Stroke treatment needs to be fast and precise. No matter where you are in Louisville, Southern Indiana or the broader region when stroke symptoms occur, Norton Neuroscience Institute is ready to provide award-winning care.

Norton Healthcare operates the area’s largest stroke system. At its core is Norton Brownsboro Hospital, which is certified as a Comprehensive Stroke Center by The Joint Commission and the American Heart Association/American Stroke Association — the highest designation available.

More stroke patients and others with neurological conditions trust their care to the specialists of Norton Neuroscience Institute than any other provider in the area.

The Norton Healthcare emergency stroke teams stand ready around the clock every day of the year to activate a well-rehearsed response when emergency medical technicians alert them to an incoming suspected stroke or when a patient enters an emergency department.

A precise diagnosis of the type of stroke and where in the brain the stroke is happening is critical to restoring blood flow to the brain quickly and giving the patient the best chance of recovery. Most strokes are ischemic, meaning they are caused by a clot blocking blood flow to the brain or inside the brain. The other type is a brain-bleed stroke, or hemorrhagic stroke. Each requires a different treatment approach.

Many ischemic strokes can be treated with a powerful medication that breaks apart a blood clot.

Others require minimally invasive endovascular procedures to insert a tiny tool through the blood vessels and thread it up to the site of the clot or the source of the bleeding. The tools clear the blockage and can retrieve the clot from the body or repair any broken blood vessels.

The emergency stroke team needs to determine the type of stroke and rule out a brain tumor, reaction to medication and other possible causes of your symptoms.

Newly installed biplane X-ray technology at Norton Brownsboro Hospital provides high-resolution imaging that allow surgeons to better see the source of a stroke. The technology has two X-ray tubes that rotate around the patient while on the operating room table to capture images that are combined digitally to produce a 3D, finely detailed picture of the blood vessels.

Norton Brownsboro Hospital’s two hybrid biplane rooms were the second and third in the country with such technology.

Knowing what to do — and what not to do — if someone is having a stroke can have a lasting impact on their recovery.

TPA Stroke Treatment

Tissue plasminogen activator (tPA) is a protein that triggers enzymes in blood to break clots apart.

Without blood supply, brain cells start to die at a rate of about 32,000 a second. To be effective, the medication must be administered within 4 1/2  hours of the first symptoms of a stroke.

Norton Neuroscience Institute’s comprehensive stroke system consistently beats the American Heart Association (AHA)/American Stroke Association’s aggressive benchmarks to deliver tPA to ischemic stroke patients quickly and safely.

The AHA awarded its Get With the Guidelines – Stroke Care award to Norton Healthcare’s four adult-service hospitals.

For example, when emergency medical services responders alert a Norton Healthcare hospital that they are en route with a suspected stroke case, an emergency stroke care team will ready computed tomography (CT) scanning equipment and keep a table free for the incoming patient. Kits are set up that contain the medication and tools for mixing the tPA and delivering the appropriate dosage. The board-certified, fellowship-trained neurologists and neurosurgeons of Norton Neuroscience Institute begin reviewing details about the patient’s condition.

If you’re picturing a race-car pit crew jumping into action, you aren’t far off.

The emergency stroke care team includes:

• Emergency medicine physicians
• Advanced practice providers and nurses
• Neurologists
• Endovascular neurosurgeons
• Neuroradiologists

Ischemic Stroke

About 85% of strokes are ischemic — caused by blood clots that block blood flow to the brain either in the neck or the skull. The clots typically form in the heart or nearby blood vessels as plaque that has built up breaks away. Once in the bloodstream, the clot can fall apart on its own. If it gets lodged in an artery that supplies blood to the brain, it causes a stroke.

Ischemic strokes most often are treated with tPA administered intravenously in the arm. The medication prompts a clot to break apart, restoring blood flow.

In some cases, especially if the clot is large and located in one of the main arteries in the brain (large vessel occlusion), the best treatment may be to remove the clot manually. Norton Neuroscience Institute endovascular surgeons can remove clots with minimally invasive tools. A tiny wire cage is threaded through a blood vessel, usually through the groin, up to the site of the clot in the brain.

The endovascular surgeon opens the tool and grabs the clot, which is secured inside the tool and retrieved.

The procedure, a mechanical thrombectomy, can be performed in conjunction with tPA or as long as 24 hours after the start of symptoms.

A transient ischemic attack, sometimes also called, incorrectly, a “mini stroke,” can last only a few minutes and not cause permanent damage. But a transient ischemic attack should be considered as a warning as many people go on to have strokes.

Signs of a transient ischemic attack resemble early stroke symptoms and go away, usually within an hour. Since treating stroke successfully relies on speed, get emergency care right away if you or someone close to you has stroke symptoms.

Brain Bleed (Hemorrhagic Stroke)

A brain bleed, or hemorrhagic stroke, occurs when a blood vessel in the brain leaks or bursts. The leaking blood puts pressure on the brain, killing brain cells. A brain bleed can be caused by conditions such as high blood pressure, an aneurysm (bulges in a blood vessel that can burst) or an arteriovenous malformation (known as an AVM, it’s an abnormal tangle of capillaries connecting an artery and vein).

Brain bleeds, also called cerebral hemorrhages, typically occur inside the brain, but also can  result from bleeding just under the tissues that cover the outside of the brain.

Treatment of a hemorrhagic stroke depends on its severity. Medications can be used to reverse the effect of any blood thinners you take, lower your blood pressure and lower the pressure in your brain.

If surgery is needed, Norton Neuroscience Institute endovascular surgeons will thread tiny tools through your blood vessels and up to the site of the bleeding to drain blood and repair the cause of the bleeding.

Aneurysms can be clamped or filled with a tiny coil to promote clotting through minimally invasive endovascular procedures. Some AVMs can be removed surgically, while others may be targeted with a focused beam of radiation in a stereotactic radiosurgery procedure.