Stroke is the fifth leading cause of death and the leading cause of adult disability in the United States, according to the American Stroke Association. High blood pressure is the most important risk factor for stroke.
For the eighth consecutive year, Manatee Memorial Hospital has received the Stroke Gold Plus Performance Achievement Award from the American Heart Association/American Stroke Association's Get With The Guidelines® program.
In this segment, Dr. Ralph Gonzalez, Neurologist and Medical Director of the Stroke and Cerebrovascular Center at Manatee Memorial Hospital gives vital information about the Stroke and Cerebrovascular Center at Manatee Memorial and the importance of recognizing the signs of stroke so that treatment can begin and outcomes may be better.
Selected Podcast
Prompt, Expert Treatment for Stroke Patients
Featured Speaker:
Ralph Gonzalez, MD
Dr. Ralph Gonzalez, MD is a neurologist and Medical Director of the Stroke and Cerebrovascular Center at Manatee Memorial Hospital. He has 22 years of experience. His specialties include Neurology and Psychiatry. Transcription:
Prompt, Expert Treatment for Stroke Patients
Melanie Cole (Host): According to the American Stroke Association stroke is the 5th leading cause of death and the leading cause of adult disability in the United States. A stroke should be treated with the same urgency as a heart attack. Every second is critical to patient care, survival, and subsequent quality of life. My guest today is Dr. Ralph Gonzalez. He’s a Neurologist and the Medical Director of the Stroke and Cerebrovascular Center at Manatee Memorial Hospital. Welcome to the show, Dr. Gonzalez. First, give us a little working definition. What is a stroke?
Dr. Ralph Gonzalez (Guest): Well, a stroke is – two types of strokes. There’s one that is called an ischemic stroke, which is the vast majority of strokes, which is where the artery in the brain becomes blocked by a clot or a piece of plaque. The second kind, which is less common, is called a hemorrhagic stroke, which is where a small blood vessel typically ruptures and causes bleeding into the brain itself.
Melanie: So if somebody is at risk, what would put them at risk for stroke?
Dr. Gonzalez: The risk factors for stroke are very similar to those for a heart attack and coronary artery disease, things such as hypertension, diabetes, high cholesterol, smoking. Male age is somewhat of a risk factor. Advancing age is also a risk factor.
Melanie: Is there anything – if somebody knows that they have some of these risk factors, is there something you’d like them to know about red flags because time is brain? What should they know about recognizing stroke risk?
Dr. Gonzalez: When you recognize a stroke itself, or a T-I-A, we typically use the acronym BEFAST, that’s B-E-F-A-S-T, and what that stands for – those are symptoms that may be a result of a stroke. B stands for balance, “Is there a sudden loss of balance?” Eyes is E, and it stands for, “Is there blurred vision, or double vision?” Face is weakness in one side of the face or, “Is the face drooping?” A is for Arm, which is, “Is one of the arms weak, or does it drift when you hold them up -- drift downward on you?” Speech, the S is for, “Is the patient having slurred, or garbled speech?” And then the T is for Time, which is one of the most important things we have here because we have to get to the hospital very quickly, so they’ll need to call 9-1-1 and activate the emergency medical system in their county so they can get to the nearest stroke center.
Melanie: And Dr. Gonzalez, what is the importance of calling 9-1-1 as opposed to driving a loved one to the hospital if you suspect that they’re having a stroke?
Dr. Gonzalez: If you activate the EMS Stroke Protocols in Manatee County, the Manatee County EMS will call the hospital ahead of time and make us aware that there is a stroke coming in and we’ll meet you at the Emergency Room door and begin the process of working you up for a possible stroke. Whereas if you come in by private vehicle, number one it takes longer to get there, and two, if you don’t say the right words to the triage nurse, you may not get recognized as a stroke right off the bat. Coming in via EMS shaves valuable minutes off the time that it takes to get the stroke process started in the Emergency Room.
Melanie: Tell us a little bit about the stroke process in the Emergency Room.
