Prime Time Living - Page 22 - Stroke from page 4

Prime Time Living
- Page 22
Stroke from page 4
like a stroke but it lasts a short time, less than 24 hours. The danger with a TIA is that those who have one think they dodged a bullet. Instead, they should appreciate that they were warned and get checked out immediately. “The risk of stroke within 90 days of a TIA,” says the Centers for Disease Control and Prevention, may be as high as 17%, with the greatest risk during the first week.

Recognizing the Symptoms FAST

If you’re having a stroke, it’s usually sudden as are the symptoms. The American Stroke Association (www.strokeassociation. org) promotes the mnemonic FAST to help you recognize these symptoms that occur suddenly: Face drooping: One side of the face may sag, or a smile is lopsided. Is one side numb?

Arm weakness: Is one side weak? Ask the person to hold out his/her arms. Does one drift downward?

Speech: Is speech slurred? Is there confusion?

Can the person say a simple sentence?

Time to call 9-1-1

According to the American Association of Neurological Surgeons (AANS), additional symptoms – warning signs – could also include any or all of the following if they happen suddenly:

•Confusion, disorientation

•Dizziness, nausea or vomiting

•Unusually severe headache

•Difficulty with comprehension

•Loss of vision or difficulty seeing

•Loss of balance

The Process

Once 9-1-1 is called, there are a series of actions that take place to treat a stroke. In Maryland, Emergency Medical Services (EMS) are part of a statewide system (see article on page 6). EMTs (emergency medical technicians and paramedics) are specially trained to identify signs of a stroke and to take you to a primary stroke center, a comprehensive stroke center or a thrombectomycapable stroke center. They call ahead, pre-notifying the venue so that you are taken directly to be assessed. In some cases, addressing the stroke starts while you’re being transported.

Evaluation

The first determination is on the type of stroke – ischemic or hemorrhagic. Once you arrive at the hospital, you’ll immediately have a CT scan or an MRI.

The ambulance took Baranoski to GBMC, a primary stroke center. She’d had an ischemic stroke, with a large clot in one branch of her carotid artery and several smaller clots in her arteries and veins. Once the team at GBMC saw this, they immediately transferred her to Sinai Hospital, the first Thrombectomy-Capable Stroke Center (TSC) in Maryland. TSCs meet rigorous standards for performing an endovascular thrombectomy (EVT), a specialized surgical procedure used to remove a blood clot from the brain during an ischemic stroke.

“It’s all about doing the right thing for the patient,” says Dr. Ashley. “Sinai Hospital is the first primary stroke center in the area to use RAPID (www.i-rapid. com), an advanced imaging program that sends images from a CT scan or MRI directly to our smartphones. In minutes, these images show what is happening in the brain in real time so we can see how much of the brain is affected, what areas are dead, what areas are at risk and what can be saved, where and how big the clot.

The window for treatment used to be six hours, not enough time to help those who woke up with a stroke or live far from a stroke center. For many, that window has been extended to 24 hours, meaning it’s better for patients.”

Treatment

Once the determinations have been made, one of two treatments will occur: an operation or a medication. “A patient may be transported to an operating room so that a mechanical device can be inserted into the artery or vein,” says Dr. Chin, “to remove the clot or we’ll put in a stent, a tube to keep the artery or vein open.

It’s dependent on the patient’s anatomy. Sometimes we’ll seal the artery so plaque doesn’t go into the brain. New surgical techniques are less invasive, meaning faster recovery.”

The medical treatment is giving a thrombolytic – a medicine that dissolves clots – called tPA by intravenous therapy.

It’s the only medication approved by the U.S. Food and Drug Administration. Other medications may be given to reduce cholesterol, blood thinners to prevent clotting, or something to control blood pressure.

With a hemorrhagic stroke, tPA cannot be used. “Hemorrhagic stroke usually requires surgery to relieve intracranial (within the skull) pressure caused by bleeding.

Surgical treatment for hemorrhagic stroke caused by an aneurysm or defective blood vessel can prevent additional strokes. Surgery may be performed to seal off the defective blood vessel and redirect blood flow to other vessels that supply blood to the same region of the brain,” according to AANS.

By the time McCreary arrived at Sinai and found the emergency department, her mother was already with the neurological unit, undergoing a thrombectomy to remove the large clot near her brain. The doctor came out and reported it went well and they were lucky because they got the big clot. “He used a tree analogy to describe what was happening. The big clot was in the trunk of the tree; now they would wait to see how the brain received the blood flow and was re-oxygenated. Then they’d deal with the smaller clots in the ‘branches.’ ‘On a scale of one to seven,’ he told us, ‘mom was a three or four.’”

Recovery

After a stroke, recovery is extremely important, especially if there’s been a loss of mobility or speech. “The body is plastic enough to reroute and restructure the brain,” Dr. Ashley says. “We see people who make a complete recovery even though the brain has a hole in it. Physical,