Transcription:
Stroke Signs and Symptoms

Melanie Cole, MS: If you have a stroke, getting medical care as quickly as possible can help prevent death or minimizing the lasting effects of stroke. So that’s why it’s so important for you to know the signs of a possible stroke, learning your risk factors, and identifying what you need to do if you suspect that you or a loved one is having a stroke. Here to tell us about that today is my guest Barbara Buesh. She’s a registered nurse and the stroke program coordinator at Temecula Valley Hospital. Barbara, tell us what is a stroke? Are there different types? What exactly is it?

Barbara Buesh: So, I’d like to start with every 40 seconds in the United States, someone suffers a stroke. Every 15 minutes, one person dies. So, a stroke is a disease of the vessels that lead to the brain or surrounding the brain. It occurs when a blood vessel that carries oxygen to the brain is blocked by either a blood clot or a burst causing blood to go into the tissues of the brain or around the brain. There’s two different types of stroke. There’s ischemic stroke, which means that a clot has formed in the brain from either coming from the heart or a plaque ruptured, similar to a heart attack except in the brain. The other one is a bleeding stroke and enters cerebral hemorrhage where actually the blood vessel bursts and blood goes into the brain tissue itself or around the brain.

Melanie: So, who would be at risk for stroke?

Barbara: Almost everybody’s at risk for stroke. Almost everybody has risk factors for stroke. There’re very many risk factors for stroke. Many of us don’t even know that we have them. So, for example, one of the statistics that I quote is 90% of women have at least one specific risk factor for stroke and they don’t even know it. So, for example, if you have high blood pressure, hypertension. If you have high cholesterol, if you're diabetic—either insulin dependent or non-insulin dependent Type I or Type II. You're at very high risk for stroke. People with a heart condition called atrial fibrillation are very high risk for stroke. Obesity can be a risk factor for stroke. Those are the three big ones. Hypertension or high blood pressure is the biggest cause of stroke.

Melanie: So, let’s talk about the symptoms because that’s what people need to know so they can get that help fast. Speak about that acronym FAST and what does it even mean?

Barbara: So, we actually use the acronym BE FAST. So, the BE FAST acronym better describes some of the symptoms for a posterior stroke also, which is a very dangerous stroke. So, the B is for balance. So, if you ever feel off balance. If you feel like you've just gotten off of a boat and you haven’t, that you have to hang on to a wall to walk straight or you have to hang on to something. The E is for eyes. So, if you have double vision, blurry vision, central vision, or peripheral vision loss, those can all be signs of stroke.

The F in fast is for face. So, if you have facial droop, facial numbness, you have drooling, you can't swallow correctly, you have difficult swallowing. The A is for arm. So, if you ask someone who you think is having a stroke of you yourself is having a stroke to hold up both of their arms like they're holding a tray of glasses. Either they can't get one of their arms up at all in the air or when you hold them up, it drifts back down to the bed or back down to their lap. The S is for speech. So, if they can't understand you, you can't understand them, or if they can't follow commands or if they can't talk at all. The T is for time. We can't treat these people unless they get to the hospital, to a primary stroke center or any hospital that can treat stroke. The timeframe is very important. There is a very finite amount of we can acutely treat a stroke.

So, the first four and a half hours from the time the symptoms until we give a drug to breakup the clot, we only have four and a half hours. So, it’s very important for people to get to the hospital. That is the number one reason we cannot treat acute stroke is because people don’t come to the hospital in time.

Melanie: So that’s a great point that you made. Why time is just so important. Should the person call 911? Or if you have a loved one, should you drive them? Does EMS help to start that process and alert the hospital of what’s going on?

Barbara: Absolutely. They should always call 911, even if you live across the street from the hospital. What happens with activating 911 is that the paramedics come to your house or wherever this incident is happening, they assess you. They then call the primary stroke center. Not all hospitals are primary stroke centers. Most are nowadays, but the EMS providers will call the hospital ahead and say hey we’re coming in with a stroke. This is what we have. The stroke team meets you at the door. So, there’s no delay of getting you in. When you come in through driving yourself, you have to go through what’s called the triage area in the waiting room. Even that five-minute delay, which is usually what it takes to get through triage, that five-minute delay can cause a lot of damage to the brain. You lose 1.9 million brain neurons every minute during a stroke.

Melanie: Wow. So, tell us what tPA, you mentioned the clot busting drug. Tell us a little bit about what that does and then what is next for someone who has had a stroke? What is life like for them after treatment?

