Transcription:
Stroke Prevention and Treatment

Evo Terra: According to the CDC, someone in the United States has a stroke every 40 seconds. Today we'll talk about lowering your risk and how to mitigate the impact of your long term health if you have a stroke. As a reminder, St. John's is a New York State designated primary stroke center, certified by the Joint Commission with Gold plus recognition from the American Heart Association and the American Stroke Association.

This is Riverside Radio HealthCast, a podcast from St. John's Riverside Hospital. Thanks for listening. I'm Evo Terra. My guest today is Linda Sugrue. She's the Stroke program director for St. John's Riverside Hospital. Linda, thank you for joining us.

Linda Sugrue: Thank you for having me. It's a pleasure to be here. Thank you for having me.

Evo Terra: We're talking about strokes, and I think it's best to start off with the obvious question. What is a stroke and how does it occur? What's the root cause behind it?

Linda Sugrue: Our brain receives blood and oxygen through blood vessels. A stroke occurs when blood flow through those vessels is interrupted. When brain cells lose oxygen, they become damaged. Which ultimately leads to the functional deficits we see in stroke. Stroke can be ischemic in nature, caused either by a blockage such as a blood clot or a plaque buildup called atherosclerosis, or when a brain vessel breaks or ruptures, which is called a hemorrhagic stroke. Ischemic stroke is the most common type of stroke, and both types of stroke are considered an emergency.

Evo Terra: Let's get into some specifics out there, a around strokes. and maybe we should start with this, the signs and symptoms that someone, perhaps myself is having a stroke?

Linda Sugrue: Sure. So the brain controls different functions throughout the body. Things like muscle movement, speech, and balance. These are all examples of activities we do every day without sinking that are controlled by the brain. Depending on where the stroke has occurred in the brain will determine which of these functions are impacted. The most recognizable signs and symptoms of stroke are slurred speech, facial drooping to one side, and weakness to one side of the body. But we also see sudden onset of imbalance or dizziness or even abrupt changes in vision.

We can also see transit symptoms or stroke symptoms that appear temporarily and resolve on their own. That's called a TIA or transit ischemic attack. And in the case of hemorrhagic stroke, we can see severe headache as. The important thing to know is that when any of these symptoms present themselves or are discovered, the immediate next step is to seek emergency medical attention, and that means calling 911 and activating emergency medical services right away the.

Evo Terra: Let's talk risk factors for a moment. I know that not everybody is going to have a stroke, but there are certain populations that will or are more likely to get there. What are some of these specific risk factors?

Linda Sugrue: Well, a risk factor is something that increases the chances of us developing a condition. So managing a stroke risk factor would be an important strategy in stroke prevention. And risk factors are typically classified as modifiable. Things we can change and non-modifiable things we can't change. So, for example, age and family history are examples of things we can't change. When we're talking about stroke, we especially look at the modifiable risk factors so we can develop a plan to address them. The top risk factors for stroke are high blood pressure, diabetes, high cholesterol, atrial fibrillation, which is a cardiac arrhythmia.

Smoking, obesity, and inactivity. These items all contribute to stroke risk, but they are modifiable, meaning there are treatments and interventions that we can implement to change them or make them better. And examples of these kinds of interventions would be targeted medication therapies and lifestyle changes.

Evo Terra: My mom actually has AFib, which means I might at some point get AFib, which is always sp spooky. so I believe you were talking treatments. I mean, that means that strokes are treatable, right?

Linda Sugrue: Absolutely. The best way to treat stroke is to prevent it, but there are two treatments available for ischemic stroke currently that can help restore blood flow to the brain. They're time sensitive, which means they need to be done as close to symptom onset as possible. Maximize stroke recovery and minimize disability. One treatment is called thrombolysis, which is the administration of a special medication via IV or intravenous, designed to break down the clot that is blocking the brain vessel. And the other treatment is mechanical thrombectomy, which is a special procedure performed by experts where the blockage in the brain vessel is physically removed with a very narrow surgical catheter.

Again, the key to both of these stroke treatments is time. Brain cells are very delicate, so damage occurs quickly when they lose oxygen, and this is where the expression time is brain comes from. Thrombolysis should be administered as soon as possible and no later than four and a half. From the patient's last known normal and thrombectomy within 24 hours.

Evo Terra: So since time is so important, obviously we need to recognize that a stroke is happening to someone. How do we do that?

Linda Sugrue: Exactly. It's very, very important. The easiest way to remember some of the symptoms of stroke is by using acronym B fast. B is for balance, problem, or sudden onset of dizziness. E stands for eyes or sudden visual abnormalities. F is for facial droop. A is for arm weakness, typically to one side. S stands for slurred speech or difficulty speaking, and T means it's time to call 911 to seek medical attention immediately.

Evo Terra: So let's say that the worst thing happens, and I am the one that is recognizing these BFAST symptoms are taking place. Should I be driving myself to the hospital or should I be calling an ambulance?

Linda Sugrue: So we do recommend you call 911. Stroke guidelines recommend we call 911. Stroke care begins in the pre-hospital setting. Paramedics and EMTs in the field are specially trained in stroke. They respond. On to the location of the stroke patient and transport them directly to a certified stroke center. They also call in to Prenotify us here in the emergency department so that we know the patient is coming before they even get here. That's how important saving time is to stroke care and how invested EMS teams are in saving brain. So yes, we do recommend you call nine one.

Evo Terra: Now I've also heard that over the counter blood thinners, aspirin is something that can be helpful if I think I'm having a stroke. Is that true?

Linda Sugrue: So it's actually a common question. Taking an aspirin is not recommended in suspected stroke prior to being examined by a healthcare team. And the reason is that aspirin has blood thinning properties. So we would need to avoid that in the event that the suspected stroke is caused by bleeding. Secondly, strokes can affect swallowing function, so holding off on oral intake, including medications until swallow function is assessed by the healthcare team is a way we help keep patients safe.

Evo Terra: That makes sense. but earlier in the conversation you said the best thing we can do is prevent stroke before it happens. So tell us about stroke Prevention?

Linda Sugrue: Well, making healthy choices in activities of daily living is very important. Managing those risk factors we talked about is essential work with your provider to keep a healthy blood pressure, avoid smoking. Exercise more, make healthy food choices, and of course learn about stroke. These are all critical pieces to stroke prevention, and one of the most critical prevention strategies is to not ignore abnormal symptoms Get checked out right away as soon as stroke symptoms are realized.

Evo Terra: And let's go to the other end of the spectrum, a stroke has happened, treatment has been sought. What happens after that?

Linda Sugrue: So following a stroke, healthcare teams will be looking very closely to identify the cause of the stroke. So plans for secondary prevention can be tailored to the specific needs of the patient. And patients themselves can play a major role as a partner in their own healthcare by embracing healthy habits, staying knowledgeable, taking medications as prescribed, and of course, following up regularly with their providers.

Evo Terra: Well, Linda, thank you. Great information on stroke prevention and treatment. I think we've all learned some things. So again, thank you for being on the show with me today.

Linda Sugrue: Thank you so much for having me. It was my pleasure to be here.

Evo Terra: Once again, that was Linda Segrue, the stroke program director at St. John's Riverside Hospital. For more information, please call our physician referral service at 914-964-4DOC. That's 914-964 4DOC, or email us at findadoc@riversidehealth.org If you found this episode helpful, please tell a friend and thanks again for listening to Riverside Radio HealthCast, a podcast from St. John's Riverside Hospital, hoping your health is good health. I'm Evo Terra.