Stroke

What Is a Stroke?

A stroke happens when a blood vessel carrying blood and oxygen to the brain gets blocked or ruptures, so brain cells don’t get the flow of blood they need. Without oxygen, nerve cells can’t function and die within minutes. When nerve cells don’t function, the part of the body they control can’t function either.

Symptoms & Warning Signs

When a stroke occurs, “time is brain.” Two million neurons (brain cells) die every minute during a stroke. If you detect any of the following symptoms, call 9-1-1 immediately. The sooner you get to the hospital, the sooner you get treatment and the damage to your brain can be minimized as much as possible. All advanced treatments for stroke are based on time, so DO NOT WAIT!  To help you remember the warning signs of stroke and what to do, remember B-E F-A-S-T!

• Balance – Sudden trouble walking, dizziness, loss of balance or coordination
• Eyes – Sudden trouble seeing in one or both eyes
• Face – Sudden drooping of one side of the face or an uneven smile
• Arm – Sudden weakness or numbness/tingling of the arm, face, or leg, especially on one side of the body
• Speech – Sudden slurred speech, trouble speaking or understanding speech
• Time – to call 9-1-1 immediately! Every second counts!

Other stroke symptoms:

• Sudden severe headache with no known cause
• Sudden confusion

Types of Stroke

Ischemic Stroke, the most common type of stroke, happens when blood vessels to the brain become narrowed or clogged, cutting off blood flow to brain cells.

Hemorrhagic Stroke is caused by a bursting blood vessel in the brain that spills blood into the brain. High blood pressure and brain aneurysms (weak spots in blood vessels) can cause this type of stroke.

Transient Ischemic Attack (TIA), or “mini-stroke,” happens when an artery leading to, or inside, the brain becomes briefly blocked, slowing or stopping blood flow (and oxygen) to an area of the brain. TIA can have any of the same symptoms of a true ischemic stroke.  There is no permanent brain tissue damage with a TIA because blood flow is restored to the area quickly and the symptoms go away. When the symptoms begin, however, there is no way of knowing right away if it is a TIA or a true ischemic stroke, so as soon as you notice any of those symptoms, call 9-1-1 immediately!

Risk Factors

The good news is that most risk factors for stroke can be modified through lifestyle changes or medical treatment. Modifiable risk factors include:

• High blood pressure (hypertension)
• Tobacco use
• Diabetes mellitus
• Carotid or other artery diseases
• Atrial fibrillation (Afib)
• Heart disease
• Certain blood disorders
• High blood cholesterol
• Physical inactivity and obesity
• Excessive alcohol intake
• Illegal drug use
• Stress
• Sleep apnea           
• Migraines with aura              
• Oral contraceptives (in combination with smoking)

However, some risk factors for stroke can’t be changed – like age, gender, heredity or history of a prior stroke.  Getting older (stroke risk doubles every decade after age 55), being female, being African American or Hispanic, and having had a stroke or TIA in the past puts you at an increased risk for a future stroke. 

Diagnosis

The Southeast Regional Stroke Center at Erlanger is one of the largest stroke centers in the nation, ready with a team of experts in stroke diagnosis and care. Our doctors will determine the most appropriate treatment by diagnosing the type, cause, and the location of the injury to the brain. The first step is getting to the emergency room quickly. (Time is brain!) Here’s what to expect in the ER.

You will be asked about your medical history:

• What symptoms are you having?
• When did your symptoms begin?
• Do you take any anti-coagulant medications (blood thinners)? If so, what is the name of the medicine and when was it last taken?
• Do you have a history of seizures?

You will have a neurological exam which may include:

• Physical exam evaluating vision, pupils, strength of arms, legs and facial muscles, coordination, feeling in arms, legs and face, ability to answer questions, etc.
• Lab/blood tests
• CT scan (computed tomography) - uses radiation to take a picture of the brain
• MRI (Magnetic Resonance Imaging) - uses a large magnetic field to take a picture of the brain
• CTA or MRA (Angiography)- CT or MRI scan that looks specifically at the blood vessels in the head and neck by using dye injected into a blood vessel
• tPA (tissue plasminogen activator) – Clot-busting medication given intravenously (through a small IV catheter in the arm)

Emergency Treatment

Emergency treatment will vary depending on whether your stroke is hemorrhagic or ischemic. Again, the key factor for successful treatment is getting to the emergency room quickly.

