Scott Webb (Host): There's a saying in medicine that time is brain, which means the sooner we're treated if we're having a stroke, the more likely that we and our brains will survive. And I'm joined today by Dr. Bryan Bjornstad. He's a neurologist with Genesis, and he's going to tell us about the different types, signs and symptoms and treatment options for stroke.

Host: This is Sounds of Good Health with Genesis, brought to you by Genesis Healthcare System. I'm Scott Webb. Doctor, thanks so much for your time today. We're going to talk about stroke, different types of stroke, latest treatment options, and so on. So, just a little baseline for listeners here, what is a stroke? What happens?

Dr. Bryan Bjornstad: So, a stroke is when an artery that supplies the brain becomes occluded or blocked, and that deprives that region of the brain from its blood supply. So depending on which portion of the brain loses its blood supply, that can affect the types of symptoms that you may have.

Host: Yeah. And I was just mentioning to you that I've hosted a number of stroke podcasts. But from your perspective and your expertise, there's different types of strokes and maybe you could take us through the different types that folks might experience.

Dr. Bryan Bjornstad: Strokes are typically classified by the mechanism in which they occur. So, ischemic strokes are when an artery becomes blocked off, and the brain loses that part of its blood supply. And that might occur either because there was atherosclerotic plaque that build up within the artery and gradually pinched off and blocked the blood supply. Or it may be an embolic stroke, meaning a clot may have come from somewhere else, traveled down through the bloodstream and landed in one of the arteries going to the brain. There are also what's known as hemorrhagic strokes, which at least from our standpoint, from neurology, we typically think of that as maybe an ischemic stroke that had hemorrhagic transformation, so it lost its blood supply, and then maybe the vessels were damaged and there's bleeding on top of the stroke. There are other types of hemorrhages that can occur within the brain, but they're kind of in a separate category.

Host: Yeah. And I know the old expression, time is heart, time is brain. So for our purposes today, time is brain and recognizing the signs and symptoms is really important in being treated as quickly as possible, right. Within just a few minutes, ideally. So, maybe you can just talk a little bit about the signs and symptoms, the sort of classic signs and symptoms of stroke.

Dr. Bryan Bjornstad: Well, a stroke is when you have sudden onset of a neurologic deficit. And that could be numbness, tingling, weakness, speech dysfunction, visual dysfunction, language dysfunction, whether it's comprehension or expression. But there are strokes that can also be silent. So just like most people have heard of silent heart attacks, they could also have silent strokes. So, sometimes we'll see a brain scan and we can see that someone has had a stroke before and they never had any symptoms whatsoever.

Host: Yeah, I've had some personal experience in my family where someone had a stroke and sort of didn't realize they were having a stroke and maybe it was one of the mini strokes they call them or a TIA. Maybe you could explain that a little bit. What's the difference between a mini stroke and, I don't know, a big stroke, an actual stroke?

Dr. Bryan Bjornstad: Well, I think when people use the term mini-stroke, it's a bit confusing. So, I'm trying to eliminate that from the vocabulary if possible.

Host: Yeah. Fighting the good fight. I hear you.

Dr. Bryan Bjornstad: Sure. A stroke is when an artery becomes blocked off, the brain loses its blood supply and a scar tissue forms that the scar tissue stays there forever and you may or may not have symptoms. And so, that stroke in and of itself might have been a minor or a small stroke, or it could have been a larger major stroke. On the flip side of that, TIA stands for transient ischemic attack, so that's where there's a temporary blockage in one of the arteries, but then the artery opens back up and it goes back to normal. Like you go back to normal, the brain goes back to normal and everything is fine. So, it gets a little confusing when people are using the term mini stroke because it's not clear whether they mean TIA or a minor stroke. So, we just say either they had stroke or TIA.

Host: Yeah, I see what you mean. Like I said, fighting the good fight. And not being a doctor, not being an expert like yourself, it seems to me that no stroke is good. So, recognizing the signs and symptoms, being treated as soon as possible is key. So, what would be your recommendations if someone believes they or someone nearby is having a stroke?

Dr. Bryan Bjornstad: We'd like them to call 911 immediately and try to get to the hospital as soon as possible because, as you mentioned earlier, time is brain. So, the sooner you can get to the hospital, the more options are available to you in terms of emergency treatment, which could end up in a better outcome in the future.

Host: Yeah, we really don't want people driving themselves, obviously. I mean, if you're at home or if it's a loved one, obviously call 911. They can start treatment immediately, notify the stroke team that you're on the way, you know, all that stuff. So, let's talk about the latest in treatment options, the different types of strokes and what you're doing to help folks.

Dr. Bryan Bjornstad: Well, that's one of the reasons that time is of the essence because we have emergency treatments available within a certain timeframe, that if people get to the hospital and are evaluated and they qualify for these treatments, that they could be candidates for that. So, one is medication that we call tPA, which is a type of clot-busting agent where a medication is administered into the vein and can potentially dissolve the clots and lead to a better long-term outcome. With an extended timeframe, even up to 24 hours, sometimes people might be a candidate for interventional treatment where a specialist would go inside the vessels and either try to open up the vessel itself or remove the clot from the vessel.

Host: Yeah. Doctors and nurses are patients too. But we as patients, we like to know that there's options and, you know, I think for most things, it seems like if we could prevent them, that would be best. So as we finish up here, what would be your best advice on how folks can prevent strokes? Whether that's taking their statins, quitting smoking, whatever it might be, what's your best advice?

Dr. Bryan Bjornstad: Well, from a personal standpoint, people can try to avoid tobacco use and not just cigarettes, but even smokeless tobacco. And also, keep a close eye on stroke risk factors with their primary care doctor, like blood pressure, blood sugar, cholesterol, those types of things that they typically monitor along with their primary care provider.

There are a number of different medications that are available. One class of medications is called antiplatelet medications, and that includes aspirin and Plavix. And then there are also older anticoagulants like Coumadin that we'll sometimes use, but there have been a newer generation of blood thinners as well that have come out that are kind of in that anticoagulation category like Coumadin, but just with a different mechanism. So, we try to take into account the entire picture and how the patient is presenting and what abnormalities we find on the testing and try to give them the best recommendation that we can in terms of whether it's aspirin, Plavix or some other blood thinner.

Host: Yeah. And in all cases, obviously quit smoking if you're smoking. Smoking is never good. I never have an expert on here to say, "Yeah, smoking's fine." So, absolutely knowing your risk factors, quitting smoking, taking your medications, calling 911 if you have these sort of emergent symptoms and so on. So, doctor, thanks so much for your time today. You stay well.

Dr. Bryan Bjornstad: Okay. You're welcome. Have a great day.

Host: And for more information, go to genesishcs.org and search stroke care services. And thanks for listening to Sounds of Good Health with Genesis, brought to you by Genesis Healthcare System. If you found this podcast to be helpful, please be sure to tell a friend and subscribe, rate and review this podcast and check out the entire podcast library for additional topics of interest. I'm Scott Webb. Stay well.