Stroke

Interesting Stroke Facts:

1. Stroke remains the #1 cause of long-term disability in the United States of America

2. Stroke kills approximately 140,000 Americans each year

3. Every 40 seconds, someone in the UnitedStates has a stroke

4. Every minute a stroke goes untreated the patient loses approximately 1.7 million neurons (brain cells)

5. The brain loses neurons at a rate equivalent to about 3.6 years of normal brain aging for every hour a stroke goes untreated.

Stroke vs TIA(“mini stroke”)

A strokes and TIAs are medical emergencies!

A stroke occurs when the blood flow to the brain, eye orspinal cord is disrupted resulting in radiographic evidence (CT or MRI shows a stroke) and/or disability. A TIA is a warning sign that a patient is at risk of a stroke. These patients present with stroke-like symptoms that resolve (they return to their normal) and there is no evidence of stroke seen on the brain scans.

Types of Stroke

There are two types of strokes: ISCHEMIC STROKE and HEMORRHAGIC STROKE

Ischemic Stroke accounts for approximately 85%of the strokes patients experience. It is caused when the tissue (brain, eye, spinal cord) is deprived of oxygen rich blood due to a blockage (cholesterol plaque or clot) or collapse of the blood vessel.

Hemorrhagic Stroke occurs when oxygen rich blood is not delivered to the tissue due to a ruptured blood vessel. As a result, the blood starts pooling in the brain vs being delivered to the parts of the brain that needs it for survival. Hemorrhagic stroke is usually caused by poorly controlled blood pressure (hypertension) or ruptured aneurysm.

Stroke Risk Factors

There are certain medical conditions and personal habits that increases one’s risk of a stroke. Below isa short list of some of the most common stroke risk factors.

Hyperlipidemia (High Cholesterol) High Blood Pressure (Hypertension) Atrial Fibrillation (Afib) Diabetes Obstructive Sleep Apnea Cancer Thyroid Disease Smoking

Stroke Diagnosis

Stroke is a clinical diagnosis which means based on the description of what symptoms the patient is experiencing and how it started, a neurologist is able to determine if the likelihood that a patient is having a stroke. To make the diagnosis, there are a series of brain scans, diagnostic testing and labs that are part of the evaluation.

Stroke Imaging

1. Non-contrast Head CT

2. Head and Neck CTA

3. Brain MRI

The Non-contrast Head CT

-this typically the first scan that is done on arrival to the Emergency Department

-it takes approximately 3-5 mins to complete so the care team is able to get the results fairly quickly

-the CT scan will help us determine if the patient is having and ISCHEMIC STROKE or a HEMORRHAGIC STROKE. This is very important because these strokes are managed very differently. For example, in patients with an ischemic stroke, the doctor will typically allow their blood pressure to remain elevated. However, if there is evidence that the person is suffering from a hemorrhagic stroke, it is imperative to treat their blood pressure if it is elevated. This so because high blood pressure can make the bleeding worse.

The Head and Neck CTA

-this imaging modality helps the physician to look at the blood vessels of the head or neck

-it helps the medical team determine if there is a vessel that is narrowed or occluded (completely blocked) due to cholesterol build or the presence of a clot.

-if a blood vessel is identified, depending on the location and size of the vessel, the patient may be eligible for a procedure where they are taken to the operating room to retrieve the clot. This procedure does not involve cutting the skull but they are able to pass instruments in one of the large vessels in the leg or wrist. They can then slide it up the network of blood vessels until they enter the brain where they can then remove the blockage.

The Brain MRI

-this imaging modality gives us the most information

-it is not done first because unlike the CT scan, it takes approximately 45mins to complete

-it also requires that the patient remains very still.Unfortunately, when someone is having an acute stroke, they are confused which makes it difficult for them to follow instructions. As a result, there is a lotof movement while in the scanner rendering the images useless.

-some patients may have devices or pieces of metal from previous accidents/injuries that make them ineligible to get an MRI.

Important Labs

The following is a list of common labs that are checked at the time of the initial assessment of a stroke patient:

-Hemoglobin A1c [HbA1c]: this is a test for diabetes.Recommended HbA1c goal for diabetic patients who have suffered a stroke or are at an increased risk for stroke is less than 6.5%

-Lipid Panel: this is a test to screen for high cholesterol.From a stroke perspective, the clinician is concerned about the LDL or the“bad cholesterol”. The recommended LDL goal is less than 70. If thepatient has elevated cholesterol, they are typically started on a high-intensity statin such as Lipitor (atorvastatin), Crestor (rosuvastatin).

-Thyroid Studies: poorly controlled thyroid diseasecan increase one’s chance of a stroke

Common Complications Associated with Stroke

1. Seizures

2. Depression

3. Post-stroke fatigue

4. Cognitive changes: forgetfulness, difficulty concentrating or performing tasks that requires one to focus.

5. Personality Changes: some patients become very irritable and at times violent with family members, friends and caregivers

6. Migraines

We use cookies to improve your experience and to help us understand how you use our site. Please refer to our cookie notice and privacy statement for more information regarding cookies and other third-party tracking that may be enabled.