Conditions We Treat
Stroke and Transient Ischemic Attack (TIA)
Stroke is a medical emergency. Highland Hospital is a New York State designated Stroke Center, and Highland Neurology is an integral part of the care team that provides comprehensive evaluation and management of stroke. From the Emergency Department to the outpatient office, our patients receive state-of-the-art evaluation for treatment and prevention of stroke.
Symptoms of Stroke
There are many different possible symptoms of stroke depending on the area of the brain affected. According to the American Stroke Association, some common symptoms include:
Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body
Sudden confusion, trouble speaking or understanding
Sudden trouble seeing in one or both eyes
Sudden trouble walking, dizziness, loss of balance or coordination
Sudden, severe headache with no known cause
Treatments are available, but must be given within hours of symptom onset. If you think someone you know is having a stroke, call 9-1-1 and get them to a hospital right away.
Different Kinds of Stroke
Stroke symptoms occur because of a problem with the blood supply to the brain (or, rarely, the spinal cord). There are two main kinds of stroke: ischemic and hemorrhagic. Ischemic stroke occurs when a blockage in a blood vessel keeps blood from flowing to part of the brain. Hemorrhagic stroke occurs when a blood vessel bursts or leaks and prevents blood from flowing to the brain.
A transient ischemic attack (TIA) is a temporary interruption in blood flow to the brain. The symptoms of TIA are identical to those of stroke, but by definition, the symptoms resolve in less than 24 hours without permanent neurological problems. Unfortunately, the diagnosis of TIA can only be made in hindsight. All symptoms of stroke are emergencies that must be evaluated promptly in the Emergency Department.
Ischemic stroke is the most common form of stroke. Blood flow is interrupted by a blockage in one of the arteries carrying blood to the brain. Ischemic strokes are usually painless. There are many different symptoms, but in all cases, nerve cells begin to suffer immediately and die within minutes unless blood flow is restored. Powerful new medications are available to dissolve blood clots, but these must be administered within three hours of symptom onset. Even when patients are not eligible for such powerful drugs, though, treatment is available to minimize the damage and optimize recovery.
Hemorrhagic stroke occurs when a blood vessel in the brain bursts or leaks. This prevents blood from flowing to the brain and causes nerve cells to die. Unlike ischemic stroke, patients with hemorrhagic stroke often experience headache and may even lose consciousness. Treatments include medications to lower pressure in the brain, control high blood pressure, and improve blood flow. In some cases, surgery is indicated. New treatments for hemorrhagic stroke are becoming available and should improve the range of possible treatments. Get more information on new treatments from the Stroke Association.
Causes of Stroke
Many of the same conditions that cause heart attacks also contribute to stroke, and all of these can be modified with treatment and lifestyle modification. These conditions include:
High blood pressure
Poorly controlled diabetes
Other risk factors include narrowing of the major arteries carrying blood to the brain, and some heart rhythm disturbances (especially atrial fibrillation).
Evaluation of Stroke
The initial evaluation of stroke takes place as soon as emergency medical technicians arrive. These professionals have been trained to recognize early symptoms of stroke in the field and alert hospital emergency personnel that a potential stroke victim is on the way.
Once the patient arrives in the Emergency Department, the patient is seen and assessed rapidly by a team of professionals including emergency medicine physicians, nurse practitioners, nurses, physician assistants, neurologists, and neuro-radiologists. Specialists from neurosurgery or intensive care medicine may be consulted depending on the patient’s condition. A rapid history and examination is performed along with urgent analysis of blood counts and blood chemistries. A computed tomography scan (CT scan or "CAT" scan) is usually performed as well. Based on all this information, a decision is made about the best way to treat the patient to halt or reverse the damage from stroke and minimize any residual problems.
Although each case is different, most patients are admitted to the hospital for further evaluation, including magnetic resonance imaging (MRI) scans, heart monitoring, other heart tests, and evaluation for narrowing or blockage in major bloods vessels flowing to the brain. Most patients are also evaluated by specialists from physical therapy, occupational therapy, speech-language pathology, and rehabilitation medicine.
Treatments for Stroke
When stroke strikes, time is brain. A study published by Dr. Jeffrey Saver of the UCLA Stroke Center estimated that for each minute without blood flow, a typical stroke patient's brain loses 1,900,000 nerve cells, 14,000,000,000 connections between nerve cells, 7.5 miles of nerve fibers, and every hour without treatment, the brain of a stroke patient ages the equivalent of 3.6 years (J. L. Saver. Time is brain – quantified. Stroke 2006, volume 37, pages 263-266).
Treatments for ischemic strokes include powerful clot-busting drugs, but these must be administered within three hours of symptom onset. Other methods to physically remove blood clots are being studied (see the National Institutes of Health for more information). In all patients, though, treatment at specialized stroke centers can minimize damage and improve outcome from stroke, regardless of how long symptoms have been present.
Treatments for hemorrhagic stroke are aimed at stabilizing the patient, stopping bleeding in the brain, controlling pressure in the brain, and preventing re-bleeding. Again, all patients benefit from the expert treatment available at designated stroke centers. In some cases, surgical evacuation of the blood can be life saving.
An important part of the stroke evaluation is determining why the patient had a stroke in the first place. Once that is known, further treatment is directed at preventing more strokes in the future. Possible treatments include use of anti-platelet agents (such as aspirin), cholesterol lowering medications, blood pressure medications, and sometimes blood thinners to reduce the risk of another stroke. Our stroke neurologists at Highland Neurology work with the patient and their other health care providers after discharge to promote rehabilitation and minimize the risk of future stroke.
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