Treating Ischemic Stroke – Doctors will work to quickly restore blood flow to your brain through one or a combination of:

• Medications. Tissue plasminogen activator (tPA), commonly known as the “clot buster drug,” may be administered within 4.5 hours (if you meet certain criteria), but the sooner the better for your brain. If tPA cannot be used, the doctor will likely use antiplatelet medications like aspirin or Plavix. 
• Endovascular Treatment (EVT). An interventional radiologist places a small catheter in a large artery in the groin (the femoral artery) and guides it up to a large clot in the brain using real-time nuclear imaging.  Then, different devices can be used to either remove the clot, or to inject tPA medication directly into the clot.  Erlanger is a world-renowned leader in this innovative procedure.

• Widening the artery – Physicians increase the diameter of an artery by placing a stent where it narrows, or by surgically removing fatty deposits attached to the vessel wall (carotid endarterectomy).  This enables adequate blood flow through the artery.

Treating hemorrhagic stroke – Doctors will work to quickly control bleeding and reduce pressure inside the cranium (skull).

• Medications – A range of drugs can encourage clotting to control bleeding, lower intracranial pressure, reduce blood pressure, and prevent seizures.
• Supportive medical care – After bleeding in the brain has stopped, treatment will likely center on allowing excess blood to be absorbed into the body (the same way a bruise heals). If there is a great deal of bleeding, surgery may be needed to remove the blood or relieve intracranial pressure.
• Surgical repair – Depending on the cause of bleeding, surgery may be used to repair blood vessel abnormalities associated with hemorrhagic strokes. Common procedures include surgical clipping or coiling of an aneurysm, endovascular embolization, AVM removal, intracranial bypass, and stereotactic radiosurgery.

Complications of Stroke

Stroke impacts everyone differently, depending on the type of stroke, the area of the brain affected and the extent/size of the brain injury. Complications of stroke can include:

• Cognitive or thinking changes (memory, problem solving, decision making, attention and reasoning)
• Hemiparesis (the loss strength in one side of the body, including the arm and/or leg)
• Sensory changes such as loss of feeling, numbness, tingling or hypersensitivity in the face, arm and/or leg
• Dysphagia, or difficulty swallowing, often leading to problems eating and drinking
• Speech and language disorders such as aphasia (inability to say the right words), dysarthria (“slurred speech”), or trouble reading words and numbers
• Perception/sensory changes including sight, touch, mobility and thought
• Partial loss of vision or blurred vision in one or both eyes
• Inability to recognize familiar objects or people
• Changes in the ability to balance while sitting, standing, or walking
• Contractures (tight muscles or tendons)
• Spasticity (unintentional movements) and movement disorders
• Edema (arm and leg swelling due to collection of fluid)

Recovery and Rehabilitation

When the initial crisis of a stroke has passed and you are stable, a custom program of rehabilitation can help you recover. Our team at the Southeast Regional Stroke Center will develop a rehabilitation plan tailored to your needs and find placement in a post-hospital rehab program if needed. Our goal will be to help you:

• Increase independence
• Improve physical functioning
• Have the best possible quality of life after stroke
• Prevent another stroke

According to your unique needs the program may include:

• Physical Therapy
• Occupational Therapy
• Speech Therapy

Outcomes

Stroke patient outcomes at Erlanger reflect clinical innovation that’s getting global attention. At the 2015 International Stroke Conference, the Southeast Regional Stroke Center was recognized for leading worldwide clinical research that proved interventional stroke care – the type of care provided exclusively in this region by Erlanger – is definitively the new standard of care for stroke. Of all participating hospitals in the worldwide clinical trial, Erlanger achieved the best overall outcomes and the fastest treatment times.

Preventing Stroke

You can reduce your chances of having a stroke by:

• Eat a Healthy Diet – Healthy eating habits can help you reduce three major risk factors for stroke – high blood pressure, poor cholesterol levels, and excess weight. We recommend a diet rich in vegetables and fruits, as well as whole-grain, high-fiber foods. Eating fish can also be a plus. At the same time, you should limit saturated fats, trans fats (partially hydrogenated oils), added sugars, salt (sodium) and alcohol.
• Be Active – Most healthy people should get the equivalent of at least 150 minutes (2 hours and 30 minutes) per week of moderate-intensity physical activity, such as brisk walking.
• Take Medications as Needed – Certain medications can help prevent a stroke, or decrease the probability of a future stroke. Antiplatelet agents keep blood clots from forming by preventing blood platelets from sticking together. Anticoagulant drugs prevent clots from forming by inhibiting clotting factors in the blood. 

Erlanger Stroke Resources

The Erlanger Southeast Regional Stroke Center has emerged as a world leader in reversing the effects of stroke. As the region’s only certified Comprehensive Stroke Center, Erlanger has earned The Joint Commission’s highest accreditation for stroke care.