Stroke Management

Someone in the United States suffers a stroke every 53 seconds.  Though not universally fatal, stroke is the third leading cause of death, and nearly 150,000 people die annually as a result of stroke.  Stroke is the leading cause of disability in the US.  About 750,000 Americans suffer a stroke each year, and there are nearly 4,400,000 stroke survivors struggling with lasting effects of their stroke at any one time in the US.

Strokes occur when blood flow to brain tissue is compromised.  This is most commonly caused by atherosclerosis.  This disease occurs in all humans to some extent, but is accelerated by certain co-morbidities (the presence of more than one health condition) or risk factors.  There are some risk factors that cannot be modified, such as age, gender, heredity and ethnicity, that have influence on the rate of progression of this disease.  There are also modifiable risk factors that create a predisposition to stroke such as high blood pressure, diabetes, high cholesterol, smoking, obesity, cardiac disease, lack of exercise and atrial fibrillation.  If these health issues are identified and treated, the risk for stroke can be greatly reduced.

Different Types of Stroke

Most strokes (>80%) are caused by blockage of a blood vessel(s) of the brain by a clot.  This results in an ISCHEMIC stroke.  The typical signs of an ischemic stroke are language difficulties, slurred speech, facial drooping or weakness, double vision, blindness in one eye, weakness or numbness on one side of the body or a sudden change in mental status.

Some patients develop signs of a stroke that resolve in minutes.  Unfortunately, these episodes are often ignored, but represent a warning of pending stroke.  These are termed “TIA’s” (transient ischemic attacks) and warn of a stroke that is about to happen in the next several weeks.  These warnings should be taken seriously.

The remaining stroke injuries, called INTRACEREBRAL HEMORRHAGE, are caused by the rupture of a brain artery causing leakage of blood, under high pressure, into the brain.  The signs of this type of injury are similar to ischemic stroke, but patients with hemorrhage often also have sudden severe headache, nausea, vomiting and alteration in their level of consciousness.

A specific subtype of hemorrhage is called SUBARACHNOID HEMORRHAGE, and is caused by rupture of an aneurysm.  An aneurysm is a pouch formed in an artery with a very thin wall.  It is this thin wall which ruptures and causes leakage of blood around the outside of the brain.  These often occur in smokers and people with high blood pressure.  The headache is quite sudden and severe, and if the aneurysmal rupture is extensive or repetitive, the risk of death is high.

Treatment of Stroke

There are many treatments available for patients with stroke.  Treatment is dependant upon the type of stroke.  Brain imaging with CT of the head, MRI scanning and/or angiography often determine the location, source and extent of the stroke.  Once understood, emergent treatment is available at certified Stroke Centers and may provide substantial benefit to patients suffering stroke injuries.

If a patient has an ischemic stroke a neurologist may offer rtPA, the “clot-buster”, which may dissolve the clot and restore blood flow to the brain, reversing the stroke injury and preventing brain injury.  This treatment is currently available to patients arriving at the hospital within 4.5 hours of onset of their stroke symptoms.

If individuals are outside the 4.5-hour window for rtPA administration, more invasive procedures are available.  In these cases, following angiography, a catheter is introduced into the arteries of the brain to remove clots and directly inject blood-thinning agents.  Though more risky than conservative treatments, in select patients the benefit greatly outweighs the risk, and stroke recovery following these interventions can be quite remarkable.

Evaluation by a neurologist in a Primary Stroke Center is essential to the treatment of stroke.  After admission and testing, the best treatment protocols are selected.  After stroke injury, rehabilitation and assessment and correction of various stroke risk factors are addressed during intense medical scrutiny. The Minneapolis Clinic of Neurology neurologists are able to provide all types of treatment for stroke victims.  They staff and attend to the emergency rooms and inpatient units of Fairview Ridges Hospital, Fairview Southdale Hospital, Mercy Hospital, North Memorial Medical Center and Unity Hospital.  They consult and advise the emergency room staff of many out-state facilities.  They are Medical Directors of two of Minnesota’s top Primary Stroke Centers, Fairview Southdale Heart, Stroke and Vascular Center and North Memorial Stroke Center, where the highest level of stroke care and technology is available to patients.

Dr. Irfan Altafullah discusses stroke signs and symptoms with Fox 9 News:

Stroke Awareness
Stroke Signs and Symptoms