Every 40 seconds in the United States a stroke occurs to one of the 795,000 Americans plagued a year. Every four minutes, someone dies from a stroke, making it the third leading cause of death in the country and the most common cause of permanent disability in adults. Recognizing the warning signs of a stroke in progress can lead to early treatment and help to avoid the death or disability.

Stroke comes in two forms. An ischemic stroke is when a clot forms in a blood vessel going to the brain. The breaking of a blood vessel in the brain is a hemorrhagic stroke.
When a stroke occurs, blood flow to an area of the brain is disrupted. This deprives an area of the brain of blood flow causing this area to malfunction. Symptoms vary depending on which area of the brain is affected. It is important to realize that symptoms occur suddenly and without warning. Some victims even awaken with the symptoms.

Common Symptoms of a Stroke
• weakness or numbness on one side of the body
• slurred speech
• loss of vision
• difficulty saying appropriate words
• difficulty understanding language
• double vision
• spinning of room (vertigo)
• imbalance
• seizures (stroke is the most common seizure in the elderly)
If any of these symptoms occur, immediate action can lead to life-saving therapies. Many ignore symptoms, and stroke victims lose essential treatment time waiting for symptoms to subside.

TIA’s May Be Warning Signs
A Transient Ischemic Attack (TIA) is a stroke that begins but then resolves, leaving no damage to the brain. While a TIA is not a stroke, it should not be ignored as it can be a warning sign of an impending stroke.

The risk of having a stroke is highest in the first 24-48 hours following a TIA, therefore all TIA patients should be admitted to the hospital and evaluated to prevent stroke. Patients are continually monitored by specially trained nursing staff that recognize neurological changes early and can start interventions as needed.

What to Do if Stroke Is Suspected
• call 911
• note the time of symptom onset
• do not take any medications while awaiting EMS.
• do not take aspirin, as aspirin can increase the bleeding.
• have someone gather all current medications and bring them to the hospital since this will affect treatment
• request that EMS go to a Joint Commission certified stroke center

Why is it important to go to a Joint Commission certified stroke center? Compared to non-accredited centers, these stroke centers have enhanced capabilities and better results. Joint Commission certified stroke centers employ a team approach to care and follow evidence-based guidelines to identify and treat patients with acute stroke or TIA. With less than 30 certified stroke centers in Virginia, it is imperative to identify nearby locations before a stroke occurs.

The first step begins at home with the identification of stroke symptoms by patients and their families. The second is seeking help immediately at the closest certified stroke center. Upon arrival at the center, immediate evaluation is undertaken including history, physical exam, blood work and brain imaging. A neurologist will also be alerted and direct the course of treatment after an initial evaluation.

Stroke Therapies
For those who arrive within a three hour window of symptom onset and are having an ischemic stroke, the use of Tissue Plasminogen Activator (TPA) may be an option. TPA is a “clot busting” FDA approved drug used in acute strokes within the first three hours of symptoms. This drug is administered through an IV and can cause the clot lodged in the blood vessel to dissolve, restoring blood flow and preventing further brain damage. Upon evaluation three months after the stroke, patients who received TPA have been found to have better outcomes versus those who did not receive TPA.

For those with a clot in a large vessel, intra-arterial TPA or clot retrieval may be undertaken. In these cases, an interventional radiologist will place a very small catheter through an artery in the groin or arm and guide it into the arteries of the brain until the clot is reached. TPA can then be infused directly into the clot to dissolve it, or devices can be used to extract the clot from the vessel. These treatments restore blood flow and prevent more brain damage from occurring.

If a hemorrhagic stroke is confirmed by the initial head CT, clot busting therapies are not possible, as they will increase the amount of bleeding. For these patients, supportive care, control of blood pressure and neurosurgical interventions are possible treatments, depending on the size and location of the bleeding.

For more information on stroke, visit the American Stroke Association website www.strokeassociation.org.