Stroke

You can help prevent stroke by making healthy lifestyle choices. Working with your health care provider, you may control any health conditions that could increase your risk for stroke. To help prevent a stroke:

• Avoid fatty foods. Follow a healthy, low-fat diet. Include several daily servings of fruits and vegetables. Adding fish to your diet at least twice a week may be helpful.
• Do not drink more than one to two alcoholic drinks a day.
• Exercise regularly: You should generally exercise for at least 30 minutes a day.
• Get your blood pressure checked every one to two years, especially if high blood pressure runs in your family. High blood pressure is the main risk factor for stroke.
• Know your cholesterol numbers. High cholesterol can lead to clogged arteries and cause a stroke. Your primary care physician can help you monitor your cholesterol and suggest lifestyle changes and medication to help lower your cholesterol if it is high.
• Follow your doctor's treatment recommendations if you have high blood pressure, diabetes, high cholesterol or heart disease.
• Quit smoking.

A stroke is an interruption of the blood supply to any part of the brain. When part of the brain does not get blood flow due to a blocked or ruptured blood vessel, that part of the brain starts to die. A stroke is sometimes called a brain attack. Approximately 795,000 Americans each year suffer a new or recurrent stroke. On average, a stroke occurs every 40 seconds.

The symptoms of stroke depend on which part of the brain is damaged. In some cases, you may not even be aware that you experienced a stroke.

Symptoms usually develop suddenly and without warning. They may be episodic (occurring and then stopping) or they may slowly get worse over time.

Stroke symptoms may include:

• Change in alertness (consciousness)
• Coma
• Decreased sensation
• Decreased vision
• Difficulty moving any body part
• Difficulty speaking or understanding others
• Difficulty swallowing
• Difficulty writing or reading
• Headache
• Lethargy
• Loss of all or part of vision
• Loss of balance
• Loss of fine motor skills
• Movement changes, usually on only one side of the body
• Nausea or vomiting
• Numbness or tingling
• Seizure
• Sensation changes, usually on only one side of the body
• Sleepiness
• Sudden confusion
• Vision changes
• Weakness of any body part

What to do? Think BEFAST Exam

Strokes are a medical emergency that require immediate attention. Knowing the symptoms of a stroke could save a life. Use the BEFAST Exam to determine if you should call 911.

• Balance: Loss of balance, dizziness
• Eyes: Vision changes
• Face: Does the face look uneven? Ask the person to smile
• Arm: Does one arm drift down? Ask the person to raise both arms
• Speech: Does their speech sound stranger? Ask the person to repeat a simple phrase, for example "The sky is blue"
• Time: If you observe any of these signs, then it's time to call 911

These tests may be performed if a stroke is suspected:

•  A neurological exam may suggest increased intracranial pressure or decreased brain function. Specific symptoms can help tell which part of the brain is affected.
•  An eye exam may show swelling of the optic nerve from pressure in the brain, or there may be changes in eye movement. Abnormal reflexes may be present.

Additional tests can help your doctor determine the type, location, and cause of the stroke and to rule out other disorders that may be responsible for the symptoms:

• An Angiogram is an imaging study used to see which blood vessel is blocked or bleeding and help your doctor decide if the artery can be reopened using a thin tube.
• Carotid Duplex is a type of ultrasound that can determine if narrowing of the neck arteries (carotid stenosis) led to the stroke.
• Computed Tomography (CT Scan) provides detailed pictures showing bones, soft tissue and blood vessels.
• Computed tomography angiography (CTA) is used to determine the location and severity of a stroke and which blood vessel is blocked or bleeding.
• Computed tomography (CT) perfusion (blood flow) imaging shows which areas of the brain are supplied with blood. Combining a series of x-rays, the CT scan provides a detailed image of the brain which shows blockages and bleeding. This test can help to diagnose stroke as well as brain tumors and other disorders.
• Electrocardiogram (EKG) is a medical test that may help diagnose underlying heart disorders. An electrocardiogram is a test that measures the electrical activity of the heart. The electrocardiogram is used extensively in the diagnosis of heart disease, from congenital heart disease in infants to myocardial infarction and myocarditis in adults.
• An Echocardiogram is an ultrasound test that determines if the stroke may have been caused by a blood clot from the heart, using sound waves to create a moving picture of the heart. The picture is much more detailed than a plain x-ray image and involves no radiation exposure.
• Magnetic Resonance Imaging (MRI) uses powerful magnets and radio frequency pulses to create images of organs and soft body tissue. This study can show the structure of the brain and how it is working. Functional MRI measures changes in blood flow with brain activity, which can help physicians evaluate the effects of stroke or other disease.
• Magnetic Resonance Angiogram (MRA), is a medical test that uses a powerful magnet, radio waves and a computer to create pictures of blood vessels, helping to determine the location and severity of the stroke and which blood vessel is blocked or bleeding. The MRA of the head and neck helps the physician evaluate a patient for a stroke or aneurysm (weakness and bulging in an artery), a tumor, and can help identify reasons for memory loss.
• Transesophageal Echocardiography (TEE) is another way to perform an echocardiogram. It provides detailed images of the heart's structure, and if you have a stroke, this test helps your physician to check for blood clots in the chambers of your heart.

