Monday, August 16, 2010

Brain Attack (Stroke)

The following article was written by staff from Wilkes-Barre General Hospital.

As a 40-year-old occupational therapist and mother of two sons, Deborah Roszkowski knows what it’s like to live a busy, sometimes hectic life. Little did she know that one sunny Memorial Day weekend in 2001, her life was about to change drastically.

Twelve hours after a routine day of caring for her family and visiting a patient at home, Deborah awoke in Wilkes-Barre General Hospital’s Intensive Care Unit, on a ventilator, paralyzed, and unable to speak. Deborah had suffered a stroke and a condition called “Locked-In Syndrome.” (The award-winning movie, The Diving Bell and the Butterfly tells the story of one patient with this condition.) After three weeks of acute care at the hospital, Deborah was transferred to The John Heinz Institute of Rehabilitation Medicine unable to see, speak, or swallow. She was being fed through a tube.

According to Dr. Sanjeev Garg, a board certified neurologist and Medical Director of the Stroke Center at Wilkes-Barre General Hospital, “A stroke, no matter how small, can change a person’s life forever. It can leave the victim with moderate to severe physical, mental or psychological disabilities, and may cause the victim to lose their memory, speech, balance, certain fine motor skills, control over certain muscles or movement of entire limbs-even paralysis of one side of the body. A person’s personality or behavior can be forever changed by a stroke. They may also have difficulty reading, processing information or eating without assistance.”

Deborah was fortunate. Gradually her speech and eyesight returned and she no longer needed a feeding tube. After just two and a half months, she was able to return home in a wheelchair, able to walk a few steps with assistance. Deborah now drives with adaptive equipment, eats a normal diet, and can speak loud enough for others to hear her.

A stroke, also known as a “brain attack,” is a medical emergency. Strokes occur when the brain doesn’t get enough blood, either when a blood clot or other particle blocks an artery supplying the brain, or when there is bleeding in the arteries in or around the brain. Almost anyone can have a stroke, but adults over 40 are the most frequent victims and people with heart disease have the highest risk. The Centers for Disease Control ranks stroke as the third highest cause of death in the U.S. and it is a leading cause of serious, long-term disability. The statistics for Northeastern Pennsylvania are significantly higher in cardiovascular and heart diseases than the state average, so the risk of stroke is higher.

The American Stroke Association and the American Heart Association have begun the ACT F.A.S.T! campaign to help recognize when someone is having a stroke. F.A.S.T. stands for face, arms, speech, and time. If someone is suffering a stroke, their face can droop on one side and they might have an uneven smile. They could have arm numbness or weakness on one side of their body. Their speech can be slurred and they can have difficulty speaking or understanding. If someone has these symptoms, the T in F.A.S.T! stresses that time is of the essence. Call 911 and get that person immediately to a hospital, preferably one with a certified stroke center. Seconds can make an enormous difference in the outcome for a stroke survivor.

Diane Kane, Program Coordinator of the Stroke Center at Wilkes-Barre General Hospital says, “There are new medications and medical procedures that may be able to minimize or sometimes eliminate the effects of a stroke, but these treatments must be started within the first three hours, and in a very select group, 4 ½ hours of having symptoms.” Tissue plasminogen activator or tPA is a clot-busting drug that can minimize the effects of some strokes, but it must be given within a short timeframe after symptoms start to be effective. The MERCI retriever is a mechanical tool that removes blood clots from the brain. Two physicians at Wilkes-Barre General Hospital are certified to do procedures using this tool, Dr. Akash Agarwal, an endovascular neurosurgeon, and Dr. Satish Patel, and interventional radiologist. The Stroke Center at Wilkes-Barre General Hospital is the only hospital locally to offer this procedure. Dr. Agarwal explains, “Mechanical removal of a clot can widen the opportunities for treatment in acute stroke patients and improve patient outcomes.” Dr. Patel adds, “These therapies come with their own risks. The staff at the Stroke Center are highly trained to determine the best treatment for each individual who presents with a stroke. “

Image from CDC website

Kane states, “We are the only Joint Commission certified Primary Stroke Center in the area. We must adhere to strict standards and criteria in treating stroke victims. Even with all the tools at our disposal, none of them work unless patients arrive quickly to the hospital.” She adds that in 2008 the Stroke Center had 74 “code purples,” the emergency announcement used for stroke. Of those 74, only 5 patients met the strict eligibility criteria for giving tPA. In 2009 the Center had 144 code purples and 25 patients met the criteria. Kane says, “We went from about 7% to 17%. That means we’re improving in getting the word out to people that they must arrive within a three hour timeframe to be considered for that type of therapy, but we still have a long way to go.”

A TIA or transient ischemic attack is sometimes called a mini stroke, but it is really a warning. It is caused by a clot blocking blood to the brain for a short time, but it doesn’t cause permanent damage or leave lasting effects. However, 15% of those who have had a TIA go on to have a full stroke. A TIA has the same symptoms as a full-blown stroke and should not be ignored.

“In medical terms strokes are called cerebrovascular accidents, but they are not accidents. There are ways to prevent them,” states Kane. The major risk factors for stroke are high blood pressure, high cholesterol, heart disease, diabetes, smoking, heavy alcohol use, physical inactivity and obesity, atrial fibrillation, and family history. “Maintaining a normal weight, eating a balanced diet, exercising, cutting back on alcohol, and stop smoking are things everyone should be doing,” says Kane. She also says that if you already have a risk factor, you should continue with the treatment recommended by your physician. “And if you see someone with stroke symptoms, remember to ACT F.A.S.T!”

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