Bill Klaproth: Stroke is the leading cause of disability and needs to be taken seriously. Unfortunately, sometimes the warning sign and symptoms of a stroke go ignored. Here to talk with us about those signs and symptoms is John Dix, a certified emergency nurse and stroke certified registered nurse at Eisenhower Medical Center. Thank you for your time today. Can you share with us, first off, the typical signs and symptoms of a stroke?
John Dix, BSN, RN: Typically, a stroke is going to present very suddenly. It's not going to be a gradual onset. It's going to be a sudden onset of weakness on one side of the body, facial droop, slurred speech, trouble coming up with your words or naming objects. There could be a sudden onset of dizziness, headache, balance problems or even vision changes.
Bill: We know that sometimes people ignore these signs and symptoms. Why do people have a tendency to do that? I guess everyone should know that when you're speaking of stroke, time is really critical, right?
John: Time is the most important thing. This is a true medical emergency that needs to be taken seriously. We really only have a couple hours to do the most benefit to save your brain tissue, so coming in quickly is the most important thing. Sometimes people ignore these symptoms because we've often had situations where we've slept wrong and maybe our arm doesn't feel right and it's a little numb or 'being asleep.' Different things like that we've experienced before and so we often times don't want to think it's happening to us, but it's if you are perfectly fine and now all of a sudden you can't move your left side of your body or you can't name a pen which you've always been able to name before. Those symptoms are very classic, but we often times want to ignore them because we don't want to think it's happening to us.
Bill: Sudden is what we need to be aware of, right? You were just saying if you're fine one minute, the next minute all of a sudden, you're dizzy or that headache, that suddenness is what you really need to be aware of.
John: Exactly. That's one of the cardinal signs of a stroke. Not that it comes on gradually, that it feels like my fingers are a little numb and now it feels like I can't move my arm, that's more potentially a sign of a neck problem where you're having some numbness down your arm and some weakness in your arm from your neck or something like that. That's gradual and that comes on very slowly. The stroke symptoms are going to happen rapidly. You're going to be perfectly fine, and now all of a sudden, you can't come up with your words basically it's a very sudden change.
Bill: That's very good to know. I know a lot of people think either I'll wait it out or I'll drive myself to the emergency department. Wrong. Tell us why that's not a good idea.
John: That's the biggest message that I want to get across to the community. We need to activate 911 when we have stroke symptoms happening. There are many different reasons for that, but one of the things people often times think they can drive themselves into the hospital, but if you're driving yourself, what if things get worse and all of a sudden, you pass out or unable to operate the vehicle? You then have to pull over and call 911 anyways. The other thing is if your loved one is driving you in and all of a sudden you go unresponsive and you have more going on, they aren't going to be able to do anything for you. The paramedics are an integral link in the chain. They're not just taxi drivers or people who drive you to the hospital, they start the treatment, so they get an IV and they get bloodwork, they check your blood sugar because if your blood sugar is low, that can be one of the reasons you're having the symptoms. They treat those things immediately that's a life-threatening emergency of another variety. If something happens on the way in, they can save your life. Secondly, they'll alert the hospital that there is something going on, so they call the emergency room on a direct line and we get the information, 'this patient has a sudden onset of weakness on their left side, trouble talking at 6:30 this morning,' they can tell us those things and get our team assembled and ready, so that when you roll through the door with the paramedics, we're already prepared and ahead of the game.
Bill: The quicker you get diagnosed too, the better chance of effective treatment, is that right?
John: Exactly. Every minute that goes by, and I know this is going to sound staggering, you're losing millions of brain cells. Fortunately, we have a lot of brain cells. We have trillions of brain cells, but it's not about 'if I go in in two hours, they'll be able to fix this and then I'll be okay after that.' Every minute that goes by, you're losing tissue in your brain if you're actually having a stroke because the blood supply is not being pushed to the areas that need it, and so it's not getting the nutrients, the oxygen and the things they need to survive. The longer the time goes on, the more brain cells that die and the less chance that we can reverse the damage and bring those back into usefulness again. We really have three hours ideally to get treatment going, but if you come in a few minutes after it started, you're better off than if you come in two hours after it started because each minute that goes by, damage is being done.
