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Stroke
When it comes to stroke, every second counts
To understand a stroke, think of it as a heart attack that happens in the brain. A stroke (or brain attack) is a potentially fatal condition that occurs when a blood clot, or ruptured blood vessel, interferes with blood flow to the brain. When this happens, part of the brain cannot get the blood and oxygen it needs, so it starts to die.
Every 45 seconds, someone in America has a stroke. It is the third leading cause of death and the leading cause of disability in adults. Depending on the type, extent and location of the damage – as well as how quickly emergency care is given – a stroke can result in death or may permanently impair a person’s ability to move, speak, think, remember, respond normally or live independently.
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Rapid Response to Stroke
The key to surviving a stroke is immediate emergency treatment at a medical center experienced in acute stroke management.
The stroke program at Hoag Hospital offers a rapid response stroke team comprised of emergency room physicians, neurologists, neurosurgeons, radiologists, highly-skilled nurses and other critical support staff. Another unique facet of Hoag’s stroke team is its onsite neurology hospitalist and interventional neuroradiologists.
“The stroke team at Hoag quickly evaluates and treats patients utilizing the latest in leading-edge diagnostic, treatment and intervention techniques,” explains Hoag Neurology Hospitalist David Brown, M.D., medical director of Hoag’s stroke program. “The sooner patients receive appropriate stroke treatment, the better their chances for survival, and for suffering the least amount of permanent damage.”
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Diagnosing Stroke
The first step in successfully treating stroke is accurately diagnosing it. Hoag provides state-of-the-art imaging technologies that enable its physicians to determine the best possible treatment for stroke patients.
“Sophisticated brain imaging provides detailed pictures of affected areas including cerebral structures and blood flow,” explains Interventional Neuroradiologist Michael Brant-Zawadzki, M.D., executive medical director of Hoag Neurosciences. “These images allow physicians to diagnose and treat stroke within minutes, and with greater precision, resulting in improved patient outcomes.”
The primary imaging techniques include computerized tomography (CT); magnetic resonance imaging (MRI), with their ability to also evaluate the blood vessels (CTA, MRA); ultrasound and nuclear brain scans. Conventional catheter angiography can also be used to detect blocked blood vessels and areas where the brain is affected.
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Innovative Stroke Treatment
More than 80% of all acute strokes are caused by blood clots. The first-line therapy for this type of stroke (referred to as “ischemic” stroke) is intravenous thrombolysis – a process by which a clot-busting drug called a tissue plasminogen activator (tPA) is administered intravenously in an attempt to dissolve the blood clot causing the stroke.
To be effective however, tPA must be administered within three hours of the onset of symptoms. That’s why it’s so important for individuals to seek immediate emergency treatment at the first sign of stroke. (See “Stroke Warning Signs”) More and more, direct approach to blockage with minimally invasive clot busting tools are being utilized.
Intra-arterial thrombolysis is an endovascular treatment option that delivers a clot-busting drug directly to the blood clot by use of a thin catheter. The catheter is navigated through the vascular system to the site where the clot is blocking blood flow. The drug is then delivered right to the clot in order to dissolve it and re-establish blood flow to the brain.
This procedure is generally effective for ischemic stroke when used within the first six hours of the onset of symptoms. Intra-arterial thrombolysis is now being combined with mechanical clot extraction, whereby a clot retrieval device is inserted via catheter to “grab” the clot and remove it. Hoag was the first to introduce the Penumbra device in Orange County - This tool uses suction to remove the clot and effectively restores blood flow to the brain in more than 80% of the cases. This treatment extends the window of opportunity to up to eight hours.
As a leader in stroke care, Hoag provides a full range of minimally-invasive endovascular techniques for both the prevention and treatment of stroke, including state-of-the-art carotid stenting and endovascular coiling, also referred to as coil embolization.
“Carotid stenting is a preventive procedure for certain high risk patients in which a tiny, metal stent is fitted inside a carotid artery,” explains Hoag Cardiologist Subbarao Myla, M.D., medical director of cardiovascular research and vascular intervention. “The stent is inserted after the physician guides a balloon-tipped catheter into the blocked artery. The balloon is inflated and presses against the blockage, flattening it out and re-opening the artery. The stent is then placed and acts as a scaffold to help hold the artery open, thus restoring blood flow.”
“Endovascular coiling may be a treatment option for patients with hemorrhagic stroke –the type of stroke caused by bleeding in the brain either due to an aneurysm or other blood vessel malformations,” notes Dr. Brant-Zawadzki. “By inserting a catheter into an artery in the groin, we are able to navigate through the vascular system into the aneurysm or ruptured vessel. Very thin coils are then deployed, stopping blood flow into the brain.”
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Patient-centered Care
Hoag’s state-of-the-art stroke program also consists of the highest quality patient-centered care, including a 12-bed Neuro Intensive Care Unit and a 12-bed designated Stroke Unit. "At the heart of each unit is a dedicated, highly-trained nursing staff experienced in telemetry monitoring and neuro assessment of stroke patients, as well as in identifying signs and symptoms of new or evolving strokes," explains Samuel Gomez, M.S.N., R.N., executive nursing director for Neurosciences.
Another important element of the stroke program is the emphasis Hoag places on patient education. Stroke unit nurses educate patients and their family members on all aspects of stroke recovery, including the many resources available, such as stroke support groups, rehabilitation and other community services.
Hoag also offers a variety of therapies for stroke rehabilitation, including physical therapy, speech therapy, occupational therapy, strength training and daily living skills to help patients regain as much of their former quality of life as possible. “We start these programs almost immediately,” explains Dr. Brown. “Because we know that the sooner stroke patients get rehabilitation, the better their outcomes, and the better their chances for an improved quality of life.”
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Building Awareness is Key
“An accurate diagnosis and skilled emergency treatment are essential to achieving the best outcome after stroke,” asserts Dr. Brown. “However, the most crucial step is immediate treatment at the first sign of distress, because with stroke, time lost is brain lost.”
Educating the public about stroke prevention is key in reducing the number of stroke-related injuries and death. It’s vital for the public to understand their risk factors for cardiovascular disease and stroke, and to partner with their physician to reduce their risk.
It’s also important for everyone to know the classic warning signs of stroke and how critical it is to act immediately in obtaining emergency care. Every second counts when it comes to surviving a stroke.
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Stroke Warning Signs
A stroke is a medical emergency. Each year, more than 780,000 Americans suffer from stroke. In fact, it is the third leading cause of death and the leading cause of disability in adults.
Getting to the hospital immediately may mean the difference between life or death. If you or anyone you know experiences the following symptoms, do not delay, call 9-1-1immediately!
- Sudden change in vision – blurred or loss of vision
- Sudden confusion or difficulty of speech – slurred or sluggish, loss of words or difficulty understanding words
- Sudden weakness – loss of strength in face, hand, arm and/or leg on one side of the body
- Sudden loss of balance or dizziness – difficulty walking or clumsiness
- Sudden change in sensation – heaviness, numbness or unusual sensation in face, hand, arm and/or leg on one side of the body
- Sudden severe headache, unexplained, often described as the worst headache ever
Even if the symptoms only last a few minutes, it could be a mini-stroke, which is called a TIA (transient ischemic attack). This is also a medical emergency that requires immediate medical attention. An unrecognized and untreated TIA may be followed by a major disabling stroke. Therefore, if any of the above symptoms occur, it is critical to seek immediate emergency treatment. Remember time lost is brain lost!
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