent an angiogram, a scan that uses X-rays to take pictures of blood vessels. The scan revealed the vessel dissected, and subsequently blocked off the middle cerebral artery, which caused mini-strokes.
Despite this, Viani-Pascale remained conscious and alert — much to the surprise of her doctors, who said the outcome could have been much different.
“They were all shocked,” she explained. “They said, ‘I can’t believe I’m even talking to you.’ Your scan shows that I should be walking into an emergency surgery right now. You talking to me and having mostly minimal symptoms is not how your scan looks.”
What saved her life?
With her middle cerebral artery blocked, collateral blood vessels provided Viani-Pascale’s brain with proper blood flow.
The human brain contains a “Circle of Willis,” or a channel of arteries that sits at the base of the organ. When a blockage or narrowing occurs on one side of the brain, blood vessels from the opposite side can take over and carry out its functions.
“The blood flow to the brain is a very complex network of blood vessels that all interconnect,” explained Dr. Paul Wright, assistant vice president of neurosciences at Nuvance Health. “The brain has an ability to have blood flow from both sides of the neck, essentially. So, for example, if I were to close off the right side, then the left side takes over. This way there’s a compensatory mechanism of the blood flow in the brain.”
But, he mentioned, the ability of those blood vessels to take over depends on the person.
“It all depends on the ability — not everybody has those collaterals already forming,” Wright said. “But for the most part, the brain has redundancy in terms of blood flow. So, if something does get blocked, other blood vessels will take over, or try to take over.”
Wright said high blood pressure, diabetes and high cholesterol are among risk factors for a blockage. But it can also be caused by several other factors, including abnormal cardiac rhythm and trauma to the neck.
Viani-Pascale said her doctor told her it may have been caused by her turning her head a certain way, but she was also told “it seems to happen randomly in people around your height and your age, more in women. They can’t really prove why.”
Being a neonatal nurse, Viani-Pascale said she had a “base knowledge” of neuroscience before her blockage. However, that experience was limited, and her interest in the area has now been piqued.
“We have babies that have neuro issues, but it’s not really the same as an adult because they don’t speak to you. We have to go off other symptoms. I don’t have a whole lot of neuro experience, let’s say that,” she said. “Neuro is definitely a new interest of mine … I want to know more about it.”
Viani-Pascale was in the hospital for five days after the episode. Her family was unable to visit her due to COVID-19 restrictions at Vassar Brothers.
Those days, her husband said, were difficult.
“All the boys decided they wanted to sleep in mommy and daddy’s bed that first night,” Pascale said. “I pulled up on the couch with the family dog. I didn’t sleep much. I was back and forth between prayers and tears.”
Her father, Al Viani, was equally as emotional.
“I just started crying. When it happens, your heart just drops,” he said. “It was pretty harrowing. I didn’t know what was going to happen, because when you hear she has a blocked artery like that, it’s pretty scary.”
Viani-Pascale was able to communicate with them, though, by video calls. Pascale said she appeared to be her normal self, although visibly exhausted.
“You could tell she was tired,” her husband said. “She has a smile that will warm any room and she really didn’t have that smile, and that was noticeable. But we were relieved to be able to see her. We knew she’d gone through a battle that had taken a toll on her physically. But knowing that over the long haul she was going to be OK, that warmed us all.”
She came home from the hospital on Dec. 3, to the delight of her four children, Lucas, Troy, Bryce and Pierce — all of whom are under the age of 11 — and assuaged the family’s fears.
“When I picked her up, it was relief, just to see her,” Pascale said. “When she saw the boys and they all saw her home, it was like the Christmas tree getting lit up at Rockefeller Center. She’s such a beautiful spirit and she’s such a great mother. It was enough light to light up the whole Hudson Valley. It was great.”
Added Viani, of his daughter’s return home: “We were really grateful. You take life for granted so many times, all the stuff going on.”
Recovery and support
Viani-Pascale was prescribed blood thinning medication, medicine to control her blood pressure and, as a precaution, cholesterol medicine for her recovery. The progress of the blood vessel’s healing will be determined when she visits the neurologist for her next test in February, she said.
Rest, she added, is also essential in recuperating. She is taking a pause from nursing activities at Vassar Brothers and working out in her spare time.
Viani-Pascale mentioned she was grateful for the immense amount of love and support she and her family received during the difficult time.
“My kids’ teams and my coworkers sent gift baskets, stuff for the kids for school and food gift certificates,” she said. “My old coaches were putting me on prayer chains. I was so overwhelmed and grateful by the outpouring of humanity.”
People she hadn’t heard from in years, she added, reached out to wish her well.
“It was life-changing,” she said. “I’m mostly a person who tries not to look past the day. I try to live on day at a time, but this is so overwhelming, really. I’m so grateful.”
A.J. Martelli: email@example.com, 845-437-4836, Twitter: @AJ_Martelli