Melanie Cole (Host): According to the American Heart Association, each year about 80,000 people experience a new or recurrent stroke. A stroke is a medical emergency, prompt treatment is crucial. Early action can minimize brain damage and potential complications. We’re pleased to announce that Henry Mayo Newhall Hospital has earned the Get with the Guidelines Stroke Quality Achievement Award and also qualified for recognition on the Target Stroke Honor Roll. This award recognizes Henry’s commitment and success in implementing a high standard of stroke care by insuring that their stroke patients receive treatment that meets nationally accepted evidence based standards and recommendations. Congratulations on your GWTD Stroke Gold Plus Target Stroke Award Henry Mayo Newhall Hospital! My guest today is Dr. Yuvi Grewal. He’s a neurologist and a member of the medical staff at Henry Mayo Newhall Hospital. Welcome to the show, Dr. Grewal. Tell us a little bit about stroke. What is it and are there different types of stroke?

Dr. Yuvi Grewal (Guest): Yes, actually there’s two major types of stroke that’s out there. Thanks for having me as well, I think it’s very important that we educate the community about stroke because there’s treatment out there that we can give within a certain time period. Stroke in of itself can occur either when a blood vessel in the brain ruptures or is blocked by a clot. We have two major types of stroke out there. One is called ischemic, and that’s usually when you have a blood vessel that’s blocked off by a clot. The other is hemorrhagic and that occurs when a blood vessel ruptures and more of bleeding is occurring.

Melanie: Are there some symptoms or signs or precursors? Let’s start with those before we even do recognizing a stroke because time is brain and we want to know how to recognize stroke right away. But are there some precursors, are there some things that people should know about risk factors for a stroke?

Dr. Grewal: Absolutely. In terms of stroke itself, 80% of strokes are due to risk factors that can actually be controlled and prevented. Some of those major risk factors include blood pressure, so it is incredibly important to keep blood pressure under control, as well as other risk factors such as cholesterol, controlling diabetes, increasing your physical activity, and keeping control in terms of excess weight. There’s also activity such as smoking which can also increase your risk factors for stroke. So all these are preventable, potential risk factors for stroke that can reduce your risk in the long term.

Melanie: So if somebody is having a stroke, what should they or a loved one recognize about this moniker that you doctors use to recognize a stroke very quickly? What is that?

Dr. Grewal: It is actually one of the mnemonics that’s been released by the American Heart and Stroke Association to look at some of the main signs and symptoms of stroke. That mnemonic is called “FAST.” F stands for face drooping. If you notice in one of your family members or loved ones that one of their sides of their face is drooping or that side has become numb, that can be an indicator of stroke. It should be noticed that this is a focal deficit so it’s one side usually. The A in the FAST mnemonic stands for arm weakness. So is one arm weak or numb. Also S stands for speech difficulty. In that we are looking to see is that speech slurred, are they unable to speak, are they hard to understand, do they have difficulty understanding what you’re saying to them. These are all kind of signs of stroke. And the last letter T in that mnemonic of FAST is it’s time to call 911. Whenever you have signs of face drooping, arm weakness, or speech difficulty it’s very possible that someone is having a stroke.

Melanie: And if they call 911 immediately when they recognize the face, arms, or speech, what can EMS do for them in that interim on the ride over?

Dr. Grewal: If they’re suspicious that the stroke is being caused by a blood clot, they can administer aspirin. They can also get your blood pressure under a certain degree of control if it’s severely elevated. These are things that the first responders can do in order to reduce the future complications of an event.

Melanie: And then what happens at the emergency room? What do you do for someone that you suspect is having a stroke?

