Every second counts when treating a stroke.
Getting a patient the treatment they need quickly can be the difference between a full recovery and permanent disability.
Learn the symptoms and how the UVA Stroke Center is working to speed diagnosis and treatment.
Selected Podcast
Treating Stroke – Every Moment Counts
Featured Speaker:
Organization: UVA Stroke Center
Dr. Andrew Southerland
Dr. Andrew Southerland is a stroke neurologist at the UVA Stroke Center.Organization: UVA Stroke Center
Transcription:
Treating Stroke – Every Moment Counts
Melanie Cole (Host): A stroke is a medical emergency, and prompt treatment is crucial. My guest is Dr. Andrew Southerland. He's a stroke neurologist at UVA Stroke Center. Welcome to the show, Dr. Southerland. So tell us, what is a stroke?
Andrew Southerland (Guest): Thank you, Melanie. I appreciate the opportunity to be with you this morning. In short, a stroke is an abnormality affecting the blood flow to the brain. It can either be an ischemic stroke, which is the majority of strokes, whereby there's a blockage of blood flow from a blood clot or a hardening, atherosclerosis of an artery, for instance, that keeps a certain part of the brain from getting oxygen and nutrient that it needs. This ultimately results in an injury to that part of the brain as many stroke sufferers and family stroke suffers. That leads to unfortunate long-term disability and, in cases, death. Stroke is one of the leading causes of long-term adult disability in this country and around the world.Of course, there can also be hemorrhagic strokes, where there's bleeding on the brain, which are also an emergency and devastating in many cases. This can be related to ruptured blood vessels from high blood pressure, or from a blood vessel abnormality, like aneurysms, like in ruptures and so forth. So a stroke is really a compilation of many different causes all leading to the same unfortunate result, which is disability and injury to the brain.
Melanie: So Dr. Southerland, what are some of the most common symptoms? Because we hear that based on those symptoms and how fast you act is how well your stroke can be treated. So explain the symptoms of a stroke, whether we would recognize them in ourselves as they happen or in our loved ones as we're watching them happen.
Dr. Southerland: Well, that's exactly right, Melanie. That's very important. The motto we use in stroke treatment is time is brain. It is very important to recognize these signs and symptoms early and call 911 if you see someone having a stroke, or if you yourself recognize symptoms. The acronym that we're really trying to put forth in the communities supported by The American Heart and American Stroke Association is FAST, and that stands for Face, Arm, Speech, and then of course, Time. The most common signs would be if you see someone with a weakness of one side of the face, commonly called drooping of the face, weakness or a drifting of an arm. And of course, this could be applied to the leg as well, but certainly more recognizable as weakness of an arm, on one side of the body. Any changes in speech starts to manifest, that's slurring speech or horrible speech, or even loss of the ability to get words out. Many people have seen this in stroke sufferers. And then the last, of course, would be time.So if you see any of those signs and symptoms, and for that matter, any new onset neurological symptoms to happen abruptly—this can even be changes in vision or even severe headache—I think the important thing to know is just to call 911 immediately and have that patient evaluated.
Melanie: How can a stroke be treated? If you call 911 and you don't want to drive someone to the hospital because time, as you say, is so important, time is brain, when you get to the hospital, what can you expect? What are the treatments for stroke?
Dr. Southerland: Well, in most hospitals -- and of course, we have designations as primary stroke centers, at UVA being having the highest level of designation on the American Stroke Association, the moment to be seen rapidly by an emergency team, and then, in many cases, a neurology team, all combined into a stroke alert of some variety, and there will be rapid neurological evaluation. And then, moving towards getting some sort of head imaging usually a CT Scan of the head to see if there is a difference between a hemorrhagic stroke or ischemic stroke because they will be treated differently. The hallmark treatment for a Ischemic Stroke or blockage of blood vessels is really a novel drug called IBPPA, its just a clot-busting drug. It's been approved for some time but really has changed the game, our ability to substantially decrease one's chance of having long-term disability or death, if we can get that medicine in soon enough. We have a window of time of several hours, but the important thing for people to know is that every minute counts. So every little delay that could happen before getting treated or evaluated may have substantial impact on one's long-term quality of life. So the sooner, the better, and we have many treatments beyond that at our disposal, whether it would interventional procedures or neurosurgical expertise. the main thing is to get the hospital soon.
Melanie: When stroke is being treated so quickly, what are the benefits? And then what is the resulting outcome?
Dr. Southerland: Well, I think if we can get TPA and soon enough for instance, for ischemic stroke, and we're able to restore or profuse the brain that might otherwise be limited in getting blood flow, then we can save brain, for instance, brain that may otherwise be at risk, that can be restored, and they can receive blood flow again. That will decrease upwards of 30 percent decreased chance of having long-term disability. It could even be a very simple difference of walking out of the hospital or ending up in a nursing house. So those are the source of quality of life measures that we're really aiming for with our rapid stroke treatment. Most everyone that presents at the hospital and having a stroke will get admitted to our neurological stroke unit, where we have nursing expertise, therapy expertise, and of course, physician expertise to help see folks through that period. And if disability is there, getting them to a rehab setting as soon as possible, start working on obtaining their faculties begin.
