Evo Terra (Host): A stroke is a medical emergency, and time is of the essence. How can you spot a stroke quickly, and what should you do? Let's find out with Deonna Wissler, a stroke APRN, that's Advanced Practice Registered Nurse, at University of Arkansas for Medical Sciences.

This is UAMS Health Talk from University of Arkansas for Medical Sciences. I'm Evo Terra. Thanks for joining me today, Deonna. Let's start with the basics. What is a stroke and how does it affect the body?

Deonna Wissler: Okay, that's a great question. So, a stroke is basically when the blood supply to the brain is altered in some way, and it causes damage to the tissue and leaves patients with lasting deficits from that. There are two different kinds of strokes. There's the bleeding kind of stroke, which is called a hemorrhagic stroke. And there's the ischemic type of stroke, which is the clotting kind and the clotting kind of strokes is the most prevalent. They're about 85% of the strokes that we see. So when we talk about a lot of the things we're going to talk about today, it will be about ischemic strokes because those are the most common that we come across.

Host: Understood, understood. Talk a little bit about how those affect the body, kind of in general.

Deonna Wissler: Okay. Strokes can affect the body in lots of different ways. The main things that we see that bring people in are numbness, weakness on one part of the body. We can see trouble with vision, balance. And a lot of times, we can see trouble with language. So, you see patients that are having trouble speaking, trouble understanding, and comprehension issues. Facial droop is pretty common, drooling. So, there are a lot of neurological changes that can manifest from a stroke.

Host: Deonna, when someone is exhibiting these symptoms, what's happening inside the body? Why do we get this drooping, this slurring? What's going on?

Deonna Wissler: So, inside of our brain, we often say the brain is like real estate. So, it's all about location. Every part of your brain is controlling something. So depending on what area of your brain is affected is the deficits that we see from it or the physical manifestations. So when someone comes in to let's say our emergency room and I see them, based on their symptoms alone, I can tell you what part of the brain is being affected. So depending on your symptoms, that means this particular part of your brain has been injured. And while that's happening, lots of other things can happen inside your body. And it's not just the brain that's affected when you have a stroke. It can cause your heart to be under stress and your breathing to be affected. So, we can see other physical effects aside from just the weakness, numbness, and those kinds of things that we had talked about a second ago.

Host: Definitely something we want to be aware of. And those symptoms, I believe there is a mnemonic device, I will say, to remember what those symptoms are called, and I believe it's called BEFAST. Can you explain that for us?

Deonna Wissler: Yes. So, BEFAST is something we try to put out to the community and talk about our patients with. So, it stands for balance is the B, and then eyesight. So, sometimes patients can have double vision, blurred vision, or the inability to see something on one side of their visual fields. So, that's always a sign. The F is for face, so facial droop. A is arm. So, you will have weakness of one of your arms. We always say hold your arms up in front of you if you notice one drifting. And then, the S is speech. That can be that your speech is slurred or the inability to understand what someone is saying, so what they're saying is nonsense, that can be another speech issue. And then, the most important part of BEFAST is the T, which is time. The treatment for stroke is very time-sensitive. So, there's lots of things that we can do to help you if you're having an acute stroke, but you need to get to the hospital very quickly for that to happen.

Time is brain, so every minute that you delay, more of your brain cells have been lost that are not recoverable. We always say if you see someone that is having stroke-like symptoms, something in the BEFAST, triggers your brain to think, I think they're having a stroke, then you should always call 911. Never try to drive them somewhere. And get them to a facility that can take care of them. And we can do things like clot-busting medications. Here at UAMS, we use tenecteplase. And there's some procedures we can do. If you have a clot inside your brain, we can see, we can go in and get that clot out. Tenecteplase requires you to get to the hospital within four and a half hours or we can't use it. And then, if you happen to be having a hemorrhagic stroke, there are things we can do to help that too. But again, very time-sensitive before the changes to your brain become permanent.

Host: That's great information. And then, yeah, that time sensitivity is certainly something to keep in mind. So if someone is suspected of having a stroke or themselves, or they see it in someone else, then definitely, first step 911 before you do anything else. Deonna, let's talk for a moment about risk factors. Am I more likely to get a stroke than someone else? How does one determine that?

Deonna Wissler: Sure. They are some standard risk factors that we talk about, diabetes, hypertension, high blood pressure. Smoking is a major risk factor, drug use. There are things that we can control that put us at a decreased risk for having a stroke. So, a lot of our patients we see that come in have uncontrolled hypertension, uncontrolled hyperlipidemia. They may be diabetic and they don't know. So, your risk factors can be reduced if you see your PCP regularly and have regular checkups and have good control of those modifiable risks, meaning that we find out you're at risk and we can do things to improve your health to prevent the stroke in the future.

There are some things that we can't change like age. So, someone who is older is at increased risk of having stroke or an increased risk of an irregular heartbeat, which can cause stroke. So, there are some things that we can't change, but we need to be mindful that most of the things that cause strokes, we can change with routine care by a physician and just taking good care of ourselves and absolutely not smoking.

Host: Yeah, absolutely not smoking. I've heard that over and over again, kind of for everything. But definitely, certainly for this. I want to take a step back from what we were talking about calling 911 immediately. Great. We call 911, but then there's some time before someone comes and shows up. What should we do as home caregivers or even just bystanders to assist someone who is having a stroke right now while they're waiting for medical help to arrive?

Deonna Wissler: I think the most important thing as a bystander is just making sure you keep them safe. So you have to be mindful that if they're having weakness on one side of their body, that they may fall. And we see a lot of patients that do fall. So, having them sit down or lie down somewhere that's safe and secure. Never try to give them anything. Don't try to give them aspirin or anything like that. And I would say don't try to give them any medications. Just lay them down, keep them safe, keep them calm, and provide basically emotional support for them until the ambulance can get there. But you may do more harm if you try to give them something.

Host: Good information to have. Deonna, is there anything else we wanted to cover today?

Deonna Wissler: I think we hit the major parts. Right now, you know, Arkansas has made a big drive towards reducing our stroke mortality and we're headed in the right direction. I think just the community being aware of what the stroke signs are and to call an ambulance and get help are the major things. And with BEFAST, we can really do that. So if you ever see anyone that you think something may be happening to them, they may be having a stroke, always err on the side of caution. Always call an ambulance. And if we see them and it turns out it's nothing, that's fine, but you've made sure someone's gotten well taken care of and possibly gotten a life-saving intervention.

Host: Yes, yes, good information. Well, again, Deonna, thank you very much for all of the information today.

Deonna Wissler: Thank you for having me.

Host: Once again, that's Deonna Wissler, a stroke APRN here at UAMS. For more information, please visit idhi.uams.edu/stroke-program or call 501-686-8000 to make an appointment. Again, that's 501-686-8000. If you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. I'm Evo Terra, and this has been UAMS Health Talk from University of Arkansas for Medical Sciences. Thanks for listening.