The following article is written by David Blady, MD, a neurologist with Summit Medical Group. In addition to his position at SMG, Dr. Blady is Director of the Stroke Unit at Hackensack University Medical Center (HUMC) Mountainside Hospital in Glen Ridge, New Jersey. Dr. Blady also is a subspecialty faculty coordinator in neurology for the HUMC Internal Medicine Residency Program. The article is part of an ongoing health series contributed by SMG physicians for Montclair Local.
When I reflect back on the beginning of my career, I always marvel at the advancements we have made in stroke care. As a neurology resident in the early ’80s, there was little I could do to help the stroke patient who came into the emergency room. Today, however, with new medications and technologies as well as high-tech imaging, I am often privileged to see many stroke patients make full recoveries when they get to the hospital right away.
Despite these improvements, stroke is still all too common in our country. Every 40 seconds someone in the U.S. has a stroke—it is the fifth leading cause of death in the nation and the number one cause of long-term disability, according to the American Stroke Association.
Lowering these figures starts at home. There is no question stroke awareness has increased, but there is room for improvement. All you have to do is remember the acronym B-E F-A-S-T—if you see B (loss of balance), E (eyes – double vision or loss of vision) F (face drooping), A (arm weakness), or S (speech difficulty) that means it is T (time) to call 9-1-1 immediately.
I always remind my patients of the phrase “time is brain.” The brain needs a constant flow of blood, which carries oxygen and nutrients, to do its job. Most strokes occur when a blockage, usually a blood clot, causes an interruption in the blood supply (ischemic stroke). They can also occur when a weakened blood vessel ruptures and bleeds (hemorrhagic stroke). Every minute a stroke goes untreated, two million brain cells die and cannot be replaced.
When a stroke patient arrives at the hospital they immediately have a CT scan. It is important to diagnose the type of stroke right away because ischemic strokes, which account for about 87 percent of all strokes, can be treated with a clot-busting drug known as tPA (tissue plasminogen activator). Physicians aim to begin treating a stroke within 45 minutes of arrival.
Research shows that stroke patients who receive tPA in the first four hours are 30 percent more likely to have a positive outcome. Recent studies have also found that a procedure called a thrombectomy, which uses a catheter to remove the clot inside the artery, may be beneficial for up to 24 hours after the onset of symptoms.
You have probably heard the term TIA or Transient Ischemic Attack. This is a temporary blockage in the brain that causes the same symptoms as a stroke, but lasts for less than an hour. A TIA does not cause permanent damage, but it is a warning stroke that says a second, more serious stroke is likely to follow.
As a neurologist, when a patient has a stroke I feel the medical community “missed the boat.” Some 80 percent of strokes are preventable. Some risk factors are uncontrollable, such as race, age and family history. But there are many red flags that you can change, such as lowering high blood pressure and cholesterol, controlling diabetes, quitting smoking and maintaining a healthy body weight. Most hemorrhagic strokes, for example, are caused by blood pressure that has been out of control for a long time. Talk to your doctor about how you can lower your stroke risk.
It has been amazing to witness this dramatic evolution in stroke care. In the last decade, the use of teleneurology, which allows community hospitals and first responders to video chat with a trained stroke neurologist have significantly improved patient care. High-tech ambulances called mobile stroke units can even perform CT scans on the patient at the scene. I am excited to see what the next 15 years will bring—and remember B-E F-A-S-T!