It can happen to anyone. A blood vessel bringing oxygen-rich blood to the brain gets blocked or burst, and a stroke results.
“Part of the brain can’t get oxygen, and those brain cells are compromised,” said Dr. David Cionni, an emergency medicine physician at UCHealth Yampa Valley Medical Center.
Below, Cionni outlines everything you need to understand about strokes.
It’s important to “B.E. F.A.S.T.” in recognizing the symptoms of stroke in order to respond quickly.
B: Balance becomes unsteady.
E: Eyes lose vision or vision doubles.
F: Facial droop
A: Arm weakness or numbness.
S: Speech difficulty.
T: Time to call 9-1-1.
Symptoms typically come on suddenly. Facial droop and weakness or numbness in a limb are often experienced on one side only. Slurred speech is the most common speech issue, but some people have difficulty finding words.
“Those are the three things that are going to be most obviously noticeable,” Cionni said.
People are often awake and alert when a stroke hits, so they may actually notice symptoms in themselves.
Act F.A.S.T. when you suspect a stroke
If a stroke is suspected, it’s critical to get help immediately.
“It used to be when someone had a stroke, you sort of crossed your fingers and hoped they got better. Now, we have pretty amazing therapies, like clot-busting medications and mechanical procedures, but they’re time-sensitive,” Cionni said. “If you suspect this disease process, you don’t want to ask somebody to lie down and rest and see if it goes away.”
The impact a stroke may have depends on a range of variables, such as the size of the clot or blockage, and where it is in the brain, brain stem or body.
While 90% of strokes are ischemic, which means they’re caused by a lack of blood flow to the brain, the other 10% are hemorrhagic, or caused by a bleed in the brain.
Risk factors for strokes
Various factors that increase the risk for stroke can’t be controlled, such as older age, having a family history of the disease, or being black, Hispanic or a woman.
“A lot of people don’t know that stroke is the No. 3 cause of death in women,” Cionni said. “It kills more women than men. One out of five women will have a stroke in their lifetime.”
That makes it especially important for women to take stroke symptoms seriously and not minimize or downplay what they’re experiencing.
Other risk factors are in your control: not smoking, exercising regularly, keeping cholesterol and blood pressure within a healthy range, and decreasing stress can all help lessen your risk of stroke.
“Stress is a big one. It increases your blood pressure and is well-known to cause atherosclerosis, heart disease and stroke,” Cionni said. “So, we could all benefit by incorporating modalities into our lives to decrease stress, such as meditation and yoga.”
Diet also plays a role: saturated fat and trans fats can increase cholesterol, eating too many calories can result in extra weight and increased salt can cause high blood pressure, all of which can increase the risk of stroke.
While making lifestyle changes can be challenging, the benefits may be life-saving.
“People need to be aware that once a stroke happens, it has happened,” Cionni said. “Preventing it is the most important thing, so paying attention to those risk factors is critical.”
Even if the worst happens, there is hope.
“This used to be a pretty dismal disease, and it still is, but now there is great potential for immediate therapy,” Cionni said. “Also, if you have a stroke and have residual deficits, there’s significant potential to get a meaningful life back with intensive therapy.”
UCHealth Yampa Valley Medical Center is using a new medication, Tenecteplase (TNK), to treat ischemic strokes, or strokes in which a blood clot prevents blood from reaching part of the brain.
The new medication replaces Alteplase (tPA), which was the standard treatment for almost three decades. Both medications break up clots to restore blood flow to the brain, but TNK is easier to administer.
Lauren Romanelli, a registered nurse in the emergency department at UCHealth Yampa Valley Medical Center, outlines things to know about this latest change in treatment.
Act quickly when you recognize the signs of a stroke
With any stroke symptoms, it’s critical to get treated quickly. When oxygen-rich blood can’t reach the brain, more damage can result with each passing minute.
Additionally, treatments are time-sensitive. If you wait too long, you may no longer qualify.
“The time of getting treatment is limited, so we always encourage people to come in,” Romanelli said. “Air on the side of caution. We would rather it be nothing.”
When someone checks into the Emergency Department with stroke symptoms, the nursing staff follows a clear workflow to quickly determine if a stroke may be involved.
“We do a ‘BE FAST’ exam to see if they check any boxes – balance, facial droop, difficulty with speech, arm weakness – and another assessment to check for visual deficits,” Romanelli said. “Those two screenings help us activate a stroke alert and get the doctor involved.”
A CT scan is taken, and if it shows the stroke hasn’t yet had a significant impact on the brain, the patient may be a candidate for receiving medication. The YVMC team also has a process to quickly connect through technology with a neurologist at UCHealth University of Colorado Hospital to assist with examination and treatment steps.
The entire process takes minutes.
“If you present with certain symptoms, our ED team is well-trained to get diagnostics – including labs, vitals and imaging – quickly,” Romanelli said.
Clot-busting medication for strokes
For patients who qualify, TNK can help break up clots, restoring blood flow to the impacted portion of the brain.
The new medication is quick to administer: instead of dosing a portion of the medication and then giving the rest through an IV over an hour, it is given all at once in a single dose.
“TNK is a one-time dose,” Romanelli said. “We fly these patients out, weather dependent, and if the flight comes quickly, now we don’t have to transfer the medication to the flight team.”
TNK, which has been used for years to dissolve clots in heart attacks, does come with a risk of bleeding: people who are taking an anti-coagulation medication or who have experienced recent trauma may not be eligible.
The medication also needs to be administered within the first four-and-a-half hours of symptom onset.
“That’s why it’s so important to get the time of symptom onset down to the minute because we want to make sure we’re appropriately giving this medication,” Romanelli said. “As more time passes since the onset of symptoms, the risk of bleeding with TNK administration increases.”
Removing the clot that caused a stroke
Clots can be physically removed through a thrombectomy. In this procedure, a skilled radiologist enters a blood vessel in the arm or leg with a catheter, then moves into the brain to pull the clot out or drip clot-busting medicine directly on it.
The procedure can be done within six to 24 hours after the onset of symptoms. This longer treatment window is especially helpful for patients who don’t recognize stroke symptoms right away, such as those who wake up with symptoms.
With treatment, many patients have a good chance of recovering partially or fully.
“If someone can act fast and get to an ED in a timely manner, even if their deficits seem catastrophic at first, people can make great strides in recovery with treatment and rehabilitation,” Romanelli said. “They’ll stop back into the department, and we’ll be shocked at how well they’re doing.”
This story first appeared in the Steamboat Pilot.