Stroke

To help prevent a stroke:

• Avoid fatty foods. Follow a healthy, low-fat diet. Include several daily servings of fruits and vegetables. Adding fish to your diet at least twice a week may be helpful. However, do not eat fried fish.
• Do not drink more than 1 to 2 alcoholic drinks a day.
• Exercise regularly: 30 minutes a day if you are not overweight; 60 - 90 minutes a day if you are overweight.
• Get your blood pressure checked every 1 - 2 years, especially if high blood pressure runs in your family.
• Have your cholesterol checked. If you are at high risk for stroke, your LDL "bad" cholesterol should be lower than 100 mg/dL. Your doctor may recommend that you try to reduce your LDL cholesterol to 70 mg/dL. Few medications have been found to clear up plaque. Statins and other cholesterol-lowering drugs can help prevent more plaque from forming.
• Follow your doctor's treatment recommendations if you have high blood pressure, diabetes, high cholesterol or heart disease.
• Quit smoking.

Heart disease may be prevented with lifestyle changes including eating a heart healthy diet, getting regular exercise, and stopping smoking if you are a smoker. Follow your health care provider's recommendations for treatment and prevention of heart disease.

Know your numbers:

• Weight
• Height
• BMI
• Blood Pressure
• Blood Sugar
• Cholesterol (total, HDL, LDL)
• Triglycerides

A stroke is an interruption of the blood supply to any part of the brain. When part of the brain does not get blood flow due to a blocked or ruptured blood vessel, that part of the brain starts to die. A stroke is sometimes called a brain attack. Approximately 795,000 Americans each year suffer a new or recurrent stroke. That means, on average, a stroke occurs every 40 seconds.

The symptoms of stroke depend on which part of the brain is damaged. In some cases, a person may not even be aware that he or she has had a stroke.

Symptoms usually develop suddenly and without warning. They may be episodic (occurring and then stopping) or they may slowly get worse over time.

Stroke symptoms may include:

• Change in alertness (consciousness)
• Coma
• Decreased sensation
• Decreased vision
• Difficulty moving any body part
• Difficulty speaking or understanding others
• Difficulty swallowing
• Difficulty writing or reading
• Gets worse when you change positions or when you bend, strain, or cough
• Headache
• Lethargy
• Loss of all or part of vision
• Loss of balance
• Loss of coordination
• Loss of fine motor skills
• Movement changes, usually on only one side of the body
• Nausea or vomiting
• Numbness or tingling
• Occurs when lying flat
• Seizure
• Sensation changes, usually on only one side of the body
• Sleepiness
• Stupor
• Sudden confusion
• Unconsciousness
• Vision changes
• Wakes you up from sleep
• Weakness of any body part
• Withdrawn

What to do? Think FAST Exam

• Face: Does the face look uneven? Ask the person to smile
• Arm: Does one arm drift down? Ask the person to raise both arms
• Speech: Does their speech sound stranger? Ask the person to repeat a simple phrase, for example "The sky is blue"
• Time: If you observe any of these signs, then it's time to call 911

Stroke is a medical emergency that requires immediate treatment. Call 911 if someone is having stroke symptoms.

These tests may be performed if a stroke is suspected:

• A neurological exam may suggest increased intracranial pressure or decreased brain function. The person's specific symptoms can help tell which part of the brain is affected.
• An eye exam may show swelling of the optic nerve from pressure in the brain, or there may be changes in eye movement. Abnormal reflexes may be present.

Additional tests can help your doctor determine the type, location, and cause of the stroke and to rule out other disorders that may be responsible for the symptoms:

• An Angiogram is used to see which blood vessel is blocked or bleeding and help your doctor decide if the artery can be reopened using a thin tube.
• Carotid Duplex is a type of ultrasound that can determine if narrowing of the neck arteries (carotid stenosis) led to the stroke.
• Computed Tomography (CT Scan) provides detailed pictures showing bones, soft tissue and blood vessels.
• Computed tomography angiography (CTA) is used to determine the location and severity of a stroke and which blood vessel is blocked or bleeding.
• Computed tomography (CT) perfusion (blood flow) imaging shows which areas of the brain are supplied with blood. Combining a series of x-rays, the CT scan provides a detailed image of the brain which shows blockages and bleeding. This test can help to diagnose stroke as well as brain tumors and other disorders.
• Electrocardiogram (EKG) may help diagnose underlying heart disorders. An electrocardiogram is a test that measures the electrical activity of the heart. The electrocardiogram is used extensively in the diagnosis of heart disease, from congenital heart disease in infants to myocardial infarction and myocarditis in adults.
• An Echocardiogram determines if the stroke may have been caused by a blood clot from the heart, using sound waves to create a moving picture of the heart. The picture is much more detailed than a plain x-ray image and involves no radiation exposure.
• Magnetic Resonance Imaging (MRI) uses powerful magnets and radio frequency pulses to create images of organs and soft body tissue. This study can show the structure of the brain and how it is working. Functional MRI measures changes in blood flow with brain activity, which can help physicians evaluate the effects of stroke or other disease.
• Magnetic Resonance Angiogram (MRA), is a medical test that uses a powerful magnet, radio waves and a computer to create pictures of blood vessels, helping to determine the location and severity of the stroke and which blood vessel is blocked or bleeding. The MRA of the head and neck helps the physician evaluate a patient for a stroke or aneurysm (weakness and bulging in an artery), a tumor, and can help identify reasons for memory loss.
• Transesophageal Echocardiography (TEE)  provides detailed images of the heart's structure, and if you have a stroke, this test helps your physician to check for blood clots in the chambers of your heart.

