Stroke Care

Know the Signs of Stroke: Act F.A.S.T.

  • Face – Ask the person to smile. Does one side of the face droop?
  • Arms – Ask the person to raise both arms. Does one arm drift downward?
  • Speech – Ask the person to repeat a simple phrase. Is their speech slurred?
  • Time – If you observe any of these signs, call ambulance immediately.

Overview

  • Dedicated team specializing in stroke treatment and available 24/7 for patients.
  • Stroke rehabilitation program as well as providing care to homebound, rural and underserved areas via telemedicine.

Team of endovascular neurosurgeons and neuro-interventional radiologists specializing in the treatment of stroke.

Technology

Health System uses technology including:

  • a state-of-the-art Siemens Artis Q biplane for interventional imaging
  • 128-slice CT scanner, which quickly scans the whole body and provides sharp 3D images of any organ.
  • telemedicineto ensure rapid assessment, diagnosis, and treatment of stroke patients when a neurologist is not immediately available in the Emergency Department.

Other Care Features

  • Neuroscience intensive care unit for stroke patients
  • stroke alert protocols both internally and with Emergency Management Services (EMS)
  • Continuum of care that includes:
    • Home Health
    • Rehabilitation
    • Referral to Rehabilitation Hospital
    • Care & Rehabilitation Center
    • Program to prevent recurrent stroke
    • Support groups for stroke, aphasia and aneurysm

Stroke Symptoms

The FAST Approach to Stroke Symptoms

F

Face: Does one side droop?

Things to look for or ask:

  • Ask the person to smile. Does one side of the mouth hang lower than the other?
  • Can the person feel you touch their face? Lightly touch them on both sides and ask them if the feeling is the same.

A

ARMS: Does one arm drift downward?

Things to look for or ask:

  • Ask the person to raise both their arms up together. Does one arm begin to fall down?
  • Ask the person to squeeze your fingers with each hand. Is one hand weaker than the other?
  • If you ask the person to try to hold something like a pen, can they do it without any difficulty?
  • Can the person feel you touch them on their arm? Lightly touch them on the skin of both arms and ask them if the feeling is the same on each.

S

SPEECH: Are words slurred or mispronounced?

Things to look for or ask:

  • Are they having problems speaking?
  • Are they having problems “getting their words out”?
  • Do they sound like they have something in their mouth when they speak?
  • Are they saying the appropriate words (do their words make sense) when they speak?

T

TIME: Time lost is brain lost?

Action:

Treatment is most effective when started immediately, greatly increasing chances of survival and decreasing chances of brain damage.

If you see the person experiencing just one of these symptoms, even if it goes away, do not wait. Call emergency help immediately – tell the dispatcher that the person may be having a stroke and request transport to a hospital certified in stroke care.

Stroke Treatment & Care

Treatment & Care When You Need it

Time is of the essence when it comes to the treatment of stroke, which is why it is vitally important to call emergency services if you or someone you are with experiences signs or symptoms of a stroke.

Once at the hospital, the emergency department team must determine whether you have had a stroke. They do this by running a series of tests, which include taking your blood pressure and performing a scan of your brain. A physician will determine which tests will be most helpful.

Medical treatment for stroke

Specific treatment for stroke will be determined by your doctor based on:

  • Your age, overall health, and medical history
  • Severity of the stroke
  • Location of the stroke
  • Cause of the stroke
  • Your tolerance for specific medications, procedures, or therapies
  • Type of stroke
  • Your opinion or preference

Emergency treatments for stroke

Treatment is most effective when started immediately. Emergency treatment following a stroke may include the following:

  • Medications used to dissolve the blood clot(s) that cause an ischemic stroke.Medications that dissolve clots are called thrombolytics or fibrinolytics and are commonly known as “clot busters.” These drugs have the ability to help reduce the damage to brain cells caused by the stroke. In order to be most effective, these agents must be given within 3 hours of a stroke’s onset, so get to the emergency department as quickly as possible.
  • Medications and therapy to reduce or control brain swelling.Special types of intravenous (IV) fluids are often used to help reduce or control brain swelling, especially after a haemorrhagic stroke (a stroke caused by bleeding into the brain).
  • Medications that help protect the brain from damage and ischemia (lack of oxygen).Medications of this type are called neuroprotective agents, with some still under investigation in clinical trials.
  • Life support measures, including such treatments as ventilators (machines to assist with breathing), IV fluids, adequate nutrition, blood pressure control, and prevention of complications.

Although there is no cure for stroke once it has occurred, advanced medical and surgical treatments are now available, giving many stroke victims hope for optimal recovery and reducing the risk of another stroke.

Other medications used to treat or prevent a stroke

Other medications that may help with recovery following a stroke, or may help to prevent a stroke from occurring, include the following:

  • Medications to help prevent more blood clots from forming.Medications that help to prevent additional blood clots from forming are called anticoagulants, as they prevent the coagulation (clotting) of the blood. Medications of this type include, for example, heparin and warfarin and enoxaparin.
  • Medications that reduce the chance of blood clots by preventing platelets (a type of blood cell) from sticking together.Examples of this type of medication include aspirin, clopidogrel or dipyridamole.
  • Medications to treat existing medical conditions, such as diabetes, heart, or blood pressure problems.These are numerous and your doctor(s) will develop a plan of care to include all your diseases.

