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Health Matters: Providence St. Mary Medical Center | 5 E very year in the United States, a whopping 795,000 people have a stroke. Also called a "brain attack," stroke is a medical emergency that occurs when blood flow to an area of the brain is cut off. As a result, brain cells die, and if it is not caught early, the stroke may result in permanent brain damage or death. Although this common neurological condition may not always be prevented, minimizing certain risk factors can help prevent a stroke from occurring. Recent advances have led to the development of highly effective tools that can minimize the damage from stroke. We asked Sonia Nayyar, MD, a neurologist at Providence St. Mary Medical Center Stroke Center, to describe the recent advances in stroke prevention and treatment, as well as strategies employed at Providence St. Mary to improve patient outcomes. Dr. Nayyar attended medical school at George Washington University in Washington, D.C.; completed her neurology residency at SUNY Upstate Medical University in Syracuse, New York; and completed her neuromuscular/EMG fellowship at the University of California, Irvine. How did you become interested in stroke? During my neurology residency, the number of patients that had strokes on a daily basis was unbelievable—and that was at a single hospital in New York. Magnify that to a global scale and the number of strokes was overwhelming. When I found out that among those who survive stroke, more than half of them have a moderate to severe disability, I knew that there was more to be done. It became evident how important not only primary prevention of stroke was, but the acute treatment options that we have available as well. What are some of the advances in treating stroke? There are several reasons for strokes, but they are usually grouped into two categories. Ischemic strokes, which are more common, are caused by clots in arteries of the brain. Hemorrhagic strokes, which are less common, are caused by bleeding in the brain. If a patient can get to a hospital quickly, there are medications available that can help dissolve the stroke. Patients also may be eligible for a thrombectomy, during which a surgeon navigates a catheter into the arteries of the brain and pulls out the clot. Both methods try to return blood flow to the brain. Can you explain why people need to get to the hospital right away when they are having a stroke? All these medications and interventions are time-sensitive. Typically, if you present to the hospital within three to four hours of symptoms starting, you may qualify for these medications. "Time is brain" in these situations, and the faster you get to the hospital, the more likely you are to save your brain. Why are people reluctant to call 911 with stroke symptoms? Sometimes the symptoms of the stroke may not seem devastating. For example, a patient may have one-sided tingling or numbness that they think is the result of sleeping on their arm wrong. Or they may have some speech issues that they think are caused by starting new medications. Some of the symptoms of stroke can be very subtle. Are there risk factors for stroke and strategies to prevent stroke? This is a huge part of stroke prevention. Primary prevention is the most important factor. Here's why: because if we prevent a stroke from happening, we prevent possible brain damage from occurring. That said, there are many risk factors for stroke—ones we can control and others we cannot control. We, unfortunately, cannot control some risk factors such as our age, gender or genetic risk. Hypertension, diabetes mellitus, atrial fibrillation (irregular heartbeat), hyperlipidemia (cholesterol issues) and heart disease are all risk factors we can change. Smoking increases your risk greatly, so stopping smoking is extremely helpful. An inactive lifestyle is also a common theme in America. Physical activity or exercise can be protective against stroke. We usually recommend 30 minutes of exercise per day, three to four times per week. Providence St. Mary is the only primary stroke center and stroke receiving center in the High Desert. What does this designation mean for the community? A stroke center is a hospital that has experts who are trained to recognize and treat strokes. Providence St. Mary has tele-stroke, which allows for a stroke neurologist to be immediately available at the bedside if needed. If a thrombectomy is needed, a patient is transferred to a larger center where a neurosurgeon can decide if intervention is needed. When patients have damage after a stroke, can they still get better and regain function? Rehabilitation is a very important part of stroke recovery for patients who may have the most subtle of symptoms or the most drastic. Our brains are quite remarkable in their ability to change and modify after a stroke. Physical therapy and occupational therapy are vital parts of stroke rehabilitation. St. Mary High Desert Medical Group contracts with the Pacific Dermatology Institute. Visit pacdermatology.com for more information about their services. STROKE IS AN EMERGENCY Doctors employ several tools to treat stroke and minimize any long- term effects. These treatments, however, often depend on patients or family members recognizing stroke symptoms when they present themselves and quickly calling for help. For help with recognition, remember the F.A.S.T. acronym: Face: One side of the face is drooping or numb. Arm: One side of the body is hanging, numb, weak or not working properly. Speech: The person cannot speak, or speech is hard to understand. Time: Time is brain. Call 911 and get to a hospital immediately. Check the time so you can tell doctors when the symptoms first appeared.

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