Stroke is the fourth leading cause of death in America and leading cause of adult disability.
Approximately 795,000 strokes will occur this year, one occurring every 40 seconds, and taking a life every four minutes.
Up to 80% of strokes are preventable; you can prevent a stroke!
The MemorialCare Neuroscience Institute is committed to raising awareness of the signs and symptoms of stroke, so when one happens, people can spot it F.A.S.T. (Face, Arms, Speech, Time) and get the help they need.
Selected Podcast
When a “Brain Attack” Hits, Will You Know What to Do?
Featured Speaker:
Nima Ramezan, M.D
Dr. Ramezan is board certified in neurology, vascular neurology, and clinical neurophysiology. Dr. Ramezan is the medical director of the MemorialCare Neuroscience Institute and Stroke Program at Long Beach Memorial. In addition to providing leading patient care, Dr. Ramezan is an advocate for raising awareness for the signs and symptoms of stroke. Transcription:
When a “Brain Attack” Hits, Will You Know What to Do?
Deborah Howell (Host): Hello and welcome to the show. You are listening to weekly dose of wellness brought to you by Memorial Care Health System. I am Deborah Howell and today’s guest is Dr. Nima Ramezan, medical director of Memorial Care Neuroscience Institute and Stroke Program, Long Beach Memorial and he is here today to answer the question when a brain attack hits, will you know what to do. Welcome, Dr. Ramezan.
Dr. Nima Ramezan (Guest): Thank you for having me on the show today.
Deborah: It’s our pleasure. You sometimes refer to stroke as a brain attack, can you tell us your definition of stroke.
Dr. Ramezan: Yeah, stroke is a loss of function in part of the brain, so how it’s called a brain attack is that it is like a heart attack, but because of the brain functions differently than the heart and has different functions of the body such as movement, speaking, balance, it’s a sudden loss of any of these functions. For example, part of the brain that controls your movement of your left side of your body, if it suddenly has either lack of blood or some kind of a process whether it is bleeding in the brain, this results in the loss of that function and that’s why it’s called brain attack.
Deborah: Okay.
Dr. Ramezan: And it’s actually quite fast. In most instances of stroke, it happens suddenly. It’s infrequent that it comes and goes, it happens at the onset and you have possibly maximum symptoms right at the onset of it.
Deborah: Okay and what are the symptoms of stroke when you are having one?
Dr. Ramezan: So, as I said the brain function involves movement, sensation, having the feeling of something when somebody touches you, ability to speak, ability to understand, ability to see objects that are in the environment as well as your balance, so when the part of the brain that controls for example left-sided movement and that gets injured that results in one side of body not moving or one side of body not feeling what it is supposed to be, but suddenly the balance comes off or typically patient say, I lost vision on my left side and that’s another symptom and language is also an important part where speaking and understanding, so somebody would be perfectly talking at one point and suddenly their speech gets affected, it becomes slurry or like having, you know, moss pollen in your mouth or sometimes it happens where you just cannot get the words out or cannot understand anything somebody tells you, sometimes this is just a sudden facial droop, but again it’s a sudden onset of symptoms which in part of the brain where it’s affected and these are the typical symptoms.
Deborah: So that’s for the person who is having a stroke, for someone trying to determine if someone else is having a stroke, there is something called FAST, may be you could go over that for us.
Dr. Ramezan: Right, so this is a quick way of evaluating somebody who is having stroke symptoms and the FAST stands for F for the face, A for the arm, S for the speech and T for time and as I said there are more symptoms, but this is a quick way of trying to assess if somebody is having stroke symptoms and again you get a sudden onset of face becoming asymmetric or not moving right. The arm or the leg, but arms can be more commonly affected where the arm is weak and it is not moving, speech gets affected and the time is important because any minute wasted could be potentially worsening of this injury to the brain, so the word FAST I think is a good representative of somebody to understand what’s happening and that it’s an emergency and 911 should be contacted.
Deborah: Okay, now that’s the stroke now, what is a transient ischemic attack or TIA and how is that different from a stroke?