When you suffer a stroke, seconds count. Early treatment can lead to higher survival rates and lower chance of severe disability. Fortunately, our stroke team offers highly specialized expertise and advanced stroke treatment options.

Hemorrhagic Stroke

Surgery to remove pooled blood from the brain and repair damaged blood vessels is often required for hemorrhagic strokes. The type of surgery depends upon the specific cause of brain bleeding.

One common problem related to brain bleeding is hydrocephalus, which is the build-up of fluid within the brain. A procedure called ventriculostomy may be needed to drain the fluid.

Ischemic Stroke

Thrombolytics, such as tissue plasminogen activator (tPA), may be given if the stroke is caused by a blood clot. This medication breaks up blood clots and helps restore blood flow to the damaged area. Thrombolytics are not given if you are experiencing a hemorrhagic stroke. The medication could cause increased bleeding.

It’s important you are examined and treated by a specialized stroke team within three hours of experiencing symptoms. If the stroke is caused by bleeding rather than clotting, thrombolytics can make the damage worse -- so care is needed to diagnose the cause before any treatment is administered.

The decision to give the drug is based upon:

• A brain CT scan to make sure there is no bleeding
• A physical exam that shows a significant stroke
• Your medical history

In other circumstances, blood thinners such as Heparin and Coumadin are used to treat strokes due to blood clots. Aspirin also may be used. Other medications may be needed to control other symptoms, including high blood pressure. Painkillers may be given to control severe headache.

Carotid Artery Surgery

Carotid artery surgery is a procedure to restore proper blood flow to the brain. The build-up of plaque in the inner layer of the wall of an artery may lead to narrowing and irregularity. Where the narrowing is severe, there is a risk that the vessel can block completely if a thrombus (blood clot) forms in the diseased segment.

There are two ways to treat a carotid artery that has plaque buildup in it. One is surgery called endarterectomy. The other is a procedure called angioplasty with stent placement.

Carotid artery surgery may help lower your chance of having a stroke. But you will need to make lifestyle changes to help prevent plaque buildup, blood clots, and other problems in your carotid arteries over time. You may need to change your diet and start an exercise program, if your doctor tells you exercise is safe for you.

Doylestown Health Stroke Services offers advanced care to help limit the damage caused by a stroke. Our team of stroke experts includes Emergency Department physicians, neurologists, and radiologists.

How the Stroke Team Responds in an Emergency

• When a call is made to 911, emergency personnel are trained to assess potential stroke victims. First responders notify our Emergency Department of a suspected stroke victim and the acute stroke team is put on alert.
• At the Emergency Department, the stroke team confirms whether you are experiencing a stroke or another medical emergency. A brain scan will be done to check for bleeding.
• If a stroke is confirmed, and it has been three hours or less since the first symptoms appeared, you may be treated with a clot-busting drug called tPA. Strict criteria apply and not all stroke patients are eligible.
• Different treatment is recommended if you are not eligible for tPA.
• If needed, you will be admitted to in an inpatient unit with nurses specifically trained in stroke care.
• Following a stroke, other hospital services may be recommended, including occupational, speech, and physical therapy.
• Social workers will help you and your family assess your needs after discharge.
• Monthly support group meetings are available to assist you and your family during recovery and beyond.

• American Stroke Association
• Children's Hemiplegia and Stroke Association
• Joint Commission
• National Stroke Association

Long-Term Stroke Treatment and Rehabilitation

The goal of long-term treatment is to help you recover as much function as possible and prevent future strokes. Recovery time and need for long-term treatment depends on your individual needs. Depending on your symptoms, rehabilitation may include:

• Occupational therapy
• Physical therapy
• Speech therapy

Family counseling may help in coping with the changes required for home care. Visiting nurses or aides, volunteer services, adult protective services, and other community resources may be helpful.