He warned patients about stroke. Then he had one.

Dr. Zan Tyson didn’t think much of the fall he took while running the trails of Salem Lake in June 2021. The cardiologist of more than 30 years has been running for decades, and this sandy route in Winston-Salem is his favorite.

“I did something I usually don’t do,” said Tyson, 63 who cares for patients at Novant Health Heart & Vascular Institute - High Point. “I went out on one of the side trails.” That’s when he stumbled on a root and hit his head on the ground. But he finished his run and went home. Everything seemed fine.

Two days later, he started to notice changes in his vision. He thought it was a migraine. Normally, he can run that off, so he went back to Salem Lake to put in some more time.

“I finished about five miles and I just kind of collapsed,” Tyson said. “I don’t have too much memory of that, other than it felt like I was going to die. I thought I was having a stroke.”

He was in a position to know. Tyson regularly talks about stroke because he treats patients dealing with atrial fibrillation, a heart rhythm disturbance that can cause stroke. Stroke is one of the most common neurological diseases and a leading cause of disability.

Tyson lost vision in his right eye right before he collapsed. “It’s like someone just pulled the shade down over the visual field,” he said. “And I can remember thinking, ‘Wow, this is just like it’s described in the book. Which is interesting. But this means I might die.’”

He couldn’t stand up but was able to call an ambulance with his cell phone.

A critical 96 hours

Tyson woke up in an MRI scanner before he was transferred to the neurocritical ICU at Novant Health Forsyth Medical Center. He found out he was right about his diagnosis: a cerebellar stroke, which occurs when blood flow is cut off to the back of the brain.

But what he couldn’t know was that the stroke wasn’t caused by that first stumble on the trail two days earlier – the stroke had likely caused the stumble. The collapse that eventually brought him to the hospital was a continuation of that stroke.

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“He was two days out from the symptoms, so we were worried, making sure that there was no further swelling,” said Dr. Yuriy Zeylikman, medical director of the neurocritical ICU, who helped treat Tyson. He pointed to that first fall as a symptom. Since the cerebellum is responsible for body control and gait balance, the direction of Tyson’s stumble – he fell to the left – was likely caused by the location of the stroke.

“Strokes are critical in the first 72-to-96-hour mark overall,” Zeylikman said. Cerebellar strokes are in the back of the head, so swelling tissue has nowhere to go. It can push the brain down and cause permanent injury. If there had been further swelling, that would have meant emergency surgery to relieve the pressure.

“It all depends on the size of the stroke and if there are complications,” Zeylikman said.

Back to walking – and running

But Tyson made it through the critical 96-hour window. After his third day in the hospital, he started walking with a walker, alongside his wife and a physical therapist.

“I’m very thankful that part of my recovery was my own determination to get better,” Tyson said. “But most of my recovery was the attention that I got from my wife and the providers and especially the neuro rehab folks.”

He was determined to push through intense physical therapy to get back to work – which he did in a month. In two months, he was back to doing procedures. In four months, he was back to running.

“The more I repeat the movements, the smoother they get,” Tyson said. “The brain relearns. It’s just a matter of toughing it out.”