A stroke is a serious and sometimes life threatening condition. It is the leading cause of disability and the fourth leading cause of death among Americans. Until recently, it you were to experience a stroke, supportive care was all that was available. Over the past ten years or so, treatments have been developed that can stop a stroke in its path. There are treatments available that can limit or even eliminate disability from stroke and save many lives. All of these lifesaving and life changing treatments are dependent on how much time has passed since your stroke symptoms have developed. Therefore recognition of stroke by the patient and/or their family is of utmost importance. This article will attempt to give you the information you need to recognize stroke and to respond accordingly.
Your brain is very important. It has blood vessels that are dedicated to providing each and every cell of your brain with the required oxygen and nutrients that it needs to survive. Over the years, plaque from cholesterol builds up in those blood vessels and causes them to narrow. If that plaque ruptures and causes damage to the blood vessel wall, your body tries to heal it. Your body will send clot forming chemicals to the site and clot off the blood vessel. Once the blood vessel is closed, there is no blood flow to the tissue beyond the blockage. This causes that tissue to begin to die. The symptoms and size of your stroke will depend upon the location of that blood clot.
The other type of stroke occurs when one of those blood vessels ruptures and causes bleeding into the head. This type of stroke is called a hemorrhagic stroke. Although not impossible to treat, this type of stroke tends to be more serious and harder to treat.
Stroke risk is increased by the same factors that increase risk for heart attack. There can be a genetic component to stroke risk. Smoking, obesity, diabetes, hypertension and high cholesterol all contribute to the risk of stroke. Anything that you can do to change those risk factors will decrease your chance of having a stroke.
Because all of the treatments for stroke depend upon the length of time symptoms have been present, recognition of stroke is extremely important. Keep in mind that stroke symptoms usually come on quite suddenly. They may get worse over time, but they start all of a sudden. (You don’t start to feel worse over the course of a day) You may be sitting at a table and suddenly be unable to hold your coffee cup or to get your words out correctly. Signs and symptoms of stroke include sudden onset of weakness on ONE SIDE, slurred speech or the inability to make your words come out right. A sudden change in the way your walk because one leg is not “acting right” can be a sign of stroke. Some patients notice changes in their ability to see. Loss of balance is a common sign of stroke. In patients who have bleeding in their brain, they will often say “they have the worst headache of their life.”
It is imperative that you get help and get to a hospital AS SOON AS POSSIBLE following the onset of symptoms of stroke. Treatment for stroke is very time dependent. A clot busting medication can be given to clear the clot from the vessel, but only if you are at the hospital within 3 hours (4.5 hours for some patients) of onset of symptoms. Call 911 IMMEDIATELY. Do not wait for family members to arrive, do not wait while you pack clothing for the hospital or wait for your family to return a call, call 911 IMMEDIATELY! The amount of damage done by your stroke is a result of how long the blood vessel remains blocked. Keep in mind that TIME IS BRAIN. For every minute you delay getting care, more brain tissue is being damaged.
If you are calling help for a friend or family member, after calling 911, you should attempt to determine the time that symptoms began. If you arrived at your family member’s house and found them with symptoms, it may be advantageous to phone a neighbor that may have seen them. You are attempting to figure out the time that the patient was “last known well.” This is important because the risk of complication from some of the medication given to treat stroke becomes too high after 3 to 4 hours and so cannot be administered. It is very important, if possible, to know when the patient was last seen normal. This may be a telephone conversation, a neighbor who saw them getting their mail earlier in the day or the report of someone who was with them when their symptoms began.
The Paramedics and EMT’s will focus on two things. Making sure that your vital signs are stable and transporting you quickly and efficiently to a stroke center that is capable of treating your stroke.
Don’t be surprised if EMS encourages you to go to a hospital other than the one that you would prefer. There are certain hospitals that are classified as “Stroke Centers” of various different levels. This designation is given to hospitals that are capable of giving a clot busting medication called rtPA to patients with stroke. Tertiary Stroke Centers (usually the larger teaching hospitals) are capable of not only giving clot busting medications but of performing procedures quickly to remove the clot from your blood flow and restore flow.
If you are transported to a hospital that is not a stroke center, valuable time will be wasted while they complete their assessment and diagnostic testing and then they will be required to transfer you to the closest stroke center for treatment. Transporting you directly to the closest Stroke Center can save precious time. Most Emergency Medical Services have protocols in place for this purpose.
There are limited treatments available for Hemorrhagic Stroke (bleeding in the brain). Most if not all of them are surgical and beyond the scope of this article. I will concentrate on the treatments available for ischemic (blood vessel blocked) stroke which is the most common form of stroke.
Clot Busting Medication - rtPA is a clot busting medication that has been used for many years for heart attack and pulmonary embolism (clots in the blood vessels of the lungs). It is given Intravenously and dissolves the clot to restore blood flow to the portion of the brain where it is blocked. It is not without complication. rtPA can cause bleeding in the brain and other parts of the body, so you will be assessed to make sure that you are not at risk of bleeding. For example, if you recently had a major injury, surgery or internal bleeding it would be too dangerous to administer a clot busting medication for your stroke. The RISK OF BLEEDING INCREASES SIGNIFICANTLY OVER TIME. That is why it is important to know when symptoms began. The time that your symptoms began is the time when the blood vessel became occluded. Clot busting medication cannot be administered if this time is longer than 3-4.5 hours. It is just too dangerous to do. There are other treatments available for those patients.
Just like with heart attack there are procedures to place a catheter directly in the brain and remove the clot that is blocking the blood vessel. This is done in a Radiology Laboratory or even a Cardiac Catheterization laboratory. A catheter is place through the groin (or other site) and threaded up to the blood vessel that has been blocked. Various types of catheters can be utilized to remove the clot.
Even though these procedures can be done much longer after onset of symptoms, remember that TIME IS BRAIN. This means that the longer the blood vessel is blocked, the more brain tissue that will die and not be able to be saved. So just like with the clot busting medication, time is of the essence.
Review the healthcare provider algorithm for response to stroke which includes the Cincinnati Prehospital Stroke Scale and take our online quiz for stroke response.
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Written by David Patterson and last updated 2015-02-27