Dr. Ramezan: So, there are two types of, we can generally categorize strokes in two categories, one is ischemic stroke where there is blockage in an artery in the brain and the second type is hemorrhagic stroke where there is bleeding in part of the brain, so each of these again depending on what part of the brain gets involved, it gives you specific type of symptoms as we talk about little earlier, now a transient ischemic attack, it goes more long with what ischemic stroke is, so in ischemic stroke you have an artery in the brain that gets blocked from a blood clot either from the blood clot in the brain or somewhere lower where it flows up into that artery of the brain and that results in these neurologic symptoms. In TIA, most of the times, TIAs last less than an hour, although by definition it is up to 24 hours, these symptoms resolve, so the artery gets temporary blocks, but then it opens up on its own or it was a small area where the symptoms are reversed rather quickly and as a result of that, the person who is having these symptoms return back to their normal baseline, so in a way, it’s actually a warning sign that a stroke may be happening, but for that person who had the symptoms are already reversed and they are back to normal and this is actually a very-very important topic because this is where damage has not occurred permanently, so it’s a very good time to intervene to prevent it.
Deborah: Okay, so if you have a TIA, you certainly need to go to your doctor to determine, you know, what caused it and how you can prevent another one.
Dr. Ramezan: Yes that is correct, again these are symptoms that should be paid attention to very carefully and the intervention can be life saving or you know prevent significant disability.
Deborah: Alright, we touched on this, but let’s get more into it, why is it so important to act fast?
Dr. Ramezan: So, in both setting, in both ischemic stroke and hemorrhagic stroke, the time of identifying the symptoms, time to identify what kind of stroke has happened, it remains really critical, so if a person or patient who has been evaluated quickly after the onset of these symptoms, potential interventions can be done. For ischemic stroke where an artery is blocked, we have FDA approved therapies where we call clot busting medicine where they can be given either through an IV and they can potentially breakup that blood clots that’s blocking that artery and that can cause improvement of the symptoms either quickly over the long term, so it becomes really important that if the signs and symptoms are there, it gets paid attention to and on emergent base should be evaluated because we have treatments that and this clot busting is usually given within the first three hours, so if it has passed that time, a person may not be an eligible candidate, although not everybody is eligible for this medicine and in some places, it can be extended little bit longer up to four and a half hours, although the three-hour window remains the FDA approved therapy at this point.
Deborah: Okay great, now Dr. Ramezan what are the risk factors for a stroke?
Dr. Ramezan: So, how I would describe this is that we have two types of risk factors, one is what we call modifiable risk factors and the other one I think we can call non-modifiable risk factors. The non-modifiable risk factors are for example aging, genetics, family history of a stroke, these are risk factors that a person can do to change things, however we have a long list or certainly a significant list of modifiable risk factors and these are the ones that can potentially be affected that can truly reduce the risk of stroke and these risk factors include hypertension, high cholesterol, smoking cessation, high cholesterol, and atrial fibrillation, so all these are factors that even in the person who has the non-modifiable risk factors, if these factors are addressed adequately and correctly, certainly the risk of the stroke can be significantly reduced and prevented from ever happening.
Deborah: Okay, well that’s good news, now can you tell me a little bit about some of the innovative ways that Long Beach Memorial is treating stroke patients.
Dr. Ramezan: Sure, so Long Beach Memorial is a primary stroke center and that patients who have had signs and symptoms of the stroke, either on where they are brought to us as a receiving center and we have a team on standby which includes the emergency room team as well as a neurologist on call who is able to get on top of the symptoms that are presenting and try to address it and quickly treat the patient, so if a patient who has had these symptoms are brought to our hospital, a team rapidly evaluates them and decision is made to treat them for their symptoms, either ischemic stroke or hemorrhagic stroke. In addition, we have interventional neuroradiology who in cases where the treatment needs more advance care, we have the ability to treat the patients who need these advanced treatments and this is done through depending on interventional neuroradiology, so we provide more comprehensive approach in treating a stroke patient and providing everything from the initial treatment paradigms going into more advanced care as well as further going into the rehabilitation needs of the patient after the symptoms have occurred and to try to maximize recovery in the long term.
Deborah: Alright, excellent information, now my last question for you is if someone is interested in getting more information on the stroke program at Long Beach Memorial, who can they call?
Dr. Ramezan: So, the hospital obviously has resources and this can be found through our website at memorialcare.org and that would be a great option and appropriate resources are available in the hospital, so they can contact us. However, I think its very important that if there are signs and symptoms of stroke, this is the time to actually call the 911 and be rushed to the hospital because I think the first few hours are the first golden hours which has been described by a stroke neurologist and that becomes really critical in trying to treat with the symptoms or address the symptoms.