Dr. Gonzalez: When a patient first arrives in the Emergency Room via EMS as a part of a stroke alert, they’re evaluated in the ambulance bay when they first come in by the ER physician. Then, if it is apparently a stroke or stroke-like symptoms, then they’re sent immediately for a CT Scan of the brain to evaluate for the possibility of hemorrhage. IF there is no hemorrhage, then they’re considered for using IV clot-busting drugs, or a drug called Activase, which has been shown to reduce disability and mortality over time, versus not getting any medication at all. After that is achieved, if there is no hemorrhage, the patient is evaluated by the ER team again and then the Neurology Service or Stroke Service evaluates the patient and determines whether or not the patient is a candidate for IV-lytic therapy, or evaluation for endovascular therapy, which is mechanical removal of the clot versus IV Activase alone. Once that’s determined, the patient will be admitted to the hospital and observed very closely for the first 24 hours, and then the remainder of the workup for his or her stroke would be undertaken over the next 24 hours or so.
Melanie: Following emergency treatment and after they’ve been admitted, then what does stroke care typically focus on?
Dr. Gonzalez: After they’ve been admitted and we’ve worked them up for stroke, we’re concentrating on what’s called secondary prevention, which is trying to prevent them from having another stroke or if it’s in the case of a TIA, having an actual stroke. That would include things such as imaging of the carotid arteries, evaluation of the heart for possible clots in the heart, evaluation for risk factors such as hypertension, diabetes, high cholesterol, working on smoking cessation if the patient smokes, and then addressing those risk factors with medications or behavioral modification-type therapies to try to reduce the risk of subsequent TIA or stroke. They also are evaluated for therapy with Physical Therapy, Occupational Therapy, and Speech Therapy all evaluating the patient. This is because patients that get aggressive Physical Therapy early tend to do better in the long-term than people that get no therapy or minimal therapy.
Melanie: If you’ve had one stroke are you then at risk for another?
Dr. Gonzalez: Yes, you tend to be at somewhat higher risk. That would depend on the type of stroke that you had and once we calculate all your other risk factors. For instance, if a patient has a TIA and they have atrial fibrillation, which is an abnormal heart rhythm, there is something called a CHADS2 Vascular Score, which can give us some predictive information about what your risk factor is for subsequent stroke with that. There’s also another score for TIAs called the ABCD2 Score, which assesses some degree of risk in patients who do not have Afib. On both of those scores, prior TIA or stroke is going to give you a higher score and subsequently increase your risk for potential future events.
Melanie: In just the last few minutes, Dr. Gonzalez, for people that might be at risk for stroke, what would you like them to think about in possibly preventing stroke altogether?
Dr. Gonzalez: I would like them to think about their current risk factors. It’s best not to wait until you have a stroke to react to risk factors. If you have high blood pressure, you need to get it treated. If you have cholesterol problems, you need to get that treated. If you have diabetes, control your blood sugar. If you smoke, please stop. These are all risk factors that we can control before you have a stroke and controlling them helps reduce your risk of subsequent stroke, or initial stroke. It’s always better to address them on the front end than it is to deal with them while you’re recovering from a stroke as well. On the short-term, if you think you’re having a stroke, call 9-1-1 and activate the Emergency Medicine System and tell them that you think you’re having a stroke because that will trigger the stroke system in Manatee County and lead to better outcomes and faster treatment than if you try to drive yourself in.
Melanie: Why should they come to Manatee Memorial Hospital for their care?
Dr. Gonzalez: Manatee Memorial Hospital has a long-standing Stroke Center. It’s been a Stroke Center since 2007, and we have been the same well-trained team since the beginning. We are recipients of the American Stroke Association “Get with the Guidelines” Gold and Gold Plus Awards, as well as Target Stroke Awards going on eight years running now. We have a very busy stroke service that’s used to handling all manners of strokes and intracranial hemorrhages. We have fully staffed ICU, Neuro team with Neurosurgeons and Neurologists on-call 24-7. We can handle everything from small TIAs to large intracranial hemorrhages. We have a well-respected and multidisciplinary approach to the care of stroke and TIAs at Manatee Memorial Hospital.
