Stroke

Stroke

Though stroke is the third leading cause of death in the U.S. and a leading cause of long-term disability, many people who experience stroke symptoms don't recognize them.

The failure of patients to quickly get the best treatment is too often responsible for disabling or killing the million or so Americans who experience a stroke each year.

Cause

"Stroke is a disruption in the blood flow to an area of the brain,” says Cynthia Miller, RN, neurosciences clinical coordinator for John Muir Health.

The most common cause of stroke is when a blood clot blocks an artery feeding the brain. Known as an ischemic stroke, it accounts for about 85 percent of all strokes. The rest are hemorrhagic strokes, which occur when a vessel bursts in or near the brain.

In both cases, loss of oxygen to the brain quickly begins killing brain tissue. New treatments are available that may prevent permanent damage or death, but doctors must administer them within a few hours of the onset of symptoms.

Symptoms

  • Sudden numbness of face, arm, or leg, especially on one side of the body
  • Sudden trouble seeing in one or both eyes
  • Sudden confusion, trouble speaking, or understanding speech
  • Sudden trouble walking, dizziness, loss of balance, or coordination
  • Sudden severe headache with no known cause

Diagnosis

It is important that patients know which facilities provide the latest treatment and how important it is to act quickly. Failure to receive specialized treatment can mean the difference between life or death, full recovery or lasting impairment.

When a potential stroke patient arrives at a certified stroke center, doctors will immediately give you a physical examination, test how well your brain functions, test your heart, and conduct a series of diagnostic procedures to rule out other problems.

These procedures help physicians figure out if the patient is experiencing a stroke and which treatment is appropriate. If doctors suspect a stroke, they will also perform brain-imaging tests to determine what type of stroke it is and the degree to which the stroke has affected the brain.

Treatment

The clot-dissolving drug called tPA (tissue plasminogen activator) is today's primary treatment for ischemic stroke, and can sometimes minimize or completely resolve brain attack if your doctor administers it within 4.5 hours of stroke onset.

Yet some hospitals and healthcare providers are not set up to initiate rapid treatment or hesitate to use this drug.

At John Muir Health, a neurologist is on call around the clock to evaluate patients for tPA eligibility.

"The complex decision to use tPA involves a discussion among the emergency room physician, neurologist, the radiologist, and the patient and/or their family," says Ray Stephens, MD, director of the stroke program at John Muir Health.

Other interventions are interarterial tPA and the MERCI Retriever. Both require insertion of a catheter into the arteries of the brain. One "shoots" tPA directly on the clot, the other pulls the clot out of an obstructed artery in the brain.

The primary treatment for a hemorrhagic stroke is to control bleeding and reduce pressure in the brain. Doctors achieve this by treating high blood pressure with drugs, elevating the patient’s head, and sometimes (though rarely) surgically removing excess blood from the skull.

Rehabilitation

After eight hours without treatment, most patients will experience some loss of function. The specially trained staff at a certified stroke center looks for signs to assist in preventing complications.

"The goal is to move people into rehabilitation as quickly as possible," says Steven Holtz, MD, medical director of the stroke program at John Muir Health. "During rehabilitation the patient can regain function or learn to overcome the deficits they do have."

The acute rehabilitation unit at John Muir Health has specially trained staff to provide individualized treatment programs.

Prevention

While stroke can occur at any age, the risk increases as one gets older. In addition, chronic conditions such as obesity, high cholesterol, high blood pressure, and uncontrolled diabetes increase the risk of stroke.

In some cases drugs or surgery can help prevent stroke. Still, as with so many health concerns, patient behaviors — including exercise and a healthy diet, as well as avoiding drugs, alcohol, and tobacco — are crucial.

Discuss your individual risk factors and appropriate treatments with your physician.

"The most important thing is to be informed," says Miller. "When symptoms strike, don't ignore them. Call 911 as quickly as possible."