Selected Podcast
Suspect a Stroke? What To Do Next
Dr. Iraj Nikfarjam shares the important warning signs of a stroke, what the acronym F.A.S.T stands for, and what to do if you suspect you or your loved one has suffered a stroke.
Featuring:
Learn more about Iraj Nikfarjam, MD
Iraj Nikfarjam, MD
Iraj Nikfarjam, MD is a Interventional Neurologist at Ocala Regional Medical Center's Comprehensive Stroke Center.Learn more about Iraj Nikfarjam, MD
Transcription:
Prakash Chandran (Host): Time is of the absolute essence if you or a loved one has a stroke. But what should you do in the event that one happens and what can you expect once you arrive at the emergency room? Let’s talk about it with Dr. Iraj Nikfarjam, an Interventional Neurologist and Medical Director of the Comprehensive Stroke Program at Ocala Regional Medical Center.
This is Helmet of Health, the podcast from Ocala Health. I’m Prakash Chandran. And first of all, Dr. Nikfarjam, what exactly is a stroke?
Iraj Nikfarjam, MD (Guest): First of all, thank you for having me here. A stroke basically is an emergency neurological condition and occurs when one of the arteries gets occluded in the brain and subsequently, the brain cells start dying very fast.
Host: Okay, so how do you know when you or someone else is having a stroke? Like what are some of the symptoms?
Dr. Nikfarjam: The stroke can manifest in a variety of symptoms, but the most frequent ones are basically facial asymmetry, speech difficulty that is characterized by slurring their words or not being able to get their words out and having numbness or tingling on one side of the body or having arm or leg weakness on one side. These are the most frequent signs and symptoms of a stroke, acute stroke.
Host: Yeah and you’ve talked about some of those symptoms. I’ve heard of this acronym called FAST. So, maybe you can break down what each of those letters mean.
Dr. Nikfarjam: So, FAST stands for face, so it is face asymmetry or drooping of the face. A stands for the arm, if there is any drift of the arm or weakness on one side of the body. S stands for speech. If the patient has slurred speech or not being able to talk as usual. And T stands for time. Stroke is an acute neurological condition that needs to be treated in a very expedited fashion. So, time is an essence under those circumstances
Host: Okay, I got it. And so, I’m curious about the situation where let’s say I’m with a friend and I notice maybe a little bit of a drooping in the face, and I suspect that they may be undergoing a stroke. What are some of the things that I should do immediately?
Dr. Nikfarjam: The first step that everybody needs to take on those circumstances is to pick up the phone and call 9-1-1. The stroke initial symptoms might be mild. Some patients might think that those symptoms are going to go away. But if they notice face being droopy or speech difficulty, arm or leg being weak or having numbness and tingling on one side of the body; those are signs of a stroke and the patient should come to the emergency department as soon as possible. So, the first step is to call 9-1-1 and come to the emergency department and the sooner the better.
Host: Okay, and I’ve actually heard this before. It’s important to call 9-1-1 because there are different types of emergency rooms that handle strokes specifically. Is that true?
Dr. Nikfarjam: That is correct. Yes and there are different hospitals with different levels of capacity to handle patients with stroke. And Ocala Regional Medical Center recently has been declared as a comprehensive stroke center. So, all different treatment modalities are available for these patients are also feasible in our institution. So, if the ambulance brings the patient with acute ischemic stroke, they need to bypass all other facilities and come to the closest comprehensive stroke center and here in Ocala would be the Ocala Regional Medical Center.
Host: Okay, it’s really good to hear about Ocala’s comprehensive care. So, if you are by Ocala Health, it’s okay to go directly there, otherwise just call 9-1-1 and you’ll be directed to the right place. So, I’m actually curious about what happens when you get to the hospital. Talk a little bit about how you treat a stroke.
Dr. Nikfarjam: First of all, I would like to clarify that in some patients or family might drive the patient to the emergency department, however, that is not the best way to do it. So, under those circumstances, some patient’s treatment might get delayed because they have go through the triage area. So, the best way to proceed if you have any patient with those FAST symptoms is to call 9-1-1. And then the ambulance bypasses the triage process and comes to the stroke part designed for these patients in the emergency department.
So, as soon as the patient is there, we go through inclusion and exclusion criteria to see if the patient qualifies to receive the medication that is called TPA and that medication basically is to dissolve the clot that is causing the stroke symptoms. And usually that medication can be provided up to three and sometimes four and a half hours after the symptoms have started. Unfortunately, if the patient arrives late to the emergency department, that medication cannot be provided.
The second option treatment that we have is that of mechanical thrombectomy. We have the capability to place a catheter in the brain and deploy the stentriever and try to retrieve the clot that is causing the stroke or aspirate it out. With that treatment modality, we have the window of opportunity up to 24 hours. So, it’s going to be very important to know that the sooner the patient comes to the emergency department, after initiation of the symptoms, the better outcome is going to have with any kind of treatment modality.
Host: That’s really good to know. And I also imagine the importance of following up with your primary care physician after you go through that treatment. But one of the things that I want to close up with here is how might someone reduce their risk of getting a stroke to begin with?
Dr. Nikfarjam: And that is a very, very good question. So, despite we having different treatment modalities for acute stroke; the best way to treat the stroke is to prevent it. And the prevention can be done by treating the hypertension, the high blood pressure, by treating the diabetes appropriately and by treating the hyperlipidemia or high cholesterol. So, after the stroke and follow up with the primary care physician is mandatory and even patients without a stroke that have high blood pressure and high cholesterol or diabetes; need to follow up with primary care physician for control of those risk factors and to be on aspirin if there’s no medical contraindication in order to prevent the possibility of future stroke.
