Understanding Stroke: The Basics

May 9, 2011

As the fourth leading cause of death in the United States, stroke is a widespread problem with little public understanding. Board certified Emergency Medicine Physician Steven Pahner, MD, and board certified Neurologist John Melton, MD, shared their knowledge of the condition.

Time = Brain Damage

When it comes to stroke, every second counts,” explained Dr. Pahner. “The most common type of stroke, ischemic stroke, which represents nine out of ten cases, occurs when a blood clot obstructs a blood vessel inside the brain. Deprived of oxygen, cells in the brain begin dying within a matter of minutes. There are clot-busting drugs capable of curbing some of the damage, but they should be used within three hours of the initial onset of symptoms. Once the brain tissue has died, body parts controlled by that area can no longer function properly, leading to disability or even death.”

S. Pahner
“There is a three hour window after the onset of symptoms when we can potentially intervene with clot-busting drugs that restore blood flow to the brain. After this, much of the damage is already done and for the most part, irreversible. There is a body of research on intra-vascular treatment options such as clot retrieval that can be used after three hours, but the best chance for successful treatment still falls within that window.”

Steven Pahner, MD
Board Certified Emergency Medicine Physician
Floyd Memorial Emergency Center

J. Melton
“One of the most common misconceptions about stroke is that its symptoms are painful. With the rare exception of sudden onset of severe headache, most stroke symptoms are completely painless, which makes being able to recognize them quickly even more critical.”

John Melton, MD
Board Certified Neurologist

Diagnosis: Ischemic vs. Hemorrhagic Stroke

Ischemic and Hemorrhagic Strokes

Dr. Pahner outlined the basic differences between the two types of stroke. “Ischemic stroke is to the brain what a heart attack is to the heart. In fact, it is sometimes referred to in layman’s terms as a “brain attack.” It is commonly caused by atherosclerosis, or hardening of the arteries, which results from a build up of fat, cholesterol, calcium and other substances that leave little space for blood flow. This is known as a thrombosis. When the thrombosis clogs the already narrow passage, an ischemic stroke occurs, resulting in the death of brain cells in the area deprived of blood. It can also be caused by a blood clot that travels to the brain from another part of the body, which is a type of ischemic stroke known as an embolism.

Hemorrhagic stroke, on the other hand, occurs when a weakened artery in the brain bursts, causing bleeding within the brain that is often very difficult to manage. The weakened artery walls that are a hallmark of this condition are typically the result of uncontrolled high blood pressure or an aneurysm.”

Treatment Options

In ischemic stroke, emergency treatment typically focuses on clot-busting medication to restore blood flow to the brain as soon as possible. According to Dr. Melton, “Once the patient is stabilized, the focus then turns to preventing future strokes by treating their risk factors and untreated conditions. These include a heart condition known as atrial fibrillation that causes an increased risk of blood clots, as well as diabetes, high cholesterol and high blood pressure. Treatment typically involves a combination of prescription medications and healthy lifestyle changes such as eating better, reducing salt intake and exercising more often.”
Dr. Melton continued, “Hemorrhagic strokes, however, are far more difficult to manage and are more likely to be fatal. Treatment focuses on controlling brain bleeding and swelling, and on the reduction of high blood pressure through medication and lifestyle changes.”

Rehabilitation

“Common problems after stroke include numbness in the arms or legs, difficulty walking, talking or swallowing, vision problems and comprehension issues,” said Dr. Melton. “These typically take anywhere from three to six months to improve, and very often require various forms of rehabilitation, including speech, physical and occupational therapy. I try to help my patients and their loved ones understand that improvement will most likely come, but it will be very gradual. I like to use the acronym STP for what stroke patients need most in their recovery process- Support, Time and Prayer.”

A Variety of Outpatient and In-Home Rehabilitation Options
Floyd Memorial’s Rehabilitation Services and Home Healthcare Departments offer physical, occupational and speech therapy on an outpatient basis at a variety of convenient locations, as well as in-home options.

For more information, call Rehabilitation Services at (812) 948-7416 or Home Healthcare at (812) 948-7447.

Warning Signs of Stroke

  • Sudden change in vision
  • Sudden change in speech or speech difficulty
  • Numbness or weakness in your legs or arms, particularly on one side of the body
  • Sudden problems with walking or balance
  • Sudden onset of severe headache that is different from past headaches

F.A.S.T Test: Talk, Wave & Smile

When stroke is suspected, use the F.A.S.T. test to help pinpoint symptoms.
Face-ask for a smile. Does one side droop?
Arms-when raised, does one side drift down?
Speech-can the person repeat a simple sentence? Does he/she have trouble or slur words?
Time-time is critical, call 9-1-1 immediately if any symptoms are present.

Free Take 2 for Heart & Stroke Screening
Thursdays, May 19, June 2, July 7 and August 4, by appointment

Floyd Memorial offers free one on-one screenings with a cardiac nurse, including a full lipid cholesterol panel, blood pressure, blood sugar and body mass index. For an appointment, call 1-800-4-SOURCE or register online at www.floydmemorial.com.