It's Your Health Radio, a special podcast series presented by Henry Mayo Newhall Hospital. Here's Melanie Cole.

Melanie Cole, MS (Host): If you have a stroke, getting medical care as quickly as possible can help prevent death or minimize the lasting effects of stroke. It's really important for you to know the signs of a possible stroke, learn your risk factors, and identify what you need to do if you suspect you or a loved one is having a stroke.

Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. And joining me today is Laura Villavicencio. She's a stroke certified registered nurse and stroke program coordinator at Henry Mayo Newhall Hospital.

Laura, thank you so much for joining us today. So, let's start with the basics. What is a stroke, and are there different kinds?

Laura Villavicencio: Yes. Well, thank you so much for having me. So, what is a stroke? A stroke is a medical emergency that happens when blood flow to part of the brain is suddenly interrupted. And this can happen in two main ways, either a blood vessel is blocked, usually by a clot or a blood vessel which ruptures and bleeds. Because the brain relies on a constant supply of oxygen and nutrients carried by the blood, when the supply is cut off, even for a short amount of time, brain cells begin to become damaged. It can die very quickly. So, that's why we often say time is brain. Every minute that passes without treatment means more brain cells are at risk. So, the faster someone gets medical care, the better the chances of recovery and preventing long-term disability.

Melanie Cole, MS: Well, thank you for that. So, tell us a little bit about risk factors for stroke. I mean, is this something that's genetic? Is it lifestyle factors? And I know there are some complications that if your stroke happens that, you know, there are certain conditions that predispose you to a stroke, but if a stroke happens, then also you could be at risk for another one. Can you speak about some conditions that would put you at a higher risk than others?

Laura Villavicencio: Yes. So, many strokes are preventable, and that's one of the most important messages that we want people to understand. So when we talk about stroke prevention, it really comes down to understanding, the personal risk factors, and these fall into two main categories. There are modifiable and non-modifiable risk factors. Modifiable risk factors would be things that you can control, things that we can manage or improve through medical care and lifestyle changes. And some of those include high blood pressure, which happens to be the number one risk factor for a hemorrhagic stroke, diabetes, high cholesterol, smoking, heart conditions such as atrial fibrillation, obesity.

But the good news is that often these can be treated or improved with the right care, whether it's through medication, diet, exercise, or quitting smoking. But then, there's also non-modifiable risk factors that you cannot change, and these are things like age, risk increases as we get older, or a family history of stroke, or sex or certain genetic factors. So even though we can't change these, knowing them helps guide how aggressive we should be with prevention.

Melanie Cole, MS: So then, let's talk about if someone is having a stroke. So what are those symptoms? Because there's an acronym, and it's really so important that we're able to identify it because as you say, time is brain.

Laura Villavicencio: So, the easiest way to recognize a stroke is to remember the acronym BE FAST. So B stands for balance, which is a sudden loss of balance or coordination or difficulty walking. E stands for eyes. If there's a sudden change in vision, such as blurry vision, double vision, or loss of sight in one or both eyes. F stands for face. A sudden facial drooping or a numbness. You can ask the person to smile and see if one side is uneven. A stands for arm. A sudden weakness or numbness in one arm or leg. You can ask the person to raise both arms, and does one arm drift downward? S stands for speech. So, that could be the patient starts showing slurred speech, difficulty speaking or understanding what is being said. So, you can ask the person to just repeat a simple sentence.

And T, T stands for time, but it also stands for terrible headache. They decided to include terrible headache so we could try to capture some of these posterior strokes. So, often the patient will complain of a very severe headache, which has a maximum intensity within seconds to a minute. So, stroke symptoms, they usually come on suddenly, and if you notice any of these signs, even if they seem mild, don't wait, call 911.

Melanie Cole, MS: Okay. So, that leads me to my next question. If someone is showing stroke symptoms, do you call 911? Should the person drive them to the ER? Tell us why it's so important to call 911 and let them know that this is possibly a stroke, because they can start some things before they get to the hospital.

Laura Villavicencio: Absolutely. And this is what we always tell people. The most important thing you can do is call 911 immediately. Don't be afraid of overreacting. Be afraid of underreacting. Do not drive the person yourself. EMS can begin care right away, and they can alert the hospital so the stroke team is ready before the patient even arrives.

Another thing I want to make note of is try to note the time of symptom onset and the last time the person was seen well, because that information is critical for determining treatment options since treatment is time-limited.

Melanie Cole, MS: Well then, what happens at the hospital? Tell us a little bit about what goes on in that trauma center when someone arrives with a possible stroke and what those treatments look like.

Laura Villavicencio: So, stroke treatment in the hospital is very time-sensitive and highly coordinated because every minute matters. So when a patient arrives with stroke symptoms, the team immediately works to confirm whether it's a stroke and determine what type, because treatment depends entirely on whether it's a blockage or bleeding.

So, what happens first is the patient undergoes a rapid assessment, which will typically include a neurological exam to assess symptoms, brain imaging, usually a CT scan to determine if it's an ischemic or hemorrhagic stroke. They'll do lab work. At the same time, the stroke team is activated, which includes the emergency physicians, neurologists, nurses, radiology staff, which are all working together.

If the stroke is determined to be ischemic, which means it's caused by a clot, there's a couple of key treatments. One is we could administer a clot-busting medication called TNK. And this can be given if the patient arrives within a specific time window. And this medication helps to dissolve the clot and restore blood flow to the brain. And then, for some patients, especially those with large clots, a procedure called a mechanical thrombectomy may be performed. This is where specialists use a catheter to physically remove the clot from the blood vessel. So, these treatments can significantly improve outcomes, but only if given quickly.

And then, if the stroke is a hemorrhagic, meaning there is bleeding in the brain, the treatment is very different. And the focus then is on controlling the bleeding, managing the blood pressure, reducing pressure in the brain. And in some cases, surgical intervention may be required to repair the blood vessel or relieve pressure. So instead of restoring flow like an ischemic stroke, we're working to stabilize the bleeding and protect the brain.

Melanie Cole, MS: Isn't that amazing what's available today? It really is fascinating. So Laura, what happens after a stroke? What is life like as you've seen patients in your career? What do you see as far as recovery and life after stroke?

Laura Villavicencio: Well, you know, we have a lot of special services. Once a patient has been discharged, patients will typically work with occupational therapy or speech therapy, physical therapy. We also have support groups for patients that they can attend and meet with other stroke survivors. So, it's always great to have a multidisciplinary team that works together to help the patient get back to their prior level of function to the best of their ability.

Melanie Cole, MS: It's so interesting, Laura, and you've given us so much great information. I'd like you to end with your best advice about hopefully preventing a stroke in the first place.

Laura Villavicencio: Well, my best advice is to be proactive about your health and to start by going to your primary care physician to get screened and tested for your personal stroke risk factors. Many of these risks, like high blood pressure or diabetes, can be managed if they're caught early. And so, my best advice would be to know your personal risk factors, manage what you can control, know the signs and symptoms of a stroke, and act fast. Call 911.

Melanie Cole, MS: Thank you for such great information, Laura. Thank you for joining us and really sharing your incredible expertise. And to learn more about the stroke program at Henry Mayo Newhall Hospital, please visit our website at henrymayo.com/stroke for more information and to get connected with one of our providers. You can also visit the free Henry Mayo Newhall Hospital online health information library at library.henrymayo.com.

That concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. Please always remember to subscribe, rate, and review It's Your Health Radio on Apple Podcasts, Spotify, iHeart, and Pandora. And for more health tips and updates, follow us on your social channels. Until next time, I'm Melanie Cole.