Deborah: Alright, time is memory. Thank you so much Dr. Ramezan. It has been wonderful to have you on the program today.
Dr. Ramezan: Thank you for having me on the program.
Deborah: Our pleasure. To listen to the podcast or for more info, please visit memorialcare.org. I am Deborah Howell, join us again next time as we explore another weekly dose of wellness brought to you by Memorial Care Health System. Have a fantastic day.
When a “Brain Attack” Hits, Will You Know What to Do?
Deborah Howell (Host): Hello and welcome to the show. You are listening to weekly dose of wellness brought to you by Memorial Care Health System. I am Deborah Howell and today’s guest is Dr. Nima Ramezan, medical director of Memorial Care Neuroscience Institute and Stroke Program, Long Beach Memorial and he is here today to answer the question when a brain attack hits, will you know what to do. Welcome, Dr. Ramezan.
Dr. Nima Ramezan (Guest): Thank you for having me on the show today.
Deborah: It’s our pleasure. You sometimes refer to stroke as a brain attack, can you tell us your definition of stroke.
Dr. Ramezan: Yeah, stroke is a loss of function in part of the brain, so how it’s called a brain attack is that it is like a heart attack, but because of the brain functions differently than the heart and has different functions of the body such as movement, speaking, balance, it’s a sudden loss of any of these functions. For example, part of the brain that controls your movement of your left side of your body, if it suddenly has either lack of blood or some kind of a process whether it is bleeding in the brain, this results in the loss of that function and that’s why it’s called brain attack.
Deborah: Okay.
Dr. Ramezan: And it’s actually quite fast. In most instances of stroke, it happens suddenly. It’s infrequent that it comes and goes, it happens at the onset and you have possibly maximum symptoms right at the onset of it.
Deborah: Okay and what are the symptoms of stroke when you are having one?
Dr. Ramezan: So, as I said the brain function involves movement, sensation, having the feeling of something when somebody touches you, ability to speak, ability to understand, ability to see objects that are in the environment as well as your balance, so when the part of the brain that controls for example left-sided movement and that gets injured that results in one side of body not moving or one side of body not feeling what it is supposed to be, but suddenly the balance comes off or typically patient say, I lost vision on my left side and that’s another symptom and language is also an important part where speaking and understanding, so somebody would be perfectly talking at one point and suddenly their speech gets affected, it becomes slurry or like having, you know, moss pollen in your mouth or sometimes it happens where you just cannot get the words out or cannot understand anything somebody tells you, sometimes this is just a sudden facial droop, but again it’s a sudden onset of symptoms which in part of the brain where it’s affected and these are the typical symptoms.
Deborah: So that’s for the person who is having a stroke, for someone trying to determine if someone else is having a stroke, there is something called FAST, may be you could go over that for us.
Dr. Ramezan: Right, so this is a quick way of evaluating somebody who is having stroke symptoms and the FAST stands for F for the face, A for the arm, S for the speech and T for time and as I said there are more symptoms, but this is a quick way of trying to assess if somebody is having stroke symptoms and again you get a sudden onset of face becoming asymmetric or not moving right. The arm or the leg, but arms can be more commonly affected where the arm is weak and it is not moving, speech gets affected and the time is important because any minute wasted could be potentially worsening of this injury to the brain, so the word FAST I think is a good representative of somebody to understand what’s happening and that it’s an emergency and 911 should be contacted.
Deborah: Okay, now that’s the stroke now, what is a transient ischemic attack or TIA and how is that different from a stroke?
Dr. Ramezan: So, there are two types of, we can generally categorize strokes in two categories, one is ischemic stroke where there is blockage in an artery in the brain and the second type is hemorrhagic stroke where there is bleeding in part of the brain, so each of these again depending on what part of the brain gets involved, it gives you specific type of symptoms as we talk about little earlier, now a transient ischemic attack, it goes more long with what ischemic stroke is, so in ischemic stroke you have an artery in the brain that gets blocked from a blood clot either from the blood clot in the brain or somewhere lower where it flows up into that artery of the brain and that results in these neurologic symptoms. In TIA, most of the times, TIAs last less than an hour, although by definition it is up to 24 hours, these symptoms resolve, so the artery gets temporary blocks, but then it opens up on its own or it was a small area where the symptoms are reversed rather quickly and as a result of that, the person who is having these symptoms return back to their normal baseline, so in a way, it’s actually a warning sign that a stroke may be happening, but for that person who had the symptoms are already reversed and they are back to normal and this is actually a very-very important topic because this is where damage has not occurred permanently, so it’s a very good time to intervene to prevent it.
