In-hospital strokes like Charlie Manuel’s are common

The Phillies say that former manager Charlie Manuel got treatment “immediately” after experiencing a stroke Saturday at a hospital in Florida.

That’s a good sign.

Prompt treatment for a stroke improves the odds that the person will recover without significant disability. Because Manuel was already in the hospital for a different procedure, that means expert stroke care likely was close at hand. By Sunday, the team said his condition had improved.

But Manuel, 79, probably will have to undergo an extended rehabilitation program to regain as much brain function as possible.

For a refresher course on strokes and why they can occur in a hospital — despite all the nurses, doctors, and high-tech equipment nearby — we spoke to Steven Messé, a neurologist at the Hospital of the University of Pennsylvania.

A professor at Penn’s Perelman School of Medicine, Messé has been working on a solution to a long-standing problem in the field of stroke care: While Manuel received prompt treatment, according to the Phillies, many others are not so lucky. For a variety of reasons, in-hospital strokes sometimes are not detected until hours after they occur.

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There are two main types of strokes. One is a hemorrhagic stroke, in which a blood vessel ruptures in the brain. The other is an ischemic stroke, in which a clot blocks the flow of blood to part of the brain. In both cases, without prompt treatment, brain cells start to die.

Ischemic strokes, the kind Manuel had, according to the Phillies, account for most strokes in the United States — nearly 90% of the 800,000 strokes that occur each year, the CDC says.

That type of stroke can be treated with medication. It also can be treated with a procedure called a thrombectomy, in which a physician carefully removes the blood clot with a catheter that is inserted through an artery into the patient’s brain.

That’s the procedure John Fetterman underwent in May 2022 during his U.S. Senate campaign. Manuel may have had the same procedure on Saturday, to judge from the limited details provided by the Phillies, Messé said.

“The hospital was able to tend to Charlie immediately and subsequently remove a blood clot,” the team said.

An estimated 4% to 17% of strokes occur in patients who are in the hospital. The exact number is unclear, as these incidents are thought to be under recognized and underreported, according to a 2015 review in JAMA Neurology.

These in-hospital strokes can be caused by clots or other vascular debris that break loose during surgery or other medical procedures.

The Phillies did not say what type of procedure Manuel was undergoing when he had his stroke on Saturday.

Some in-hospital strokes are not detected until hours after they occur. Such delays in detection can be caused by a variety of factors, Penn’s Messé said.

One is simply that the patient is lying in bed. As a result, visitors and even trained medical providers may not immediately recognize if the patient’s bodily movements are impaired — a possible sign of stroke. When people have a stroke while at home, on the other hand, family members may notice immediately if they have trouble walking or speaking.

In-hospital stroke detection also can be delayed for patients who are sleepy and uncommunicative as they emerge from being under anesthesia. That’s normal behavior for someone waking up after surgery, but an inability to communicate also can be a sign of stroke.

To make sure that isn’t the case, anesthesiologists typically ask their patients to wiggle their fingers and toes upon awakening from surgery, Messé said.

“They may pick it up right away,” he said. “But it may be hours later.”

To address the problem, Messé and others at Penn have developed a wristband-mounted stroke monitor that is expected to undergo trials in the next few months. The device, to be made by a Penn start-up called Neuralert, is designed to identify strokes by detecting asymmetrical movement.