Dr. Grewal: In the past it used to be that when somebody came in with a stroke the treatment was primarily geared towards preventing new ones. Recently, however, we’ve had a lot of advancement in terms of the field of stroke so there are certain treatments that can be given immediately once a stroke starts. The usual time window for those treatments is about 6 hours. If you come in within 4.5 hours there’s a clot busting drug that is now released called IV TPA that can be administered. That has been shown to reduce the amount of disability associated with strokes. With most of the studies it shows a significant improvement in terms of disability. Another thing that can be done is a clot removing procedure called a thrombectomy. That can be performed within 6 hours of onset of stroke. It is a surgical technique used to physically remove a large blood clot from an artery in the brain. That is something that can be done within 6 hours. These are two new treatments in terms of stroke that if someone comes in early enough is able to be received and that is why we generally recommend that someone come into the emergency room as soon as they have these symptoms of stroke. Also if the stroke is caused by a bleed or a hemorrhage there can also be other surgical procedures that can be done to reduce that impact of bleeding and prevent potential worsening of symptoms. And just as an example, something like subarachnoid hemorrhage where you have bleeding from an aneurysm, that aneurysm can be coiled or clipped. Something like a subdural hemorrhage, which can be caused by trauma, and bleeding outside the brain, that can be evacuated by a surgical procedure. So it’s very important that time is of the essence when somebody recognizes symptoms that might be consistent with a stroke that they get treatment right and away and not wait for it to potentially go away.

Melanie: Dr. Grewal, people have heard that if you think someone is having a heart attack, you give them an aspirin, and you mentioned aspirin with EMS, but if we don’t know the type of stroke that it is, giving an aspirin to someone you love that you think is having a stroke could have detrimental effects, yes?

Dr. Grewal: Absolutely. That’s why when you come into the emergency room for a stroke, one of the first things that you’ll have done is a CT scan of the head. That’s really to look at what type of stroke is going on. Is this a bleed or is this caused by a clot?

Melanie: So then what’s life like after someone’s had a stroke? Do they start physical and occupational therapy? Can they help improve some of the neurological deficits that might have occurred during their stroke?

Dr. Grewal: Yes, absolutely. Once a stroke has occurred the most important thing is to identify what the cause of the stroke was and to work on optimizing those risk factors that may have caused the stroke. Like I was talking about before in terms of those major risk factors for stroke, anyone who has had a stroke will usually get the full workup in terms of determining what risk factors they have and getting them within a certain reference range to prevent future strokes or prevent that particular risk factor from being a problem in the future. One of the things that your doctor will most likely do in the event that you have a stroke is to look at first of all a brain MRI, as well as some of the vascular image of the carotid arteries and some of the arteries that go to the brain to see if there’s any major blockages there from which a stroke, might have occurred. Also, we’ll check a marker of diabetes, as well as cholesterol to ensure that those are under control. We’ll also get an echocardiogram of your heart to see if you have any heart defects which may predispose you to stroke. After all that is done and we have optimized your risk factors, the only thing to look at going forward is physical and occupation therapy to try and get your brain to readjust and improve some of the deficits that you may have suffered as a result of stroke.

Melanie: Are you at risk of a second stroke if you’ve had one?

Dr. Grewal: Yes, absolutely. Anyone who has had one stroke is at a higher risk of having a future stroke. That’s way in these individuals it is very important to identity those risk factors and get them on the proper medications for prevention. In somebody that has very uncontrolled diabetes, it is important to get that diabetes under control and to place them on a blood thinning medication, such as aspirin or Plavix. In the case of abnormal heart rhythms causing stroke, like atrial fibrillation, to put them on a stronger blood thinning medication, like Coumadin.

Melanie: So then wrap it up for us Dr. Grewal. What is your best advice for people who might be at risk for stroke? What would you like them to know about hopefully preventing it in the first place or recognizing those very important symptoms that they need to know?

Dr. Grewal: Well I think that the most important thing is to go to their primary care physician or their doctor and to ask them to be tested for some of the risk factors for stroke. Ensure that their blood pressure is under control, they’re not smoking, they don’t have diabetes, their cholesterol is under control, and they keep a relatively active lifestyle. In addition to that, to keep in mind those symptoms of stroke that I was discussing earlier – FAST, the face drooping, arm weakness, speech difficulty. And if they see that or feel like they’re undergoing one of those symptoms to get care right away because there are things that we can do if you get into the emergency room fast enough.

Melanie: Thank you so much for being with us today. It’s such important information for listeners to hear. You’re listening to It’s Your Health Radio with Henry Mayo Newhall Hospital. For more information, you can go to HenryMayo.com. This is Melanie Cole, thanks so much for listening.