Melanie: Dr. Southerland, tell us about iTREAT, a new UVA program to speed stroke treatment.
Dr. Southerland: Well, Melanie, iTREAT's a really exciting program that we are starting in the early phases here at UVA. It is a project using mobile to telemedicine, so simple, tablet-based portable devices, such as an iPad and a modem to help communicate with paramedics and EMS workers while they're bringing stroke patients to the hospital. Traditionally, we have to wait for the patient to get to us in order to start a diagnostic and treatment process, but now, with simple mobile teleconferencing equipment, we can take advantage of this increasing technology and wireless Internet to put ourselves in the back of the ambulance. And in a place like UVA, where patients may be traveling from a rural area upwards of half an hour, there's a substantial time that we can go ahead and begin that treatment process and really, again, continue to focus on that aspect, that time is brain, and not letting minutes be wasted from the moment that someone strokes out a stroke to the moment that we can get them lifesaving treatment.
Melanie: That is amazing. Tell us where we can find out more about iTREAT.
Dr. Southerland: Well, if you'd like to know more about iTREAT, I would encourage listeners to look on the Internet, also the combination of UVA and UC. That's USEED, it will take you to a link to our current website, where we're raising funds for this feasibility research right now. It also has a lot more information and a little video, and so I encourage our listeners to seek that out. Of course, they can also contact our Stroke Center at 434-924-2783 and/or business referrals or more information as well, so.
Melanie: The program is called iTREAT. It's a new UVA program to speed stroke treatment for victims that are suffering from a stroke. So Dr. Southerland, in the last minute here, tell us why patients should choose UVA for their stroke care, and your best advice about stroke for us.
Dr. Southerland: Well, I think that at UVA, we certainly do our best to provide all the possible offerings that one might want related to comprehensive stroke care, and this ranges not only from the stroke neurology team, from which I'm a part of, but also to our nursing staff, to our therapy staff, to world-class neurosurgical care and neurological ICU care. We also have a wonderful interventional neuroradiology team that can do amazing things in some cases of stroke, going up into the brain and actually removing clots from the brain. So lots of novel technology as well as clinical research studies as well. Patients might not otherwise have the opportunities they get in other institutions, and we certainly are doing everything we can to continue to improve the outcomes for our stroke patients, and we can continue to offer these novel going forward.
Melanie: Thank you so much, Dr. Andrew Southerland. For more information, you can go to uvahealth.com. You're listening to UVA Health System Radio. I'm Melanie Cole. Thanks so much for listening.
Treating Stroke – Every Moment Counts
Melanie Cole (Host): A stroke is a medical emergency, and prompt treatment is crucial. My guest is Dr. Andrew Southerland. He's a stroke neurologist at UVA Stroke Center. Welcome to the show, Dr. Southerland. So tell us, what is a stroke?
Andrew Southerland (Guest): Thank you, Melanie. I appreciate the opportunity to be with you this morning. In short, a stroke is an abnormality affecting the blood flow to the brain. It can either be an ischemic stroke, which is the majority of strokes, whereby there's a blockage of blood flow from a blood clot or a hardening, atherosclerosis of an artery, for instance, that keeps a certain part of the brain from getting oxygen and nutrient that it needs. This ultimately results in an injury to that part of the brain as many stroke sufferers and family stroke suffers. That leads to unfortunate long-term disability and, in cases, death. Stroke is one of the leading causes of long-term adult disability in this country and around the world.Of course, there can also be hemorrhagic strokes, where there's bleeding on the brain, which are also an emergency and devastating in many cases. This can be related to ruptured blood vessels from high blood pressure, or from a blood vessel abnormality, like aneurysms, like in ruptures and so forth. So a stroke is really a compilation of many different causes all leading to the same unfortunate result, which is disability and injury to the brain.
Melanie: So Dr. Southerland, what are some of the most common symptoms? Because we hear that based on those symptoms and how fast you act is how well your stroke can be treated. So explain the symptoms of a stroke, whether we would recognize them in ourselves as they happen or in our loved ones as we're watching them happen.
Dr. Southerland: Well, that's exactly right, Melanie. That's very important. The motto we use in stroke treatment is time is brain. It is very important to recognize these signs and symptoms early and call 911 if you see someone having a stroke, or if you yourself recognize symptoms. The acronym that we're really trying to put forth in the communities supported by The American Heart and American Stroke Association is FAST, and that stands for Face, Arm, Speech, and then of course, Time. The most common signs would be if you see someone with a weakness of one side of the face, commonly called drooping of the face, weakness or a drifting of an arm. And of course, this could be applied to the leg as well, but certainly more recognizable as weakness of an arm, on one side of the body. Any changes in speech starts to manifest, that's slurring speech or horrible speech, or even loss of the ability to get words out. Many people have seen this in stroke sufferers. And then the last, of course, would be time.So if you see any of those signs and symptoms, and for that matter, any new onset neurological symptoms to happen abruptly—this can even be changes in vision or even severe headache—I think the important thing to know is just to call 911 immediately and have that patient evaluated.
