Joey Wahler (Host): Strokes are among the leading
causes of death in the United States. Fleetwood Max singer, Christine McVie,
recently died after experiencing an ischemic stroke. So, we're discussing the
different types of stroke and how they're treated. Our guest, Dr. Raghu Ramaswamy.
He's a neurosurgeon for Crouse Health.

Host: This is Crouse Healthcast, a podcast from
Crouse Health. Thanks for listening. I'm Joey Wahler. Hi, Dr. Ramaswamy. Thanks
for joining us.

Dr Raghu Ramaswamy: Hey, Joey. Thanks for inviting
me.

Host: Great to have you. So first, in a nutshell,
what exactly is a stroke and how many people experience one each year?

Dr Raghu Ramaswamy: So, stroke is basically a lack of
blood supply or damage to the brain tissue for some reason which causes a
functional deficit. It's fairly common actually. If you look at it in terms of
numbers, we have about 800,000 people every year having strokes in the US. And
just to put it in perspective, that's one person having a stroke every 40
seconds. And amongst these, one person dies from a stroke every four minutes.
So, that really makes it the fifth leading cause of death in the US.

Host: So obviously, some eye-opening numbers there.
What types of strokes do you see most often and how does the aforementioned
ischemic stroke differ from the others basically?

Dr Raghu Ramaswamy: Essentially, there are two types
of stroke. The first and the most common type is called the ischemic stroke,
which happens when there is lack of blood supply to the brain for multitude of
reasons we'll go into. The other kind of stroke, it's called as a hemorrhagic
stroke, which basically is some kind of a hemorrhage within the brain or on the
surface of the brain. So, this obviously includes two further types, which is
an intracerebral hemorrhage, which is bleeding within the brain tissue and a
subarachnoid hemorrhage, which is essentially bleeding on the surface of the
brain. But ischemic strokes by far makes the largest proportion of strokes,
which is close to about 85-87% of all strokes.

Host: And the latter that you mentioned involving
hemorrhaging, et cetera, that's the most serious of the two types, yes?

Dr Raghu Ramaswamy: Well, both are equally serious.
They're serious just in different ways, that's all.

Host: Okay. Gotcha. So to quickly recognize stroke
symptoms and minimize damage or even the chance of death when one occurs,
there's an acronym called FAST, F-A-S-T. What does that stand for?

Dr Raghu Ramaswamy: When it comes to stroke,
everything is a matter of time. So even recognizing the stroke needs to happen
fairly quickly and it needs to happen FAST as in F-A-S-T, which basically F is
for facial weakness or droop. If you see someone having a droop on one side of
the face, they may be having a stroke. A is for arm or even leg weakness or
both. So if someone's having weakness on one side of the body, arm, or leg,
they can be having a stroke. S is for slurred speech. If someone's slurring
their words, they're not drunk, then they may be having a stroke. And that
leads to the last letter, T, which basically means it's time to call 911. So
essentially, this is a way to encourage people to recognize strokes fast and
act fast as well.

Host: And when you call 911, what information, if
possible, do you want to provide the personnel over the phone?

Dr Raghu Ramaswamy: Essentially, any amount of
information you can provide about the patient's basic demographic details,
starting from age, name to medical history, which can be extremely useful; the
medications they take, like if they are on any antiplatelet, anticoagulant
medications; if they have any medical issues like renal failure, cardiac
failure. All of these carry significant impact on how we have to investigate
patients, how we can treat these patients. Any allergies, these things make a
big difference as well. So, any kind of information that can be provided comes
in extremely handy when we are treating patients.

Host: How about symptoms-wise? Do they differ
depending upon the type of stroke?

Dr Raghu Ramaswamy: Well, absolutely. We have two
different compartments of circulation within the brain, wherein blood
circulates. One is the largest of the two, which is called as the anterior
circulation, which is the front of the brain. And strokes in this area have
very typical presentation as in where they typically come in with slurred
speech, facial weakness, weakness or numbness on one side of the body. That's a
very common kind of a stroke.

The other part of the circulation, the other compartment of
circulation it's called, is the posterior circulation. And strokes in this area
happen at the back of the brain. The brain stem area and strokes in this area
can be, even for trained medical personnel, very difficult to identify.
Patients with this area of stroke can come in with just confusion, nausea,
vomiting, room can be spinning. They can have trouble with vision or they can
flat right come in a coma. So, these very vague presentations are fairly common
with the posterior circulation strokes.

Host: Who's most at risk for a stroke, generally
speaking? What can people do in their own lifestyle to minimize the risk of
having one?

Dr Raghu Ramaswamy: So, some medical conditions, when
people have these, they can be extremely prone to have both strokes as well as
cardiac disease. Things like high blood pressure, high cholesterol, smoking is
extremely bad for almost everything for the body, obesity, diabetes, all of
these make people extremely prone to have vascular disease, which includes
vascular cerebral disease or vascular cardiac disease. And just controlling a
lot of these controllable or modifiable factors like reducing blood pressure,
reducing cholesterol, quitting smoking, changing the lifestyle to control
overweight or obesity, controlling blood sugars, strokes can be reduced close
to 60-70%.

Host: And when we talk about stroke risk, doctor,
what's the significance among the black population?