Deborah: Okay, so if you have a TIA, you certainly need to go to your doctor to determine, you know, what caused it and how you can prevent another one.
Dr. Ramezan: Yes that is correct, again these are symptoms that should be paid attention to very carefully and the intervention can be life saving or you know prevent significant disability.
Deborah: Alright, we touched on this, but let’s get more into it, why is it so important to act fast?
Dr. Ramezan: So, in both setting, in both ischemic stroke and hemorrhagic stroke, the time of identifying the symptoms, time to identify what kind of stroke has happened, it remains really critical, so if a person or patient who has been evaluated quickly after the onset of these symptoms, potential interventions can be done. For ischemic stroke where an artery is blocked, we have FDA approved therapies where we call clot busting medicine where they can be given either through an IV and they can potentially breakup that blood clots that’s blocking that artery and that can cause improvement of the symptoms either quickly over the long term, so it becomes really important that if the signs and symptoms are there, it gets paid attention to and on emergent base should be evaluated because we have treatments that and this clot busting is usually given within the first three hours, so if it has passed that time, a person may not be an eligible candidate, although not everybody is eligible for this medicine and in some places, it can be extended little bit longer up to four and a half hours, although the three-hour window remains the FDA approved therapy at this point.
Deborah: Okay great, now Dr. Ramezan what are the risk factors for a stroke?
Dr. Ramezan: So, how I would describe this is that we have two types of risk factors, one is what we call modifiable risk factors and the other one I think we can call non-modifiable risk factors. The non-modifiable risk factors are for example aging, genetics, family history of a stroke, these are risk factors that a person can do to change things, however we have a long list or certainly a significant list of modifiable risk factors and these are the ones that can potentially be affected that can truly reduce the risk of stroke and these risk factors include hypertension, high cholesterol, smoking cessation, high cholesterol, and atrial fibrillation, so all these are factors that even in the person who has the non-modifiable risk factors, if these factors are addressed adequately and correctly, certainly the risk of the stroke can be significantly reduced and prevented from ever happening.
Deborah: Okay, well that’s good news, now can you tell me a little bit about some of the innovative ways that Long Beach Memorial is treating stroke patients.
Dr. Ramezan: Sure, so Long Beach Memorial is a primary stroke center and that patients who have had signs and symptoms of the stroke, either on where they are brought to us as a receiving center and we have a team on standby which includes the emergency room team as well as a neurologist on call who is able to get on top of the symptoms that are presenting and try to address it and quickly treat the patient, so if a patient who has had these symptoms are brought to our hospital, a team rapidly evaluates them and decision is made to treat them for their symptoms, either ischemic stroke or hemorrhagic stroke. In addition, we have interventional neuroradiology who in cases where the treatment needs more advance care, we have the ability to treat the patients who need these advanced treatments and this is done through depending on interventional neuroradiology, so we provide more comprehensive approach in treating a stroke patient and providing everything from the initial treatment paradigms going into more advanced care as well as further going into the rehabilitation needs of the patient after the symptoms have occurred and to try to maximize recovery in the long term.
Deborah: Alright, excellent information, now my last question for you is if someone is interested in getting more information on the stroke program at Long Beach Memorial, who can they call?
Dr. Ramezan: So, the hospital obviously has resources and this can be found through our website at memorialcare.org and that would be a great option and appropriate resources are available in the hospital, so they can contact us. However, I think its very important that if there are signs and symptoms of stroke, this is the time to actually call the 911 and be rushed to the hospital because I think the first few hours are the first golden hours which has been described by a stroke neurologist and that becomes really critical in trying to treat with the symptoms or address the symptoms.
Deborah: Alright, time is memory. Thank you so much Dr. Ramezan. It has been wonderful to have you on the program today.
Dr. Ramezan: Thank you for having me on the program.
Deborah: Our pleasure. To listen to the podcast or for more info, please visit memorialcare.org. I am Deborah Howell, join us again next time as we explore another weekly dose of wellness brought to you by Memorial Care Health System. Have a fantastic day.