Melanie: Thank you, so much, for being with us today, Dr. Gonzalez. You’re listening to Manatee Talk Radio with Manatee Memorial Hospital. For more information, you can go to ManateeMemorial.com, that’s ManateeMemorial.com. Physicians are independent practitioners who are not employees or agents of Manatee Memorial Hospital. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks, so much, for listening.
Prompt, Expert Treatment for Stroke Patients
Melanie Cole (Host): According to the American Stroke Association stroke is the 5th leading cause of death and the leading cause of adult disability in the United States. A stroke should be treated with the same urgency as a heart attack. Every second is critical to patient care, survival, and subsequent quality of life. My guest today is Dr. Ralph Gonzalez. He’s a Neurologist and the Medical Director of the Stroke and Cerebrovascular Center at Manatee Memorial Hospital. Welcome to the show, Dr. Gonzalez. First, give us a little working definition. What is a stroke?
Dr. Ralph Gonzalez (Guest): Well, a stroke is – two types of strokes. There’s one that is called an ischemic stroke, which is the vast majority of strokes, which is where the artery in the brain becomes blocked by a clot or a piece of plaque. The second kind, which is less common, is called a hemorrhagic stroke, which is where a small blood vessel typically ruptures and causes bleeding into the brain itself.
Melanie: So if somebody is at risk, what would put them at risk for stroke?
Dr. Gonzalez: The risk factors for stroke are very similar to those for a heart attack and coronary artery disease, things such as hypertension, diabetes, high cholesterol, smoking. Male age is somewhat of a risk factor. Advancing age is also a risk factor.
Melanie: Is there anything – if somebody knows that they have some of these risk factors, is there something you’d like them to know about red flags because time is brain? What should they know about recognizing stroke risk?
Dr. Gonzalez: When you recognize a stroke itself, or a T-I-A, we typically use the acronym BEFAST, that’s B-E-F-A-S-T, and what that stands for – those are symptoms that may be a result of a stroke. B stands for balance, “Is there a sudden loss of balance?” Eyes is E, and it stands for, “Is there blurred vision, or double vision?” Face is weakness in one side of the face or, “Is the face drooping?” A is for Arm, which is, “Is one of the arms weak, or does it drift when you hold them up -- drift downward on you?” Speech, the S is for, “Is the patient having slurred, or garbled speech?” And then the T is for Time, which is one of the most important things we have here because we have to get to the hospital very quickly, so they’ll need to call 9-1-1 and activate the emergency medical system in their county so they can get to the nearest stroke center.
Melanie: And Dr. Gonzalez, what is the importance of calling 9-1-1 as opposed to driving a loved one to the hospital if you suspect that they’re having a stroke?
Dr. Gonzalez: If you activate the EMS Stroke Protocols in Manatee County, the Manatee County EMS will call the hospital ahead of time and make us aware that there is a stroke coming in and we’ll meet you at the Emergency Room door and begin the process of working you up for a possible stroke. Whereas if you come in by private vehicle, number one it takes longer to get there, and two, if you don’t say the right words to the triage nurse, you may not get recognized as a stroke right off the bat. Coming in via EMS shaves valuable minutes off the time that it takes to get the stroke process started in the Emergency Room.
Melanie: Tell us a little bit about the stroke process in the Emergency Room.
Dr. Gonzalez: When a patient first arrives in the Emergency Room via EMS as a part of a stroke alert, they’re evaluated in the ambulance bay when they first come in by the ER physician. Then, if it is apparently a stroke or stroke-like symptoms, then they’re sent immediately for a CT Scan of the brain to evaluate for the possibility of hemorrhage. IF there is no hemorrhage, then they’re considered for using IV clot-busting drugs, or a drug called Activase, which has been shown to reduce disability and mortality over time, versus not getting any medication at all. After that is achieved, if there is no hemorrhage, the patient is evaluated by the ER team again and then the Neurology Service or Stroke Service evaluates the patient and determines whether or not the patient is a candidate for IV-lytic therapy, or evaluation for endovascular therapy, which is mechanical removal of the clot versus IV Activase alone. Once that’s determined, the patient will be admitted to the hospital and observed very closely for the first 24 hours, and then the remainder of the workup for his or her stroke would be undertaken over the next 24 hours or so.
