Think Fast: Understanding Stroke

When I was in nursing school, a friend of mine was walking out of a class when he suddenly couldn’t speak, his left arm and leg stopped working.

There were other students all around him, but they didn’t recognize what was happening and they kept asking him what they should do. Because the blood was cut off to a part of his brain that controlled speech he couldn’t tell them.  He knew that it was an emergency -- that they needed to call 911 and get help, but he couldn’t tell them.

He was in his second year of nursing school. He knew he was experiencing the symptoms of a stroke.

A stroke is a life threatening emergency and an life altering event.

Recognizing the signs and symptoms of stroke and understanding the importance of getting help fast can make a world of difference for you or someone you know.

It is estimated that every 40 seconds someone in the United States has a stroke. According to the Center for Disease Control, stroke is the leading cause of long term disability in the United States and it kills more than 140,000 people a year - that is one out of every 20 deaths. While risk of stroke increases with age, more than one third of people hospitalized after a stroke were younger than 65 years of age. Risk also varies by race, ethnicity and gender. More women than men suffer strokes and stroke kills twice as many women each year as breast cancer.

So what is it?

A stroke occurs when the flow of blood is interrupted a part of the brain. You might have also heard the more technical term CVA Cerebral Vascular Accident. It can occur from bleeding, but it is much more common for a stroke to be caused by a clot that blocks the blood supply to a part of the brain. So called ischemic strokes account for 87 percent of all strokes.

Because different parts of the brain control different parts of our body, often stroke symptoms appear as a problem on one side of the body. Often patients will have a facial droop, weakness, numbness or even paralysis on just one side of the body. It can start suddenly and when it does start, time is of the essence. The sooner the patient gets care, the better chance of restoring blood flow. The CDC reports that patients that receive care within the first three hours often have much less disability than those who delay care.

The American Heart Association has developed the act FAST campaign to emphasize what to look for.

• Facial Droop on one side.
• Arm drifts downward when raised.
• Speech is slurred
• Time is critical - call 911 immediately.

Because most strokes are caused by a clot in the brain, hospitals can give clot-busting medications to break up the clot, but these medications are only effective within a few hours of the start of the stroke.

Moreover, if the patient is bleeding in their brain, those clot-busting medications can make the problem much much worse. So a CT scan looking for bleeding must rapidly be performed before any medication is given. Cut off from its oxygen supply, brain tissue can die and leave permanent damage, so every second counts in getting oxygenated blood flowing again.

Ocean Beach Hospital’s medical staff train to respond quickly to help a patient presenting with symptoms of a stroke. Our hospital works with Providence’s telestroke system so a remote neurologist can examine the patient in the Emergency Room using a direct video connection. While we make sure that all happens as quickly as possible, it all takes time - so it is important to recognize the stroke symptoms and call 911 to get help immediately.

There are other, less common symptoms of strokes that occur in different parts of the brain. A sudden headache or loss of vision can be the first sign of a stroke. An inability to speak, or understand language in a fully awake patient can mean a clot in the part of the brain that controls language. That said, the vast majority of strokes have symptoms that only affect one side of the body.

Sometimes the stroke symptoms may occur and resolve without medical intervention. These are called “mini-strokes” or TIA - Transient Ischemic Attacks. TIAs are strokes but temporary. However, they shouldn’t be ignored because they are highly associated with strokes that cause permanent damage. Don’t delay calling 911 hoping the symptoms just go away.  TIAs are warning signs for a full blown stroke.

It is important to note the time that the stroke symptoms started. Paramedics or nurses may ask when was the patient last seen normal -- this time is what we use when the start the clock ticking for the clot busting medications.

There are a number of factors that increase our risk for stroke. High blood pressure, high cholesterol, diabetes, lack of physical activity and being overweight all put you at increased risk.

An irregular heart rhythm known as atrial fibrillation can also increase the risk of stroke. Smoking -- particularly when combined with pregnancy or oral contraceptives -- greatly increases the risk of stroke. Excessive drinking and recreational drugs also increase stroke risk.

Effort to raise awareness have been working. According to the American Stroke Association, stroke mortality rates have decreased 39 percent from 1999 to 2016 and awareness of the need to call 911 at the first symptoms of a stroke has doubled since 2012.

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Ed Hunt is an Emergency Room nurse at Ocean Beach Hospital.