Bill: It's so important and hopefully now we've got people's attention, so talk to us about risk factors. Who is at risk for a stroke?
John: All of the things that cause damage to our arteries and our body that can cause us to have a heart attack also can cause us to have a stroke. It just is in a different area of the body and the brain instead of in the heart. What you're looking at is uncontrolled blood pressure, high cholesterol, diabetes with the blood sugars out of control, and things like drinking excessive amounts of alcohol, drug use, lack of exercise, just sitting in that chair is not a good thing - you need to move and keep your body active and keep all your muscles working and doing what they're supposed to do - and also smoking is just one of the most detrimental things that you can do to your body because smoking causes damage to every part of your body, including all the vessels that would be necessary for carrying blood around our body and would prevent us from having a stroke. The same risk factors for heart attack are the things that we need to control in order to keep us from having a stroke.
Bill: Those are all great things to be aware of. Can you talk about the different types of stroke?
John: There's actually two major different types of stroke. Not to get into a lot of the details, but one is caused by a blood clot blocking the blood flow to further parts of the brain and the other is caused by that same blood vessel bleeding or having a break in it and it ends up bleeding into that surrounding tissue in the brain. Both are considered strokes, one is an embolic stroke and the other is a hemorrhagic stroke, the bleeding variety, but both are treated very differently. Often times, people know when they're having a heart attack that they should take an aspirin and they chew up a full-strength aspirin. That is a great thing if you're having a heart attack, but if you're having an embolic stroke, we'll give you aspirin at the hospital. If you're having a hemorrhagic stroke, the aspirin is going to make you bleed more. It's really not a good idea to take that aspirin if you think you're having stroke symptoms. It's better for us to delineate which type of stroke you're having and then to treat you in the hospital accordingly. They really are two different types of stroke and they are treated very differently. With the bleeding stroke, we need to very quickly control the blood pressure so that you don't bleed more. Secondly, we need to reverse any of those blood thinning agents that people take in order to help with things like arterial fibrillation or blood clots that they've had in the past - the Coumadin, the Pradaxa, the Eliquis, the Xarelto, even the 81-mg baby aspirin is enough to make your blood thin enough that we may have to reverse it by giving you a medication to take care of it and make your blood stick together a little better to stop the bleeding. On the other side with the embolic stroke, which is caused by a blood clot blocking that vessel, we then need to give you a medicine called TPA that will break up that clot and make it so that we restore blood flow to the portions of the brain past that. Both are strokes, but both are treated very differently and taken very seriously.
Bill: That's an important distinction. Is there one that's more common than the other?
John: Truly the one that's the most common is the blood clot variety or what we call an embolic stroke. That's the one that we're often times thinking of when we think of a stroke. That's 83% of the time I think it's embolic. The other 17% are of the hemorrhagic variety, a lot lower percentage, but there's the huge distinction between the two. The embolic stroke will often times cause major disability; it's the leading cause of disability in our world. The hemorrhagic stroke can kill you. If you bleed into your brain, obviously that makes sense that it's not a very good thing; that's the variety that can actually kill you. Even though it's a smaller percentage of the time, it's extremely serious and you're going to end up in the intensive care unit. The other variety really is just going to potentially disable you, but if we can get blood flow restored quickly enough, we can help regain some of that tissue, and then our body can do a miraculous job of healing and create pathways around that around that was affected so that we restore blood flow and function to our bodies. They're both very different, one much more common, but both medical emergencies.
Bill: Good to know and take those signs and symptoms seriously and call 911 right away. Thank you so much for your time. To learn more, visit eisenhowerhealth.org/stroke. That's eisenhowerhealth.org/stroke. If you would like to attend a community event about stroke prevention or any other health topic that interests you, visit eisenhowerhealth.org/calendar. That's eisenhowerhealth.org/calendar. This is Living Well with Eisenhower Health. I'm Bill Klaproth. Thanks for listening.