New advances in stroke care — what you need to know
Every 40 seconds someone in the United States has a stroke. A stroke, or “brain attack,” is the third leading cause of death, and the number one cause of disability in the country. Treatments for stroke have advanced dramatically in the last 10 years, but their effectiveness relies on getting rapid treatment.
Everyone should learn to recognize a stroke’s warning signs, which typically appear suddenly:
• Numbness or weakness of the face, arm or leg, especially on one side of the body
• Confusion, trouble speaking or understanding
• Trouble seeing in one or both eyes
• Trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache, often described as the “worst headache of my life!”
If any of these symptoms occur, call 911 immediately. Rapid treatment for stroke can help prevent disability, and even death.
There are two main types of stroke. A hemorrhagic stroke occurs when a blood vessel in the brain bleeds, due to a tear or an aneurysm. The more common type of stroke is called “ischemic,” and is caused by a blockage in one of the arteries carrying blood to the brain. This blockage prevents oxygen and nutrients from reaching the brain and causes brain cells to die rapidly. That’s why you often hear the phrase, “time is brain,” in stroke treatment. The goal is to restore blood flow to the brain as quickly as possible to prevent permanent brain damage or death.
Alteplase, also known as tPA, is a clot-dissolving medication used to treat ischemic stroke. The drug can only be administered when the onset of symptoms occurs no more than a few hours before a patient arrives in the emergency department.
One of the newest treatments for stroke is endovascular intervention. This procedure is similar to the one performed by cardiologists to open up arteries in the heart. With stroke, a neuro-interventionalist removes the clot in the artery leading to the brain. The highly specialized procedure only can be done at an endovascular-capable hospital, or a Certified Comprehensive Stroke center. As with other stroke treatments, time is critical. The procedure must be performed within six hours of a stroke’s onset.
To determine the type of stroke along with the most appropriate treatment, call 911 as soon as a stroke is suspected. The EMS team starts to provide care immediately after arrival, and alerts the emergency department staff to prepare for appropriate diagnostic testing. In the emergency department, staff then follows a Stroke Alert protocol to assure the patient’s treatment follows evidence-based practice.
Due to a nationwide shortage of neurologists, many hospitals rely on tele-neurology to assure that a physician is readily available to evaluate the patient, review the CT scan films, conclude a diagnosis and make recommendations for appropriate treatment. These tele-neurologists are board certified, specialty trained and accredited by the Joint Commission of Hospitals and Health Systems.
For patients who may benefit from endovascular intervention: Because this is only performed at select centers, a system for rapid transportation for care must be available to assure treatment occurs within a six-hour window. Following the endovascular intervention and initial recovery phase, the stabilized patient may return to a local hospital for rehabilitation.
Patients who receive the clot-busting drug Alteplase typically are monitored in the hospital’s intensive care unit for 48 hours. In cases where stroke has caused limited or extensive disability, inpatient rehabilitation begins within days of treatment.
Preventing a stroke is ideal. If you have a family history of stroke or any of the common risk factors, including high blood pressure, high cholesterol, diabetes, smoking, atrial fibrillation, poor diet, obesity or lack of exercise, you should take steps right now to address those conditions and prevent stroke. Everyone should be able to recognize the warning signs of a stroke and call 911 to begin treatment immediately.
— Mondell is the stroke program coordinator at UPMC Susquehanna, an accredited Joint Commission Primary Stroke Center since 2006.