Melanie: How can a stroke be treated? If you call 911 and you don't want to drive someone to the hospital because time, as you say, is so important, time is brain, when you get to the hospital, what can you expect? What are the treatments for stroke?
Dr. Southerland: Well, in most hospitals -- and of course, we have designations as primary stroke centers, at UVA being having the highest level of designation on the American Stroke Association, the moment to be seen rapidly by an emergency team, and then, in many cases, a neurology team, all combined into a stroke alert of some variety, and there will be rapid neurological evaluation. And then, moving towards getting some sort of head imaging usually a CT Scan of the head to see if there is a difference between a hemorrhagic stroke or ischemic stroke because they will be treated differently. The hallmark treatment for a Ischemic Stroke or blockage of blood vessels is really a novel drug called IBPPA, its just a clot-busting drug. It's been approved for some time but really has changed the game, our ability to substantially decrease one's chance of having long-term disability or death, if we can get that medicine in soon enough. We have a window of time of several hours, but the important thing for people to know is that every minute counts. So every little delay that could happen before getting treated or evaluated may have substantial impact on one's long-term quality of life. So the sooner, the better, and we have many treatments beyond that at our disposal, whether it would interventional procedures or neurosurgical expertise. the main thing is to get the hospital soon.
Melanie: When stroke is being treated so quickly, what are the benefits? And then what is the resulting outcome?
Dr. Southerland: Well, I think if we can get TPA and soon enough for instance, for ischemic stroke, and we're able to restore or profuse the brain that might otherwise be limited in getting blood flow, then we can save brain, for instance, brain that may otherwise be at risk, that can be restored, and they can receive blood flow again. That will decrease upwards of 30 percent decreased chance of having long-term disability. It could even be a very simple difference of walking out of the hospital or ending up in a nursing house. So those are the source of quality of life measures that we're really aiming for with our rapid stroke treatment. Most everyone that presents at the hospital and having a stroke will get admitted to our neurological stroke unit, where we have nursing expertise, therapy expertise, and of course, physician expertise to help see folks through that period. And if disability is there, getting them to a rehab setting as soon as possible, start working on obtaining their faculties begin.
Melanie: Dr. Southerland, tell us about iTREAT, a new UVA program to speed stroke treatment.
Dr. Southerland: Well, Melanie, iTREAT's a really exciting program that we are starting in the early phases here at UVA. It is a project using mobile to telemedicine, so simple, tablet-based portable devices, such as an iPad and a modem to help communicate with paramedics and EMS workers while they're bringing stroke patients to the hospital. Traditionally, we have to wait for the patient to get to us in order to start a diagnostic and treatment process, but now, with simple mobile teleconferencing equipment, we can take advantage of this increasing technology and wireless Internet to put ourselves in the back of the ambulance. And in a place like UVA, where patients may be traveling from a rural area upwards of half an hour, there's a substantial time that we can go ahead and begin that treatment process and really, again, continue to focus on that aspect, that time is brain, and not letting minutes be wasted from the moment that someone strokes out a stroke to the moment that we can get them lifesaving treatment.
Melanie: That is amazing. Tell us where we can find out more about iTREAT.
Dr. Southerland: Well, if you'd like to know more about iTREAT, I would encourage listeners to look on the Internet, also the combination of UVA and UC. That's USEED, it will take you to a link to our current website, where we're raising funds for this feasibility research right now. It also has a lot more information and a little video, and so I encourage our listeners to seek that out. Of course, they can also contact our Stroke Center at 434-924-2783 and/or business referrals or more information as well, so.
Melanie: The program is called iTREAT. It's a new UVA program to speed stroke treatment for victims that are suffering from a stroke. So Dr. Southerland, in the last minute here, tell us why patients should choose UVA for their stroke care, and your best advice about stroke for us.
Dr. Southerland: Well, I think that at UVA, we certainly do our best to provide all the possible offerings that one might want related to comprehensive stroke care, and this ranges not only from the stroke neurology team, from which I'm a part of, but also to our nursing staff, to our therapy staff, to world-class neurosurgical care and neurological ICU care. We also have a wonderful interventional neuroradiology team that can do amazing things in some cases of stroke, going up into the brain and actually removing clots from the brain. So lots of novel technology as well as clinical research studies as well. Patients might not otherwise have the opportunities they get in other institutions, and we certainly are doing everything we can to continue to improve the outcomes for our stroke patients, and we can continue to offer these novel going forward.
Melanie: Thank you so much, Dr. Andrew Southerland. For more information, you can go to uvahealth.com. You're listening to UVA Health System Radio. I'm Melanie Cole. Thanks so much for listening.