In stroke care and treatment, every minute matters

Brain Health

by Dion Graybeal, MD

Sep 21, 2018

Stroke causes an estimated 140,000 deaths each year, according to the Centers for Disease Control and Prevention. The longer a stroke is in progress, the greater the risk of permanent brain damage or death. This is why Comprehensive Stroke Centers are designed around very rapid diagnosis and treatment.

For every minute a patient is having a stroke, almost two million brain cells are lost. The sooner a medical team can intervene, the more quickly the patient receives a drug or device, limiting damage, reducing disability and ensuring a better outcome.

Stroke occurs when blood flow to the brain is interrupted or reduced, resulting in a lack of oxygen and subsequent tissue damage. The most common types of stroke are ischemic stroke, which is typically caused by an arterial blockage in the brain, and hemorrhagic stroke, which occurs when an artery in the brain leaks blood or bursts. Less common is cryptogenic stroke, which is a stroke with no readily apparent cause.

How to recognize a stroke

Because time is of the essence when it comes to stroke, it is important to quickly recognize the early signs and symptoms. The National Stroke Association suggests using the term “BEFAST” to help you remember the basics:

Balance: Rapid onset of balance problems
yes: Double vision or loss of vision in one or both eyes
ace: One side of the face droops or is numb
rm: One arm is weak
peech: Changes in speech, such as slurred words or speaking gibberish
ime: Time is critical. If you see any of these signs, call 911.

Time is especially important. If you identify these symptoms in your or someone around you, call 911 immediately. Emergency medical services (EMS) personnel know where the closest stroke center is located, and it’s vital that intervention occurs as quickly as possible.

Keep in mind that other parts of the body may also be affected by stroke, such as the legs, and that numbness or weakness typically occurs on only one side of the body. Other common symptoms include sudden vision problems in one or both eyes, trouble walking, dizziness, loss of balance or coordination, and a sudden, severe headache with no known cause, which may indicate bleeding in the brain.

What happens when you come to the ER with stroke symptoms

Similar to the systems that direct patients to appropriate-level trauma centers based on the type of injury or illness, stroke patients require different levels of care depending on the type and severity of their condition.

There are three levels of hospital designation for stroke, with Level 1 being the most comprehensive. Baylor University Medical Center was accredited as a Level 1 Comprehensive Stroke Center in 2015 and has become one of the largest and busiest centers in Texas. Baylor Scott & White Medical Center – Temple is also a Level 1 program.

Several other centers across the Baylor Scott & White Health system have been designated as Primary Stroke Centers. Primary stroke centers provide emergency care, including clot-busting therapy, and more extensive evaluation and treatment than the average stroke-ready hospital.

Some patients, though, need more advanced treatment options, and require care in a comprehensive stroke center. These centers are equipped to provide advanced neurosurgical interventions and are able to handle the most difficult cases. They also have specialized neurological intensive care units.

To facilitate a rapid-care response, the stroke program works closely with its emergency medical services (EMS) partners, who confirm the stroke diagnosis, determine its severity, and relay this and additional information to the emergency department flow coordinator en route.

Related: 8 questions that can predict your risk of stroke

Innovating new stroke treatments

When you come into the Baylor University Medical Center emergency department experiencing a stroke, we have all of the tools immediately available to cut down on the time to provide treatment. We are at the point where we have the processes in place to give a clot-busting drug within 20 minutes of your arrival at our center.

This drug, tPA (tissue plasminogen activator), approved by the FDA in 1996, is the gold standard for the treatment of ischemic strokes. Initially, it was believed that the drug had to be administered within three hours of the onset of stroke for maximum effectiveness. However, in recent years, several international clinical trials have extended that window to four and a half hours, giving us more time to provide lifesaving intervention.

When it comes to stroke, time is critical.

There have also been significant advances in the tiny mechanical devices that are sometimes used to remove stroke-causing blood clots out of the brain, a technique that has proven effective more than six hours after a stroke has started. Such advances spring from ongoing international research into the diagnosis and treatment of stroke — something the stroke program at Baylor University Medical Center has been deeply involved in for years.

Research is important, but it’s individual patient outcomes that drive our work, including stroke severity before and after administering tPA, and level of disability three months after treatment. A much higher percentage of patients achieve little to no disability after their stroke when they receive tPA as quickly as possible — proving that when it comes to stroke, time is critical.

Find out more about the Comprehensive Stroke Center at Baylor University Medical Center or for additional stroke services, find a provider in your area.

About the Author

Dion Graybeal, MD, is medical director of the Comprehensive Stroke Program at Baylor University Medical Center.

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