Dr Raghu Ramaswamy: Right. So if you look at the data
from American Heart Association, more than half of African-Americans have
hypertension. And the problem with the hypertension in African-Americans is
that it appears at a much younger age, and they're a lot more severe. And also,
they're quite resistant to treatment actually, to control. That makes them a
lot more prone to stroke. Close to 70% of African-American men and close to 80%
of African-American women are either overweight or obese. So, that again
increases their risk. They're equally prone to diabetes, smoking as well,
equally prone to stroke. So, all of these put together, they are at increased
risk of having strokes.

Host: So, some more attention-getting numbers there
to say the least. How about when medical personnel respond to a stroke? We
mentioned that FAST acronym earlier, but there's also a saying, "Time is
brain," which means what?

Dr Raghu Ramaswamy: So again, to put it in
perspective, every minute a person is having a stroke, we are losing close to
about 2 million neurons in the brain. That's a lot of brain tissue loss. So,
time is extremely important.

So when speaking of what happens at Crouse when patients are
brought in with a stroke or brought in with a suspicion of having stroke, it's
like almost everything else kind of stops and stroke patients are fast-tracked
towards treatment. So when patients come into the emergency department,
patients are very quickly assessed by the ED provider. And the CT scanner stops
doing scans on any other patients, and they are put on hold for scanning the
stroke patients. So from ED, patients are rushed very quickly to the CT scanner
for imaging. And the moment the patients arrive in Crouse Emergency Department,
there's a common pager that goes out to the whole stroke team, which includes
the neurology team, the neurosurgery team. And mid-levels from both of these
teams immediately go to either the CT scanner if the patient's in the CT
scanner already or to the ambulance bay. Patients are very quickly assessed.

If patients are candidates to receive a clot-busting drug,
either tPA or TNK, that's the newer drug, then they are given the drug
immediately after scan, which confirms there's no bleed. And following
administration of the clot-busting drug, patients undergo vascular imaging,
which tells us if there is a large vessel occlusion, as in one of the main
arteries in the brain is blocked. And if it is, patients are rushed down to the
interventional neuroradiology stroke unit where they undergo a procedure called
a mechanical thrombectomy wherein we go up with a catheter into the brain and
try and suck out the clot and open up the arteries. And essentially, we are
aiming to do the whole process between the patients coming to the emergency
department to the first time a therapeutic catheter meets the clot in less than
90 minutes. That's what we aim for. And in Crouse, we generally try and hit
between 60 to 65 minutes in fact.

Host: Well, I know that Crouse Health is a designated
comprehensive stroke center, and that designation achieved by meeting the most
stringent clinical quality requirements and recognizes the Crouse stroke team's
dedication to providing the most advanced and, as you point out, doctor, the
quickest stroke treatment available in the area. And so, you just laid out for
us in detail and did a great job with it how that all unfolds. Couple of other
things, you could probably practice at almost any hospital. Why did you choose
Crouse in the first place?

Dr Raghu Ramaswamy: Well, I trained at Crouse to
start with, and that's my fellowship. I did my fellowship at Crouse. And one
thing I noticed was physicians at Crouse are allowed to practice to the best of
patient's interests without much of interference from the administration. So,
that's hard to see. And the kind of camaraderie we have between colleagues at
Crouse, the kind of camaraderie we have between physicians and the
administration in fact, it's extremely good. So, it's a wonderful place to
practice really.

Host: Well, that's great. Let me ask you this in
summary. I know that treating the brain and treating strokes as a result can be
a very tricky business even for neurosurgeons like yourself. And so when you're
dealing with a delicate situation like a stroke attack, to say the least, for
both the patient and their family, how would you kind of summarize what the
patient care philosophy is at Crouse for you and yours when you're dealing with
stroke-affected people?

Dr Raghu Ramaswamy: Well, essentially at Crouse, we
try and do what is best for the patient. We try and do it as fast as we
possibly can do. And we do it to the best of our ability, all of us, that
includes the whole team, in fact. And we clearly mention this to our patients,
and even without mentioning, a lot of our patients notice it themselves by the
way patients are dealt with, the speed at which we kind of deal with all these
things and the compassion and care the nurses and the physicians show towards
not just the patient, but to the family as well. The family recognizes this as
well. That's essentially the simplest philosophy you need to deal with any
patients for that matter.

Host: And finally, patience, no pun intended, not
-ients, but -ience, patience is important when a stroke occurs, isn't it, for
both a patient and their loved one, because sometimes you don't know right away
what the exact prognosis is. Correct?

Dr Raghu Ramaswamy: Exactly. When stokes happen or
any kind of brain injury happens, recovery can take up to six to 12 months. So,
that is one thing I stress to both the patients and the relatives because it's
very easy during that period to get frustrated, to get disheartened. But the
important thing to remember is things can continue to improve up to six to 12
months. And the more effort they're able to put in, the more they're able to
work with physical therapy to strengthen the weakened side, the better the
outcome. So, patience is extremely important.

Host: Well, folks, we trust you are now more familiar
with strokes and their treatment, particularly at Crouse Health, where their
team does the great job that the doctor just described in detail. Dr. Raghu
Ramaswamy, thanks so much again.

Dr Raghu Ramaswamy: Thank you so much.

Host: And for more information, please visit
crouse.org/stroke. Again, crouse.org/stroke. Now, if you found this podcast
helpful, please share it on your social media. And thanks again for listening
to Crouse Healthcast, a podcast from Crouse Health. Hoping your health is good
health. I'm Joey Wahler.