Barbara: So tPA is called, it’s tissue plasminogen activator or alteplase or the trade name is Activase. It’s the only FDA approved drug for treating acute stroke. The issue with tPA is that it can only be given during the first four and a half hours of a stroke. After that time, what tPA does is it breaks up the clot. It breaks up clot all over the body. We normally produce alteplase or Activase in our body systems all the time. We’re always making and breaking down clots all the time in our bodies. So, what this tPA does, or this alteplase dose is, it’s a super 100 times more than what you normally have in your body. It’s just a super dose of it. It runs in over an hour in the emergency department and it breaks up the clot that’s causing the stroke in your brain, hopefully. So that’s what it does. But, again, after four and a half hours, the risk of bleeding into that stroke or from that stroke is very, very high. So, we can't give it after four and a half hours. So, you really have to come in right away.

Melanie: Then what about the next steps. Rehab, life after, and does it put you at risk for another stroke?

Barbara: It does. Once you have a stroke or a TIA… So, a TIA, we didn’t talk about that yet, but a TIA is a transient ischemic attack. It’s like a mini stroke. People call it a mini stroke. What it is is when symptoms happen and then they go away on their own without being treated. If you have a TIA, you have a one in four chance of dying of a stroke within a year. So, a lot of my patients come in and they’ll say, “Oh this happened to me a couple of weeks ago, but the symptoms went away so I stayed home.” You really need to go in and have someone, a physician or the emergency department look at you once you’ve had a TIA. Even if those symptoms go away, you need to be evaluated because it really is a warning sign for a stroke. So, you are at higher risks for having a second stroke, especially if you're younger. We have a lot of younger people that are coming in for stroke, and they are twice as likely of having another event—either a stroke or a heart attack—than their peer group. So, it’s very, very important that you get treated and you get in there because you are at higher risk for another stroke.

Having a stroke, depending on your symptoms, most of the patients nowadays go home from their stroke. I think the national statistics are about 50% of people go home after they have a stroke to their home care. They have visiting nurses, or they have home health and home physical therapy and occupational therapy and speech therapy. Many patients go to either in-patient acute rehab or to skilled facility acute rehab. So, there is a rehab period that occurs after a stroke and it just depends on how the severe the stroke is and what your symptoms are from the stroke that were left over after your stroke was completed. There is very good treatment for stroke post event now. When I first nursing in 1982, there was not a whole lot we could do for stroke. Now, stroke people get better every day. There’s no limit to when you stop getting better. People can get better with every day. You just have to keep working at it.

Melanie: Wow, Barbara, what great information. Wrap it up for us with your best advice for hopefully preventing a stroke in the first place, and the importance of recognizing BE FAST as the acronym for stroke symptoms.

Barbara: So, I think the best thing I can tell you is make sure you control your risk factors. If you have hypertension or high blood pressure, make sure that you're taking your medications every day as directed by your physician. Do not stop taking them without talking to someone. Many times, people stop taking their high blood pressure medications because they have side effects from it. There are literally hundreds of medications out there that can treat high blood pressure. Please, please, please go back and have your physician go back and give you another medication for that blood pressure if you're having side effects from one. Don’t just stop taking it and think everything’s fine. Hypertension or high blood pressure is considered the silent killer because most people have high blood pressure up to five years before they actually have any kind of symptoms from it that they get treatment for. So, if you have high blood pressure, stay on your medications. Don’t ever stop taking them.

Same with high cholesterol. High cholesterol is a very high-risk factor for stroke and heart disease. There’s many ways to treat it. If you have a reaction to one of the statins, which is the class of drugs that we use to treat high cholesterol levels, there’s many, many more that you can be given. Diet and exercise work, and there’s many different drugs that you can be put on. Atrial fibrillation is another risk factor. It’s an arrythmia or an abnormal rhythm of the heart. It causes clots to form in the heart that when the heart squeezes, it shoots the heart clot up into the brain. There’s many different anticoagulation therapies you can be on now that you need to stay on once you're put on them. You shouldn’t really stop taking them without talking to your doctor. There’s side effects from some of those, but again they can switch you to another one.

The biggest piece of advice is if you have risk factors, you need to control them as soon as you can. That’s the biggest piece of advice. BE FAST. Remember that acronym. Make sure that your family and your friends and your loved ones know that acronym, especially if you have one of the risk factors. Children are very good. Grandkids being around grandparents. Make sure that they understand. There’s FAST magnets you can get places. We hand them out all the time at street fairs and health fairs to put on your refrigerator and make sure that everyone in your household knows how to activate 911, when to activate 911, and especially little kids.

We had a situation here at Temecula Valley where a seven-year-old noticed the symptoms on his grandfather and called 911. We were able to treat the gentleman. So even kids can help with this. So, you need to make sure that everyone understands the BE FAST acronym, knows what to look for, and how to activate 911.

Melanie: Thank you so much, Barbara. Great information and so beautifully laid out for the listeners. Thank you again. It’s really important for them to understand that acronym and learn what to do in the case of a stroke. You're listening to TVH Healthchat with Temecula Valley Hospital. For more information, please visit temeculavalleyhospital.com. Physicians are independent practitioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.