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Strokes are the fifth-leading cause of death in the U.S. and a major cause of long-term disability.
There are two main types of stroke: ischemic stroke (caused by a blood clot) and hemorrhagic stroke (caused by bleeding in the brain).
Providence vascular neurologist Dr. Srinivas weighs in on common questions related to signs of stroke, treatment and the importance of continued care after discharge.
Chances are, you know someone who has experienced a stroke. According to the Centers for Disease Control and Prevention, every 40 seconds, someone in the United States has a stroke. Strokes are the fifth-leading cause of death in the U.S. and a major cause of long-term disability.
“Strokes are medical emergencies that require immediate attention,” says Meghana Srinivas, M.D., a vascular neurologist at Providence Stroke and Cognitive Care Center. “Fortunately, strokes are also a condition that can be recognized and, with timely medical intervention, treated.”
There’s so much to know when it comes to strokes. Dr. Srinivas joins us to answer some common questions related to stroke, including signs and symptoms, what to look for in a stroke program and why treatment should continue after discharge.
What is a stroke?
Strokes occur when there is a disruption of the blood supply to the brain. The lack of blood flow to the brain from a stroke deprives brain cells of oxygen, leading to cell damage and death. The two main types of strokes are:
- Ischemic stroke: Occurs when a blood clot or plaque blocks a blood vessel in the brain, reducing or cutting off blood flow. Ischemic strokes are the most common type of stroke, accounting for around 87% of cases.
- Hemorrhagic stroke: Often occurring in patients with longstanding hypertension, these strokes happen when a blood vessel in the brain ruptures or leaks, causing bleeding into the surrounding brain tissue.
In addition to these two, people can also experience a transient ischemic attack (TIA), also known as a “mini-stroke.” TIA is a temporary interruption of blood flow to the brain that causes stroke symptoms but typically does not last as long and does not cause permanent damage.
“TIAs should be taken seriously as they can be a warning sign of stroke in the future,” Dr. Srinivas explains.
Is there a connection between atrial fibrillation and stroke?
Atrial fibrillation (AF) is a significant risk factor for stroke, as patients with AF have an estimated five-fold increase in stroke risk. AF is a common type of irregular heart rhythm in the upper chambers of the heart (atria) that can lead to ineffective pumping of blood. This blood can pool and form clots within the atria. For patients with AF, factors like age and sex, along with history of stroke, hypertension, diabetes, congestive heart failure and vascular disease can all affect the likelihood of stroke.
The American Heart Association and American College of Cardiology recommend anticoagulants (blood thinners) for most patients with AF with high-risk factors. These medications help prevent blood clots from forming and reduce the chances of a clot reaching the brain and causing a stroke.
“It’s important for individuals with atrial fibrillation to work closely with their health care providers to manage their condition,” says Dr. Srinivas. “Regular medical check-ups, adherence to prescribed medications and lifestyle modifications can help reduce the risk of stroke and improve overall heart health.”
What are the signs and symptoms of a stroke?
Strokes can cause a variety of symptoms depending on the area of the brain affected, but common signs to look out for include:
- Difficulty with coordination and balance: Stroke can affect patients’ movement, including their ability to walk, leading to dizziness or loss of balance.
- Facial drooping: One side of the face may droop or feel numb, causing a lopsided smile or an inability to control facial movements.
- Severe headache: A sudden and severe headache, which may be accompanied by dizziness or vomiting, can be a sign of a stroke.
- Sudden weakness or numbness: Typically occurs on one side of the body and can affect the face, arm or leg. Patients may have difficulty moving or lose feeling in these areas.
- Trouble speaking or understanding speech: A stroke can cause sudden difficulty speaking, slurred speech or difficulty understanding.
- Vision problems: Patients may experience sudden blurred or decreased vision, double vision, or a loss of vision in one or both eyes.
These signs can be summed in a helpful acronym, B.E.F.A.S.T.:
- Balance: Has the person suddenly lost their balance or coordination?
- Eyes: Is the person experiencing blurred or decreased vision, or double vision?
- Face: When the person smiles, does one side of their face droop?
- Arm: Ask the person to raise both arms. Does one arm drift downward or not move at all?
- Speech: Is the person’s speech slurred or strange?
- Time: If you observe any of these signs of stroke, it's essential to call emergency services immediately. Time is critical for stroke treatment.
“The symptoms of a stroke can vary but remembering the B.E.F.A.S.T. acronym can help you quickly identify potential stroke symptoms and take appropriate action by seeking emergency medical attention,” says Dr. Srinivas. “If someone experiences these symptoms, it is crucial to seek immediate medical attention by calling emergency services. Quick medical intervention is vital to minimize brain damage and improve the chances of recovery.”
I think someone is having a stroke. What should I do?
If you see someone experiencing stroke symptoms, don’t wait – call 911 immediately. Time is of the essence when it comes to treating stroke patients.
"Unfortunately, there’s nothing bystanders can do on-site to support stroke patients,” says Dr. Srinivas. “The most important thing you can do if you witness a stroke is call 911 without further delay. Don’t second guess yourself.”
What should I look for in a stroke program?
Providence is proud to offer an all-encompassing stroke program to support patients and our community. Our program provides community support to identify and prevent strokes, emergency support to treat strokes quickly, and outpatient clinics to empower patients’ rehabilitation.
"A successful stroke program encompasses several key factors that contribute to optimal patient outcomes,” says Dr. Srinivas. Some of the factors that contribute to successful stroke programs, like that at Providence, include:
- Community engagement to raise awareness about stroke symptoms, risk factors and the importance of early intervention.
- Comprehensive stroke education for health care professionals, patients and the community on stroke recognition and prevention.
- Data collection and research, which allows for ongoing research and continuous improvement, to identify trends, patterns and areas for further research and development.
- Multidisciplinary team collaboration, including emergency medicine physicians, neurologists, neurosurgeons, interventional radiologists, nurses, rehabilitation specialists and pharmacists.
- Quality improvement initiatives, to monitor key performance metrics, track adherence to guidelines and participate in benchmarking programs to enhance the overall quality of stroke care.
- Rapid and efficient emergency response, including a well-coordinated emergency medical services (EMS) system and ensuring rapid transportation of patients to stroke centers.
- Specialized stroke centers, equipped with specialized resources, including stroke units that can provide life-saving diagnostic services and interventions.
- Standardized, evidence-based protocols and guidelines that cover stroke assessment, diagnostic evaluations, treatment strategies and secondary prevention measures.
Is after-care necessary following a stroke?
While immediate intervention is imperative for effective stroke treatment, it is just the first step. As one of the leading causes of long-term disability, effective stroke care doesn’t stop when the patient leaves the emergency department.
The Providence Stroke and Cognitive Care Center is equipped to see patients following discharge from the hospital or from community referrals. The center is one of the only outpatient stroke clinics serving eastern Washington, Idaho and Montana. The clinic supports outpatients by:
- Continuing secondary stroke prevention by making sure risk factors are under control
- Evaluating patients more closely to ensure rehab is going well
- Having more uninterrupted one-on-one time with patients and their families to answer their questions and help them through their recovery.
“It’s so important for stroke patients to have follow-up with a stroke specialist,” says Dr. Srinivas. “This field is an evolving one and we need to stay close to patients to provide them the latest, proven care to improve their outcomes.”
Stroke awareness series
This is part two of a two-part series promoting stroke awareness. Read part one here.
Meghana Srinivas, M.D., is a vascular neurologist at Providence Stroke and Cognitive Care Center.
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