Types of surgery to treat or prevent a stroke

Several types of neurointerventional surgery may be performed to help treat a stroke, or help to prevent a stroke from occurring, including the following:

  • Carotid endarterectomy.Carotid endarterectomy is a surgical procedure used to remove plaque and clots from the carotid arteries, located in the neck. These arteries supply the brain with blood from the heart. Endarterectomy may help prevent a stroke from occurring.
  • Carotid stenting.A large metal coil (stent) is placed in the carotid artery much like a stent is placed in a coronary artery. The femoral artery (in your groin area) is used as the site for passage of a special hollow tube to the area of blockage in the carotid artery. This procedure is often done in radiology labs, but may be performed in the cath lab.
  • A craniotomy is a type of surgery in the brain itself to remove blood clots, relieve pressure, or repair bleeding in the brain.
  • Surgery to repair aneurysms and arteriovenous malformations (AVMs).An aneurysm is a weakened, ballooned area on an artery wall that has a risk for rupturing and bleeding into the brain. An AVM is a congenital (present at birth) or acquired disorder that consists of a disorderly, tangled web of arteries and veins. An AVM also has a risk for rupturing and bleeding into the brain. Surgery may be helpful, in this case, to help prevent a stroke from occurring. The surgery may involve surgical clips placed on aneurysms to prevent them from rupturing (and thus causing life-threatening bleeding in the future) or tiny coils curled up inside the aneurysm. The coils are placed inside the aneurysm through a special catheter advanced mechanically through the arteries of the body from a puncture site, usually through the large artery located in the groin. An AVM may be treated not only surgically, but also through the use of new chemical substances commonly called glues, which clot off some of the blood vessels that are part of the AVM. Special energy waves known as gamma waves are part of a relatively new mode of radiosurgery, in which part of an AVM can be scarred (and thus prevented from bleeding in the future) by use of a tool known as a “gamma knife” or a “cyber knife.”

Recovering from a Stroke

Typically, stroke patients require rehabilitation to regain their strength in the affected area of the body and motor skills, as well as relearn daily tasks, like eating and getting dressed. Some stroke patients also may need to relearn how to speak or swallow.

Participating in rehabilitative therapy helps you recover as quickly as possible.

Because people are affected differently by stroke, each patient is provided with an individualized plan of care that meets his or her specific needs and gets him or her on the path to recovery.

Constraint-Induced Therapy (CIT) for arm and hand paralysis after stroke

Many individuals who have a stroke are left with paralysis of the upper extremities. CIT is a treatment that encourages the use of the stroke-affected limb by constraining the nonaffected limb in a mitt, sling, splint or glove. Intense exercises are done using the stroke-affected arm or hand.

  • CIT restraints are worn for up to 90% of the waking hours.
  • Restraints can be removed for activities, such as bathing.
  • Small steps are used to break down complex tasks, such as making a phone call.
  • Verbal and written feedback is used to help motivate and inform people undergoing CIT.

Stroke Prevention

Reducing Your Stoke Risk

To prevent a stroke, you must understand the risk factors that lead to stroke as well as the strategies that are used to reduce stroke.

Risk Factors

When it comes to stroke risk factors, some are hereditary and others can be controlled with medication, proper diet and exercise.

Risk factors include things you can’t change, such as:

  • Age– the risk of stroke doubles every decade after the age of 55
  • Family history– your risk may increase if a grandparent, parent, brother or sister has had a stroke
  • Race– Some groups have a higher risk of stroke
  • Gender– women have a higher risk of stroke than men
  • History of a prior stroke, transient ischemic stroke (TIA) or heart attack

There also are risk factors that can be changed, treated, or medically managed, including:

  • High blood pressure – having high blood pressure is the leading cause of stroke
  • Smoking
  • High cholesterol
  • Diabetes
  • Carotid or other artery disease
  • Atrial fibrillation
  • Heart disease
  • Sickle cell disease (sickle cell anaemia)
  • Poor diet
  • Obesity
  • Physical inactivity

Other risk factors of stroke to consider, include:

  • Where a person lives. Strokes are more common among people living in certain regions than in other areas. This may be due to regional differences in lifestyle, race, cigarette smoking, and diet
  • Temperature, season, and climate. Stroke deaths occur more often during periods of extreme temperatures
  • Socioeconomic factors. There is some evidence that strokes are more common among low-income people

What is a Stroke?

Understanding Stroke

Before defining what a stroke is, it is important to explain that the blood vessels that carry blood from the heart to the brain are called arteries. Like all organs in the body, the brain needs a constant supply of blood to get the oxygen and nutrients it needs to function. Each artery supplies blood to specific areas of the brain.

A stroke occurs when an artery is blocked or bursts, causing a lack of blood flow and oxygen to part of the brain, resulting in the death of brain cells.

The brain needs a constant supply of oxygen and nutrients in order to function. Even a brief interruption in blood supply can cause problems. Brain cells begin to die after just a few minutes without blood or oxygen. The area of dead cells in tissues is called an infarct. Due to both the physical and chemical changes that occur in the brain with stroke, damage can continue to occur for several days. This is called a stroke-in-evolution and requires close observation.

A loss of brain function occurs with brain cell death. This may include impaired ability with movement, speech, thinking and memory, bowel and bladder, eating, emotional control, and other vital body functions. Recovery from stroke and the specific ability affected depends on the size and location of the stroke. A small stroke may result in problems such as weakness in an arm or leg. Larger strokes may cause paralysis (inability to move part of the body), loss of speech, or even death.

It is important to learn the 3 Rs of stroke:

  • Reduce the risk
  • Recognize the symptoms
  • Respond by calling emergency services

Stroke is an emergency and should be treated as such. The greatest chance for recovery from stroke occurs when emergency treatment is started immediately.