Questions about stroke? Ask a stroke expert
Diagnosing and treating stroke — a life-threatening condition where blood flow to the brain is cut off — has changed dramatically, and more people survive stroke than even just a few years ago. Still, stroke affects nearly 800,000 people each year, and is the fifth leading cause of death in the United States.
MultiCare's hospitals are recognized by the American Heart Association and American Stroke as providing a high level of stroke care. We asked one of our stroke experts, Valerie Lyttle, RN, MSN, CEN, CNRN, SCRN, Stroke Program Coordinator at MultiCare Good Samaritan Hospital, to answer some common questions about stroke diagnosis and treatment.
Q. What causes a stroke?
A. Stroke can be caused by a blockage of a blood vessel in the neck or brain, called an ischemic stroke, or bleeding into the brain, called a hemorrhagic stroke. Ischemic strokes, or a blood clot in the brain, account for most of the strokes we treat in this country, about 87 percent of all strokes, according to the National Stroke Association.
Q. Where did the stroke awareness acronym FAST come from?
A. It stands for Face, Arms, Speech and Time. Another acronym is BE FAST, which stands for Balance, Eyes, Face, Arms, Speech and Time, as other stroke symptoms also include sudden onset of dizziness/vertigo and vision changes. These are the common signs of stroke, and the more symptoms a person has, the higher the likelihood is that it’s stroke.
The longer explanation of this acronym is: Face: check for facial drooping or weakness by asking the person to smile. Is the smile crooked? Arms: ask the person to hold their arms out in front. Does one arm drift downward? Speech: is their speech affected? Slurred, slow or garbled? Time: Calling 911 as quickly as possible and getting the person emergency treatment is critical if a stroke is happening. Someone should make note of the time the symptoms began, since the time in between when symptoms started and when treatment begins is crucial.
Q. Are stroke symptoms always as dramatic as the FAST images make them seem?
A. No, sometimes the symptoms are subtle, a slight slurring of speech, a sudden numbness or weakness of the face, arm or leg. Even subtle findings are considered positive for stroke.
Q. What does "Door to Treatment" mean?
A. This refers to the actual time it takes from first arrival to the Emergency Department to clot-busting medication or intervention starting. Because the longer the brain goes without blood, the greater the long-term damage is to the patient, the standard Door to Treatment time is 60 minutes or less. Some health care providers also refer to this as “The Golden Hour.”
Q. How do the doctors find the blood clot?
A. Often a special type of CT scan, called a CT-angiogram, is done during the acute stroke workup to look at the blood vessels in the brain. If there is a large clot they are more likely to be seen on this study.
Q. How is the blood clot removed?
A. If the person meets criteria, a clot busting IV medication can be given to help break up the clot. For some types of stroke caused by a large blood clot, the clot may be able to be removed in a specialized neuro interventional radiology suite by trained neuro interventional specialist — a doctor, usually a radiologist, who using imaging and minimally invasive techniques to treat stroke, cerebral aneurysm and other life threatening conditions of the central nervous system. Timing is key when considering any type of intervention, as the more time goes by, damage caused by the stroke is larger and the risks that come with treatment are greater.
Q. What are people like after a stroke?
A. This depends on many things, including the size of the stroke, the area of the brain affected and the age of the person. Recovery from stroke can be a lifelong process, and many times stroke can leave a person changed. Physical abilities may be altered, communication may be affected. Post-stroke fatigue and depression are very common. While stroke has recently been lowered to the number-five cause of death in America, it remains the number-one cause of disability in adults.
Q. What should a person do if they suspect stroke in themselves or someone else?
A. Call 911 immediately! Time is Brain!
This post was originally published in May 2015 and updated in May 2016.