Adam Rochman, MD, is the medical director of Augusta Health’s Emergency Department and a member of Augusta Health’s Stroke Team. The Stroke Team brings together staff from many departments throughout the hospital to focus on the care and treatment of stroke patients. This interdisciplinary team meets monthly to discuss stroke quality metrics and measurements, treatments and stroke care, and performance improvement opportunities.
Here are five points Dr. Rochman wants everyone to know about stroke and stroke care at Augusta Health:
1. Early recognition is key
In the United States, strokes are the leading cause of adult disability and the fifth leading cause of death. On average, a stroke happens every 40 seconds and someone in the United States dies from a stroke every four minutes.
Symptoms will depend on where in the brain the stroke is occurring. Stroke symptoms include:
- Sudden numbness or weakness of face, arm or leg — especially on one side of the body
- Sudden confusion, trouble speaking or understanding
- Sudden trouble seeing out of one or both eyes
- Sudden trouble walking, loss of balance or coordination
- Sudden severe headache with no known cause
Note the time that the first symptoms appeared — this will be important for treatment — and seek immediate emergency medical attention.
Do not wait or ignore the symptoms, hoping they will go away. Even if they seem to improve, you should be seen by a doctor.
2. Know the two types of strokes
Ischemic stroke: The most common type of stroke is an ischemic stroke. This is when a blood clot in one of the blood vessels in the brain prevents blood from reaching all parts of the brain. About 85% of strokes are ischemic.
Hemorrhagic stroke: The second type of stroke is a hemorrhagic stroke. This is when a blood vessel bursts or leaks, and blood spills into the brain causing swelling, pressure and damage. Only about 15% of strokes are hemorrhagic, but they are responsible for 40% of stroke deaths.
3. Early treatment leads to better outcomes
The more quickly stroke treatment begins, the better the possibility for a good outcome. According to the stroke.org website, for each minute a stroke goes untreated and blood flow to the brain continues to be blocked, a person loses about 1.9 million neurons. This could affect a person’s speech, movement, memory or other functions. To reduce the possibility of death or disability from a stroke, it’s important to seek emergency attention any time someone experiences one of the signs or symptoms of a stroke.
The only Food and Drug Administration-approved drug treatment for ischemic stroke is tissue plasminogen activator, tPA. It’s a clot-busting drug given by IV. It works by dissolving the clot and improving blood flow to the part of the brain being deprived.
There is a time limit for tPA. It should be given within three hours of the first sign of stroke. In some cases, it can be given within 4.5 hours of the onset of the stroke. Some patients, such as those with high blood pressure or a high risk of bleeding, are not candidates for tPA.
4. Another option: surgery
For patients who are not candidates for tPA, and even for some who have received it, there is a surgical option for removing the clot during an ischemic stroke. It’s called endovascular therapy, or thrombectomy. It’s similar to the cardiac cath procedure done to remove blockages in the heart. A neuro-interventionist inserts a mechanical device into the blocked artery. Once inside the blood vessel, a tool can be used to either break up the clot or pull it out.
Thrombectomy works best for big clots, located in the proximal vessels that are discovered and treated within six hours after the start of symptoms. So it depends on the size of the clot, its location and the time since the stroke. At Augusta Health, between 18 and 30 patients have been candidates for thrombectomy each year. They are flown to the University of Virginia Health System (UVA).
5. Augusta Health Neurology and the UVA Telestroke Team work together
Because it’s important to rapidly identify which patients may be candidates for thrombectomy, Augusta Health and UVA have been connected via the Telestroke Program since 2015. Over the years, the two staffs have developed a great relationship and rapport that benefits the patients. They work together on neurological evaluations and confer in real time to determine what steps are appropriate. The tPA can be administered at Augusta Health. If the patient needs to have a thrombectomy, he or she can be sent to UVA without delay. The results for patients have been amazing!