A neurologist talks about treating and recognizing strokes
Once, in the not-so-distant past, doctors treated strokes in an after-the-fact manner: The stroke occurred, did its damage and then — if the patient survived — a rehabilitation team stepped in to address the stroke's debilitating effects.
But in 1996, the Food and Drug Administration approved tissue plasminogen activator (t-PA), which has the power to dissolve the blood clots that lead to ischemic strokes (strokes caused by an interruption in blood flow to the brain) and help restore normal blood flow to the brain if administered in a prompt manner.
The timing of treatment is crucial since lost time can lead to lost brain function.
Today, stroke specialists like those found at Rush follow a timed, standardized set of procedures, which requires that diagnostic tests and treatment be given as quickly as possible.
This approach to stroke care has had a significant impact on patient outcomes, both in terms of survival and quality of life. James Conners, MD, MS, a stroke neurologist at Rush, sheds some light on stroke survival and recent advances.
Number of stroke survivors on the rise
We've seen a decline in the number of total strokes each year as well as the number of stroke deaths per year.
From 1997 to 2007 the number of stroke deaths dropped by nearly 19 percent, which indicates significant progress.
Stroke has historically been the third leading cause of death in the United States; however, based on preliminary data from the Centers for Disease control, cerebrovascular disease may now rank fourth among all causes of death, after diseases of the heart, cancer and chronic lower respiratory diseases.
Stroke incidence is also declining over time. Over the last 30 years, lifetime risk of stroke by 65 years of age decreased from approximately 20 percent to 15 percent, so we're definitely making progress.
A different approach to stroke treatment
The improvement in stroke survival rates is due to many factors, including advances in treatment soon after stroke and stroke prevention.
"We now have multiple treatment options for patients who suffer from ran acute stroke the first time, including clot busting medications like t-PA and endovascular devices that can be used to reopen blocked blood vessels," says Conners.
"We're also now more aware of stroke risk factors, and we're better at controlling those risk factors with lifestyle modifications and, when necessary, medications," he adds. Better detection and treatment of high blood pressure have played significant roles, in addition to the use of new antiplatelet medications, statins to help lower cholesterol and improved control of diabetes.
Abnormal heart rhythms, like atrial fibrillation, can also lead to stroke. New medications, such as blood thinners, may help patients who have atrial fibrillation and are at risk of having blood clots form in the heart, which can then dislodge and travel up into the brain causing stroke. The blood thinners help to prevent the blood clots from forming.
Technological advances = better survival rates
Today's imaging technology allows us to detect stroke within minutes of the first symptoms, visualize blood vessels in the brain that may be blocked as well as determine where blood is and isn't flowing.
"It is helpful to know where blood flow is blocked when you are considering an intervention to reopen the vessel and it also helpful for us to understand the stroke mechanism or what's causing the stroke," Conners explains. "This all assists in the decision-making process and helps us improve outcomes."
To treat strokes successfully and limit damage to the brain and body, treatment with clot-busting medications must begin within just a few hours of a stroke's onset.
Unfortunately, access to stroke neurologists is greatly limited at many hospitals, so many stroke patients do not receive specialized stroke care in a timely manner. That was the impetus for Rush's telemedicine program, a partnership with community hospitals that is bringing world-care to more patients.
"Telemedicine involves advanced videoconferencing and imaging technology to allow a stroke neurologist to assess patients remotely," Conners says. "The videoconferencing capability gives the added benefit of seeing and talking to the patient face-to-face. We are able to examine the patient and review radiologic imaging, which aids in a quick and accurate diagnosis. We are then able to quickly recommend plans of care."
The Mobile Stroke Unit: timely stroke care and transport
Also enabling more rapid stroke treatment is Rush's Mobile Stroke Unit (MSU), a state-of-the-art ambulance designed to deliver immediate, expert stroke care to patients on-scene. It's the first Mobile Stroke Unit in Cook County.
The MSU team of emergency stroke specialists includes a stroke neurologist, registered nurse, CT technician and paramedic. The team is able to quickly assess the patient, start brain-saving treatment on-site and transport the patient to the closest certified stroke center that is appropriate for their specific condition, whether that means a primary stroke center or a comprehensive stroke center like Rush.
To provide optimal care, the ambulance is equipped with the following:
- A CT scanner that transmits images of the brain instantly to a Rush radiologist
- Telemedicine technology to enable immediate consultation with a Rush stroke neurologist
- Clot-busting medications and reversal agents for earlier treatment on the way to the nearest stroke center. Nationally, less than five percent of ischemic stroke patients receive clot-busting medication. Unlike standard ambulances, the MSU is equipped with tPA (alteplase), so the team can administer this life-saving treatment.
Available 24/7, 365 days a year, the Mobile Stroke Unit is dispatched (if available) after a 911 call about any stroke symptoms. It is based at near west suburban Rush Oak Park Hospital.
If you suspect a stroke, don't delay: Time is brain. Each minute a stroke goes untreated [increases] the potential for disability and death.
What you can do to improve your chances of surviving a stroke
One of the most important ways to improve your chances of surviving a stroke is to be able to recognize the signs and symptoms of a stroke. The acronym FAST is an easy way to remember signs of stroke and what to do if you think a stroke has occurred. The following are symptoms to look for:
- Numbness or weakness of the face, or an arm or leg, especially on one side of the body
- Trouble speaking or understanding
- Trouble seeing in one or both eyes
- Difficulty walking
- Loss of balance or coordination
- Severe headache with no known cause
If you or someone around you has the sudden onset of any of these symptoms, call 911 and ask to be taken to the closest primary stroke center.
Primary stroke center designation is given by the health care accrediting organization the Joint Commission to hospitals like Rush, which tailor treatment to individual needs as well as encourage communication, adhere to national stroke guidelines and continually assess and improve how care is delivered.
The key take-home point is that if you suspect a stroke, don't delay: Time is brain. Each minute a stroke goes untreated, 1.9 million brain cells die, increasing the potential for disability and death.
With our current treatments, however, we can prevent further damage and improve outcomes in many patients.
Take steps to reduce your stroke risk
To prevent a stroke, a healthy diet and moderate exercise are absolute musts. According to the American Stroke Association, a healthy level of physical activity for adults ages 18 to 65 should be at least 30 minutes of moderate exercise five days a week.
You can also use the following strategies to change the way you prepare your meals to help reduce your risk for stroke:
- Keep portions moderate
- Drink more water; hydration is important for overall health
- Limit your use of salt: Use vinegar, lemon juice, red pepper flakes, garlic and onions instead of salt
- Limit use of sugar
- Use canola, olive, corn or safflower oil in cooking
- Buy fresh lean cuts of meat and trim the fat before cooking
- Eat plenty of fruits and vegetables