Are You at Risk For a Stroke?

Brian Huettl, MDDepartment of Emergency Medicine

Saint Francis Hospital

Agenda• Stroke

– Definition and statistics• Evidence-based medical literature

– Prevention• Risk factors

– Early identification, diagnosis, treatment– Organized care

• What can you do?

Stroke: StatisticsFact: Stroke is our nation’s #3 killer and a leading cause of disability

• 780,000 Americans have a stroke each year– 600,000 are first time strokes

• One stroke occurs every 40 seconds on average

• Every 3-4 minutes, someone dies of stroke– Of those who survive, 90% have a functional

deficit• Stroke kills 2 million brain cells per minute• Stroke costs approximately $60 billion/year in the U.S.

Stroke: StatisticsFact: Some people have a higher risk of stroke.

• About 60,000 more women than men suffer a stroke each year

• African-Americans have almost twice the risk of a first ever stroke compared to Caucasians

• People with high blood pressure (140/90+) have about twice the risk of stroke as people with blood pressure under 120/80

Stoke: Definition• Ischemic stroke• Hemorrhagic stroke• Transient Ischemic Attack (TIA)

Ischemic Stroke• Approximately 83% of

strokes are caused by ischemia– Large vessel (Atherosclerotic) = 30%

– Small vessel (Lacunar) = 25%– Embolic = 30%

• Results from blockage within the blood vessels that supply blood to the brain

*Reference: American Heart/Stroke Association 2008

Hemorrhagic Stroke• Approximately 17% of

strokes are from hemorrhage– Intracerebral

hemorrhage – Subarachnoid

hemorrhage • Results from a weak

brain vessel that ruptures

*Reference: American Heart/Stroke Association 2008

TIA• aka, “mini stroke”• Blood clot temporarily blocks the blood

vessel• Stroke prevention factors

– Medical treatment– Surgical evaluation

Evidence-Based Medical Literature

• Prevention• Early detection• Early diagnosis and treatment• Organized care

Prevention: Controllable Risk Factors

• High blood pressure

• Cigarette smoking

• Diabetes mellitus

• Carotid or other artery disease

• Atrial fibrillation• Other heart

disease• Obstructive

sleep apnea

• Sickle cell disease

• High cholesterol• Poor diet• Decreased

physical activity• Obesity• Alcohol/drug

abuse

Prevention: Uncontrollable Risk Factors

• Age• Family history• Race• Gender• Prior stroke, TIA, heart attack

Secondary Prevention• Blood pressure management• Aspirin• Plavix• Coumadin• Statin• Smoking cessation• Eliminating alcohol intake• Weight reduction/modified diet• Exercise

Early Identification• Fact: Stroke is

highly treatable within the first three hours

• Time is brain!

Stroke Signs/Symptoms• When a part of the brain begins to die,

there are signs and symptoms that this is happening– 2 million brain cells die each minute

• Remember as much as possible about a person’s responses– Actions or lack of actions– What time did the signs begin?

Stroke signs/symptoms

Stroke Signs/Symptoms

Stroke signs/symptoms

Is their BALANCE off?Things to look for or ask:• Can they stand and sit straight and tall?• Do they slump of lean to the right or left?• Can they walk in a straight line or do they

veer to the left or the right?• Do they drag a right or left leg or foot?• Do they let a right or left arm hang when

they walk?

Is their SPEECH SLURRED or FACE DROOPY?

Things to look for or ask:• Does one side of the mouth droop when

they smile?• Do both eyes close when they blink?• Can they stick their tongue out straight?• Can they say “______________”?• Do they sound like they have something in

their mouth when they speak?• Do their words make sense?

Is one side WEAK or NUMB?Things to look for or ask:• Ask the person to raise both their arms up

together in front of them. Does one arm begin to fall down?

• Ask the person to squeeze your fingers with each hand. Is one hand weaker than the other?

• Ask the person to try to hold something like a pen, cup, spoon or fork. Can they do it without any difficulty?

• Can the person feel you lightly touch them on both arms? Ask them if the feeling is the same on each.

Is their VISION all or partly lost?

Things to look for or ask:• Ask the person whether they can see. Do

you look clear to them? Do you look blurred? Do they see more than one of you?

• Ask the person whether they normally wear glasses or contact lenses.

• Ask the person to describe any changes in vision.

• When they look straight ahead, can they see a little to both sides and up and down?

Is their HEADACHE severe?Things to look for or ask:• Do they have any pain anywhere?• Do they have a headache? On a scale of 1-10,

10 being the worst, ask them to rate their headache.

• Do they normally have headaches? Is this headache any different from their usual headache?

• Does this feel like the worst headache of their life?

• Does light bother or hurt their eyes?• Does a sound or loud noise make the headache

worse?• Is their pain different when they stand, sit or lie

down?

Immediate Actions to Take• Remember what is happening or write it

down if it does not slow down in getting emergency help

• Time is brain!• Options:

– Call 911– Get to an Emergency Department

Stroke Treatment: Thrombolytics

Alteplase (tPA)=

Clot buster

tPA Benefits• Independent life vs. dependent

– Excellent recovery = 31% vs. 20%– Death = 9% vs. 20%

• For every 100 patients treated with tPA:– 32 benefited– 3 were harmed

Organized Care• Consistent, efficient use of proven medical

treatment in an organized manner• Care protocols• Outcome measures

Primary Stroke Centers: Proven Outcomes

• Rapid evaluation and treatment– ie: thrombolytics

• Urgent referral for more advanced clot treatment

• Specialty units in the hospital with experienced staff

• Initial and ongoing reviews of care– Certifying agency such as Joint Commission

Primary Stroke Centers: Proven Outcomes

• 19% decline in mortality• 25% decline in death/institutional care• 29% decline in death/dependency• Increase in expediency of MD evaluation,

CT, tPA administration

*Reference: Cochrane Database, 2000

What Can You Do?Community and family outreach• Reduce risk• Recognize signs• Respond quickly

Questions?Resources available:• Resurrection Health Care 1-877-RES-INFO (1-877-737-4636)

www.reshealth.org

• Your Resurrection Health Care Hospital’s Stroke Care Coordinator

• American Heart/Stroke Association 1-888-4-STROKE www.strokeassociation.org

• National Stroke Association 1-800-STROKES • www.stroke.org

• American Physical Therapy Association 1-800-999-APTA (2782)• www.apta.org

• American Occupational Therapy Association 301-652-2682• www.aota.org

• American Speech-Language-Hearing Association 301-296-5700• www.asha.org