Host: All right Dr. Nikfarjam, I really appreciate your time today. That’s Dr. Iraj Nikfarjam, an Interventional Neurologist and Medical Director of The Comprehensive Stroke Program at Ocala Regional Medical Center. Thanks for checking out this episode of Helmet of Health. Head to www.ocalahealthsystem.com to get connected with a provider. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll see you next time.
Prakash Chandran (Host): Time is of the absolute essence if you or a loved one has a stroke. But what should you do in the event that one happens and what can you expect once you arrive at the emergency room? Let’s talk about it with Dr. Iraj Nikfarjam, an Interventional Neurologist and Medical Director of the Comprehensive Stroke Program at Ocala Regional Medical Center.
This is Helmet of Health, the podcast from Ocala Health. I’m Prakash Chandran. And first of all, Dr. Nikfarjam, what exactly is a stroke?
Iraj Nikfarjam, MD (Guest): First of all, thank you for having me here. A stroke basically is an emergency neurological condition and occurs when one of the arteries gets occluded in the brain and subsequently, the brain cells start dying very fast.
Host: Okay, so how do you know when you or someone else is having a stroke? Like what are some of the symptoms?
Dr. Nikfarjam: The stroke can manifest in a variety of symptoms, but the most frequent ones are basically facial asymmetry, speech difficulty that is characterized by slurring their words or not being able to get their words out and having numbness or tingling on one side of the body or having arm or leg weakness on one side. These are the most frequent signs and symptoms of a stroke, acute stroke.
Host: Yeah and you’ve talked about some of those symptoms. I’ve heard of this acronym called FAST. So, maybe you can break down what each of those letters mean.
Dr. Nikfarjam: So, FAST stands for face, so it is face asymmetry or drooping of the face. A stands for the arm, if there is any drift of the arm or weakness on one side of the body. S stands for speech. If the patient has slurred speech or not being able to talk as usual. And T stands for time. Stroke is an acute neurological condition that needs to be treated in a very expedited fashion. So, time is an essence under those circumstances
Host: Okay, I got it. And so, I’m curious about the situation where let’s say I’m with a friend and I notice maybe a little bit of a drooping in the face, and I suspect that they may be undergoing a stroke. What are some of the things that I should do immediately?
Dr. Nikfarjam: The first step that everybody needs to take on those circumstances is to pick up the phone and call 9-1-1. The stroke initial symptoms might be mild. Some patients might think that those symptoms are going to go away. But if they notice face being droopy or speech difficulty, arm or leg being weak or having numbness and tingling on one side of the body; those are signs of a stroke and the patient should come to the emergency department as soon as possible. So, the first step is to call 9-1-1 and come to the emergency department and the sooner the better.
Host: Okay, and I’ve actually heard this before. It’s important to call 9-1-1 because there are different types of emergency rooms that handle strokes specifically. Is that true?
Dr. Nikfarjam: That is correct. Yes and there are different hospitals with different levels of capacity to handle patients with stroke. And Ocala Regional Medical Center recently has been declared as a comprehensive stroke center. So, all different treatment modalities are available for these patients are also feasible in our institution. So, if the ambulance brings the patient with acute ischemic stroke, they need to bypass all other facilities and come to the closest comprehensive stroke center and here in Ocala would be the Ocala Regional Medical Center.
Host: Okay, it’s really good to hear about Ocala’s comprehensive care. So, if you are by Ocala Health, it’s okay to go directly there, otherwise just call 9-1-1 and you’ll be directed to the right place. So, I’m actually curious about what happens when you get to the hospital. Talk a little bit about how you treat a stroke.
Dr. Nikfarjam: First of all, I would like to clarify that in some patients or family might drive the patient to the emergency department, however, that is not the best way to do it. So, under those circumstances, some patient’s treatment might get delayed because they have go through the triage area. So, the best way to proceed if you have any patient with those FAST symptoms is to call 9-1-1. And then the ambulance bypasses the triage process and comes to the stroke part designed for these patients in the emergency department.
So, as soon as the patient is there, we go through inclusion and exclusion criteria to see if the patient qualifies to receive the medication that is called TPA and that medication basically is to dissolve the clot that is causing the stroke symptoms. And usually that medication can be provided up to three and sometimes four and a half hours after the symptoms have started. Unfortunately, if the patient arrives late to the emergency department, that medication cannot be provided.
The second option treatment that we have is that of mechanical thrombectomy. We have the capability to place a catheter in the brain and deploy the stentriever and try to retrieve the clot that is causing the stroke or aspirate it out. With that treatment modality, we have the window of opportunity up to 24 hours. So, it’s going to be very important to know that the sooner the patient comes to the emergency department, after initiation of the symptoms, the better outcome is going to have with any kind of treatment modality.
Host: That’s really good to know. And I also imagine the importance of following up with your primary care physician after you go through that treatment. But one of the things that I want to close up with here is how might someone reduce their risk of getting a stroke to begin with?
Dr. Nikfarjam: And that is a very, very good question. So, despite we having different treatment modalities for acute stroke; the best way to treat the stroke is to prevent it. And the prevention can be done by treating the hypertension, the high blood pressure, by treating the diabetes appropriately and by treating the hyperlipidemia or high cholesterol. So, after the stroke and follow up with the primary care physician is mandatory and even patients without a stroke that have high blood pressure and high cholesterol or diabetes; need to follow up with primary care physician for control of those risk factors and to be on aspirin if there’s no medical contraindication in order to prevent the possibility of future stroke.
Host: All right Dr. Nikfarjam, I really appreciate your time today. That’s Dr. Iraj Nikfarjam, an Interventional Neurologist and Medical Director of The Comprehensive Stroke Program at Ocala Regional Medical Center. Thanks for checking out this episode of Helmet of Health. Head to www.ocalahealthsystem.com to get connected with a provider. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll see you next time.