Josh Crabtree remembers he coughed one time as he drove with his wife and two children on a recent overnight Halloween trip to St. Louis. The 39-year-old believes the cough unleashed a bizarre chain of medical events.

“Things just got a little hazy,” he recalled. “I could not read the giant, green exit signs on the side of the highway.”

Josh asked his wife of 14-years, Jenna, to clean his sunglasses. It didn’t help. Fourteen miles later, he asked Jenna to drive. Thirty-two miles after that, the situation worsened.

“It was like someone was filling up my eyeballs with motor oil,” Josh recalled vividly. “I saw a black bubble with a yellow line on top of it and it started going up.”

Things did get better…for awhile

Josh’s vision improved slowly as the family reached the outskirts of St. Louis. 

Some quick, informal research by Josh and his wife along the way made them aware of a condition called ocular migraine. The American Optometric Association says an “ocular migraine is an episode of vision loss in one eye, usually lasting less than one hour and is associated with a headache.”

While his vision loss affected both eyes and he did not have a headache, the strange episode lasted less than one hour. Maybe it was an ocular migraine, Josh thought. 

Upon reaching St. Louis he took Tylenol, drank Gatorade and laid down for a nap. When he awoke, some haziness in his eyes remained, but Josh was able to enjoy the evening with his family at a Halloween event at Grant’s Farm.

The next morning brought a new symptom.

Now the headache hits

“When I woke up, it was like I had bounced my head off a gym floor. It was substantial pain in the back of my head and on the sides, just above the ears. And I was getting motion sick.”

Josh didn’t know where to turn. “Do I go see an eye doctor because it’s my vision?  Do I go to an emergency room? We weren’t sure where to go. It might just be an ocular migraine, and this must be what people experience.”

The family headed back to Quincy as scheduled. 

The first thing Monday morning, Josh called his primary care provider, Terin Blanchard, MD, of Blessing Health. Upon hearing the symptoms, Dr. Blanchard was concerned.

“His vision loss was a red flag because it is a symptom that might be associated with a medical condition that could threaten life, limb, or eyesight. It can't be ignored and evaluation cannot be delayed,” said Dr. Blanchard. “Josh needed immediate evaluation by an optometrist or ophthalmologist.”

Josh was able to see his optometrist, Sara Siebert, O.D., shortly after speaking to Dr. Blanchard. Immediately after Josh’s evaluation, Dr. Siebert called Dr. Blanchard reporting no eye-related condition was apparent, but that she was concerned Josh might have an aneurysm – a weakening of an artery wall. The doctors determined the best course of action was for Josh to go to the Blessing Emergency Center immediately. It was a referral he was not expecting, but he followed.

It wasn’t an ocular migraine

Shortly after his arrival Josh underwent a CT scan followed by an MRI. The imaging confirmed he had suffered a Vertebral Artery Dissection. The vertebral artery runs along the back of the neck and supplies the brain and spine with blood. If the artery tears, it can affect blood flow to the brain and lead to life-threatening complications.

In Josh’s case, the complication was a stroke. In fact, he had two strokes at the same time while driving to St. Louis. As a blood clot formed at the artery tear, it broke loose in two pieces and entered Josh’s brain – affecting his vision and eventually leading to his mammoth headache.

“They were very informative and let me know everything they were doing and why they were doing it,” Josh said of the Blessing Emergency Center team. “They were awesome.”

Blessing Hospital is a nationally designated Stroke Center and is recognized by the American Heart and Stroke Associations for meeting or exceeding national standards for stroke care.

Josh spent the night in Blessing Hospital for observation to ensure he had suffered no long-term effects from his strokes. He had not. 

Today, Josh has 97% of his vision back. It may take as long as 18 months for the other three percent to return. He has to take an aspirin every day for one year and can do no heavy lifting. Josh will have a follow-up CT scan in early 2024 to ensure the vertebral artery is healing.

Dr. Blanchard said the quick collaboration between Dr. Siebert, himself, and the Blessing Emergency Center played a role in Josh’s positive outcome. “Vertebral Artery Dissection can sometimes be pretty catastrophic,” the doctor concluded.

Isn’t Josh too young to have a stroke?

No. At 39 years old Josh was not too young to have a stroke. According to my.clevelandclinic.org, up to 25% of stroke cases in young and middle-aged adults are caused by vertebral artery dissection.

The site goes on to say that in some people there is no known reason for vertebral artery dissection. In other cases, it can be caused by injury - some as violent as a car accident, others through simple functions including blowing your nose too hard, sneezing, or vomiting.

Josh thinks his cough on the road to St. Louis might have been the culprit of his vertebral artery dissection and strokes.

Lessons learned

“I am told people who have two strokes, as I did, often lose motor (muscle) function,” Josh said.

“If I can tell anyone anything now, after what I have been through, is if you feel something out of the ordinary - something that you know is wrong - go get it checked out. My strokes affected my vision. It could have been something worse and I might not be here.”

“I’m very lucky and blessed.”

For more information on stroke risk factors and symptoms, go to https://www.blessinghealth.org/stroke