A neurologist and neurosurgeon explain why time is essential when treating a stroke. Comprehensive Stroke Center certification means a hospital is set up to offer the highest level of care — fast.
We’ve all heard “time is money” and “time heals all wounds.” What about this one? “Time lost is brain lost.”
Treating a stroke quickly can mean the difference between recovery and irreversible brain damage, or even death, according to Bryan J. Eckerle, M.D., neurologist with Norton Neurology Services, and Tom L. Yao, M.D., endovascular neurosurgeon with Norton Neuroscience Institute.
BE FAST if you suspect a stroke
If you think someone might be having a stroke, remember to BE FAST to get help:
Balance: Is the person having trouble walking? Does the person have a loss of balance or coordination or dizziness?
Eyes: Is the person having trouble seeing? Has the person had a change in vision in one or both eyes?
Face: Ask the person to smile. Does the smile look even? Warning sign — One side of the face does not move as well as the other.
Arms: Ask the person to raise both arms. Does one arm drop down? Warning sign — One arm does not move, or one arm drifts.
Speech: Ask the person to repeat a simple sentence such as, “You can’t teach an old dog new tricks.” Does the person have trouble speaking or seem confused? Warning sign — The person slurs words or cannot speak.
Time: Call 911 immediately; time lost = brain lost. Let emergency responders know the last time you saw the person well. More advanced treatment options may be available if medical care is received within three hours of the start of symptoms.
Another symptom could be a sudden, very severe headache.
Remembering these steps could save the life of someone you care about.
Adapted from Intermountain Healthcare. BE FAST was developed by Intermountain Healthcare, as an adaptation of the FAST model implemented by the American Stroke Association. Reproduced with permission from Intermountain Healthcare. Copyright 2011, Intermountain Healthcare.
Once someone has a stroke, the single most important factor in avoiding or reducing the chance of brain damage is the time it takes to start treatment, according to Dr. Eckerle.
As soon as a patient enters a Norton Healthcare emergency department with stroke symptoms such as facial weakness, difficulty talking or trouble moving one side of the body, Norton Healthcare doctors and others know what to do. They move quickly to use cutting-edge tools to determine the type of stroke and the right treatment.
Spotting different kinds of strokes
There are two types of strokes: ischemic and hemorrhagic. About 90 percent of strokes are ischemic strokes, when there’s a disruption of brain function caused by a blockage in a blood vessel that flows to the brain. Hemorrhagic strokes occur when blood pools in or around the brain due to a ruptured aneurysm or vessel, or other condition. Treatment is very different for each type.
In order to determine whether an individual has suffered an ischemic or hemorrhagic stroke, a treating physician traditionally employs diagnostics such as a standard computed tomography (CT) scan, magnetic resonance imaging (MRI) or a CT angiogram (which involves injecting dye into blood vessels to evaluate blood flow). These traditional diagnostic methods are limited, however, because they only show the physical abnormality. More advanced technology, in the form of a CT perfusion scan, now enables doctors to distinguish between portions of the brain which have suffered irreversible damage versus other portions which are still at risk for brain death.
“That helps us make decisions about which patients should be rushed to the operating room,” Dr. Eckerle said.
Time is still the biggest factor
Traditionally, stroke treatment was strictly based on how quickly they were treated. The first-line treatment for an ischemic stroke is tPA (tissue plasminogen activator) to dissolve clots within the first 4½ hours of the first symptoms. Mechanical thrombectomy, a procedure in which a surgeon inserts a catheter into the blocked blood vessel from the groin to remove the clot, works best if performed within 12 hours of the first symptoms.
Although time is still critical, advanced imaging (like CT perfusion) allows doctors to expand the potential number of patients who can benefit from advanced intervention, such as thrombectomy.
“Because scans can identify how much brain is already dead or about to die, we can then individualize treatment to optimize each patient outcome and better quantitate the risk of surgery versus medical treatment,” Dr. Yao said. “Obviously the more at-risk brain there is, the more potential brain we can save. In all cases, when at-risk brain is identified, it’s important we move as fast as possible to save that brain before it dies.”
In a bleeding stroke, it’s essential to stabilize the patient as soon as possible, according to Dr. Eckerle. This may require emergency surgery to stop the bleeding.
Comprehensive Stroke Center care at the hub
Norton Healthcare is the region’s largest stroke system, with diagnosis and treatment response times faster than the national average.
Norton Neuroscience Institute
At Norton Neuroscience Institute, our team of nationally recognized neurologists, neurosurgeons and neuropsychologists provide innovative care tailored to the individual needs of our patients.
The American Heart Association and The Joint Commission have certified Norton Brownsboro Hospital as a Comprehensive Stroke Center. With the system’s most advanced diagnostic technology, it serves as Norton Healthcare’s hub for stroke care and supports its other hospitals, which are certified Primary Stroke Centers. Norton Women’s & Children’s Hospital is certified as an Acute Stroke Ready hospital.
“We make sure all our hospitals are fully trained to handle any stroke patient,” Dr. Yao said. “It doesn’t matter where they land in our system” to get the best care available.
Dr. Eckerle encouraged everyone to be vigilant about the warning signs of stroke.
“It’s frustrating when we see a patient who thought they might be having a stroke but ignores it and come in hours or days later when there is nothing we can do,” Dr. Eckerle said. “We would rather people overreact to their symptoms than ignore them.”