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• Understanding Stroke, the Nation's Third Leading Killer

Though stroke is the third leading cause of death in the U.S. and the leading cause of long-term disability, many people who experience stroke symptoms don't recognize them, often choosing to go to bed rather than call 911.

It's a devastating choice.The failure to quickly receive the most appropriate treatment is too often responsible for disabling or killing the 700,000 Americans who experience a stroke each year. That is why the Joint Commission on Accreditation of Healthcare Organizations awards special certification to those facilities that demonstrate specialized skills and knowledge in the treatment of strokes.

When To Call 911

"Stroke is a disruption in the blood flow to an area of the brain,"says Cynthia Miller, R.N., 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 almost 90 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 they must be administered within a few hours of the onset of symptoms.

Any of the following symptoms demand an immediate call to 911.

• 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 walking, dizziness,loss of balance or coordination
• Sudden severe headache with no known cause

Diagnosis And Treatment Options

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, a series of diagnostic procedures are initiated immediately. These procedures help physicians determine if the patient is experiencing a stroke and which treatment is appropriate.

The clot-dissolving drug called tPA (tissue plasminogen activator) is today's primary treatment for acute stroke and can sometimes minimize or completely resolve brain attack if administered within 3 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 Medical Center's Walnut Creek and Concord Campuses, a neurologist is on call around the clock, so patients can be expertly evaluated 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, M.D., director of the Stroke Program at John Muir Medical Center - Concord Campus.

Other interventions available at John Muir Health are interarterial tPA and the Merci Retriever, recently approved by the Food and Drug Administration. 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 cerebral artery.

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, M.D., medical director of the Stroke Program at John Muir Medical Center - Walnut Creek Campus. "During rehabilitation the patient can regain function or learn to overcome the deficits they do have." The Acute Rehabilitation Unit at John Muir Medical Center - Walnut Creek Campus has specially trained staff to provide individualized treatment programs.

Preventing Stroke

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 increases the risk of stroke. In some cases drugs or surgery can help prevent stroke. Still, as with so many health concerns, patient behaviors— including avoiding drugs, alcohol, and tobacco, as well as exercise and a healthy diet—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." John Muir Medical Center - Walnut Creek and Concord Campuses are the first in Contra Costa County to receive Stroke Center certification from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The two hospitals are the first two stroke centers in California to receive the "Get with the Guidelines - Stroke" Initial Performance Achievement Award from the American Stroke Association.

For a free stroke risk assessment form or more information about John Muir Health's Stroke Centers, click here.