Melanie: Following emergency treatment and after they’ve been admitted, then what does stroke care typically focus on?
Dr. Gonzalez: After they’ve been admitted and we’ve worked them up for stroke, we’re concentrating on what’s called secondary prevention, which is trying to prevent them from having another stroke or if it’s in the case of a TIA, having an actual stroke. That would include things such as imaging of the carotid arteries, evaluation of the heart for possible clots in the heart, evaluation for risk factors such as hypertension, diabetes, high cholesterol, working on smoking cessation if the patient smokes, and then addressing those risk factors with medications or behavioral modification-type therapies to try to reduce the risk of subsequent TIA or stroke. They also are evaluated for therapy with Physical Therapy, Occupational Therapy, and Speech Therapy all evaluating the patient. This is because patients that get aggressive Physical Therapy early tend to do better in the long-term than people that get no therapy or minimal therapy.
Melanie: If you’ve had one stroke are you then at risk for another?
Dr. Gonzalez: Yes, you tend to be at somewhat higher risk. That would depend on the type of stroke that you had and once we calculate all your other risk factors. For instance, if a patient has a TIA and they have atrial fibrillation, which is an abnormal heart rhythm, there is something called a CHADS2 Vascular Score, which can give us some predictive information about what your risk factor is for subsequent stroke with that. There’s also another score for TIAs called the ABCD2 Score, which assesses some degree of risk in patients who do not have Afib. On both of those scores, prior TIA or stroke is going to give you a higher score and subsequently increase your risk for potential future events.
Melanie: In just the last few minutes, Dr. Gonzalez, for people that might be at risk for stroke, what would you like them to think about in possibly preventing stroke altogether?
Dr. Gonzalez: I would like them to think about their current risk factors. It’s best not to wait until you have a stroke to react to risk factors. If you have high blood pressure, you need to get it treated. If you have cholesterol problems, you need to get that treated. If you have diabetes, control your blood sugar. If you smoke, please stop. These are all risk factors that we can control before you have a stroke and controlling them helps reduce your risk of subsequent stroke, or initial stroke. It’s always better to address them on the front end than it is to deal with them while you’re recovering from a stroke as well. On the short-term, if you think you’re having a stroke, call 9-1-1 and activate the Emergency Medicine System and tell them that you think you’re having a stroke because that will trigger the stroke system in Manatee County and lead to better outcomes and faster treatment than if you try to drive yourself in.
Melanie: Why should they come to Manatee Memorial Hospital for their care?
Dr. Gonzalez: Manatee Memorial Hospital has a long-standing Stroke Center. It’s been a Stroke Center since 2007, and we have been the same well-trained team since the beginning. We are recipients of the American Stroke Association “Get with the Guidelines” Gold and Gold Plus Awards, as well as Target Stroke Awards going on eight years running now. We have a very busy stroke service that’s used to handling all manners of strokes and intracranial hemorrhages. We have fully staffed ICU, Neuro team with Neurosurgeons and Neurologists on-call 24-7. We can handle everything from small TIAs to large intracranial hemorrhages. We have a well-respected and multidisciplinary approach to the care of stroke and TIAs at Manatee Memorial Hospital.
Melanie: Thank you, so much, for being with us today, Dr. Gonzalez. You’re listening to Manatee Talk Radio with Manatee Memorial Hospital. For more information, you can go to ManateeMemorial.com, that’s ManateeMemorial.com. Physicians are independent practitioners who are not employees or agents of Manatee Memorial Hospital. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks, so much, for listening.