When stroke happens, seconds count. Every minute the brain lacks blood flow 1.9 million neurons (brain cells) are lost. Fortunately, we offer highly specialized expertise and advanced stroke treatment options.

Hemorrhagic Stroke

For hemorrhagic stroke, surgery is often required to remove pooled blood from the brain and to repair damaged blood vessels. The type of surgery depends upon the specific cause of brain bleeding.

One common problem related to brain bleeding is hydrocephalus, which is the build-up of fluid within the brain. A procedure called ventriculostomy may be needed to drain the fluid.

Treatment for Ischemic Stroke

Thrombolytics, such as tPA, may be given if the stroke is caused by a blood clot. Such medicine breaks up blood clots and helps restore blood flow to the damaged area. Thrombolytics are not given to someone who is having a hemorrhagic stroke. They could worsen the stroke by causing increased bleeding.

The most important rule is to be examined and treated by a specialized stroke team within 3 hours of when your symptoms start. If the stroke is caused by bleeding rather than clotting, thrombolytics can make the damage worse -- so care is needed to diagnose the cause before giving treatment.

The decision to give the drug is based upon:

• A brain CT scan to make sure there is no bleeding
• A physical exam that shows a significant stroke
• Your medical history

In other circumstances, blood thinners such as heparin and Coumadin are used to treat strokes due to blood clots. Aspirin may also be used. Other medications may be needed to control other symptoms, including high blood pressure. Painkillers may be given to control severe headache.

Intra-Arterial Thrombectomy (IAT)

Revolutionary Stroke Treatment, Close to Home

Our innovative approach takes stroke care to another level by providing access to advanced stroke treatment not typically offered in a suburban hospital setting. Intra-Arterial Thrombectomy (IAT), commonly referred to as clot retrieval, is clinically shown to be a highly effective treatment for large artery occlusive stroke; improving outcomes and restoring a patient's quality of life.

IAT is the retrieval and removal of a clot blocking the blood flow to an artery. Upon arrival to the emergency room, you will typically be administered an intravenous dose of the clot-busting medication tissue plasminogen activator (tPA). If you do not respond to tPA, they are taken to the catheterization for the IAT procedure.

Not available at all hospitals, IAT is a breakthrough in the treatment of stroke. Our Interventional Cardiologists offer this advanced nonsurgical, catheter-based innovation to diagnose and treat blocked large vessels.

• IAT improves patient outcomes for large vessel blockages by eliminating the transfer time to another facility.
• Recent international clinical trials have demonstrated that stent retrievers (IAT), in conjunction with intravenous tPA, give patients with large vessel blockages better outcomes.
• IAT increases the likelihood of independence after recovery and a quicker return to day-to-day activity a patient experience prior the stroke.

Carotid Artery Surgery

Carotid artery surgery is a procedure to restore proper blood flow to the brain. The build-up of plaque in the inner layer of the wall of an artery may lead to narrowing and irregularity. Where the narrowing is severe, there is a risk that the vessel can block completely if a thrombus (blood clot) forms in the diseased segment.

There are two ways to treat a carotid artery that has plaque buildup in it. One is surgery called endarterectomy. The other is a procedure called angioplasty with stent placement.

Carotid artery surgery may help lower your chance of having a stroke. But you will need to make lifestyle changes to help prevent plaque buildup, blood clots, and other problems in your carotid arteries over time. You may need to change your diet and start an exercise program, if your doctor tells you exercise is safe for you.

Doylestown Health Stroke Services offers advanced care to help limit the damage caused by a stroke. Our team of stroke experts includes Emergency Department physicians, interventional cardiologists, neurologists, radiologists, lab and pharmacy.

How the Stroke Team Responds in an Emergency

• When a call is made to 911, emergency personnel are trained to assess potential stroke. First responders notify our Emergency Department of a suspected stroke victim and the acute stroke team is put on alert.
• At the Emergency Department, the stroke team confirms whether you are experiencing a stroke or another medical emergency. A brain scan checks for bleeding.
• If a stroke is confirmed, and it has been three hours or less since the first symptoms appeared, you may be treated with a clot-busting drug called tPA. Strict criteria apply and not all stroke patients are eligible.
• Different treatment is recommended if you are not eligible for tPA. Through a clinical partnership with Jefferson University Hospital, if you could benefit from advanced neurosurgical interventions, you can be immediately transported via helicopter to Philadelphia for treatment.
• If needed, you will be admitted to in an inpatient unit with nurses specifically trained in stroke care.
• Following a stroke, other hospital services may be recommended, including occupational, speech, and physical therapies.
• Social workers will help you and your family assess your needs after discharge.
• Monthly support group meetings are available to assist you and your family during recovery and beyond.

• American Stroke Association
• Children's Hemiplegia and Stroke Association
• Joint Commission
• National Stroke Association

Long-Term Stroke Treatment and Rehabilitation

The goal of long-term treatment is to help the patient recover as much function as possible and prevent future strokes. The recovery time and need for long-term treatment differs from person to person. Depending on the symptoms, rehabilitation may include:

• Occupational therapy
• Physical therapy
• Speech therapy

Family counseling may help in coping with the changes required for home care. Visiting nurses or aides, volunteer services, homemakers, adult protective services, and other community resources may be helpful.

Legal advice may be appropriate. Advance directives, power of attorney, and other legal actions may make it easier to make ethical decisions regarding the care of a person who has had a stroke.