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Stroke 101: Signs, Diagnosis and Treatment

Patti Brettell, MD, neurologist and Medical Director for the stroke program at Skagit Regional Health and Jay Biessel, DO,  Emergency Department provider and stroke champion at Skagit Regional Health, discuss strokes, the signs and symptoms, what you should do if one happens and more.

Patti Brettell, MDMany of us would be hard-pressed to say we don’t know anybody who had ever suffered a stroke. This medical condition is incredibly common among Americans—with nearly 800,000 strokes occurring in the United States each year. To put that in perspective: Every 40 seconds, an American has a stroke. Every 3.5 minutes, someone dies.

Given that, it’s incredibly important to know the signs of a stroke. Strokes can be debilitating, but they don’t have to be if early intervention occurs.

Recognizing Stroke’s Red Flags

A popular and effective strategy to promote stroke awareness has been through the acronym BE FAST. It’s an easy way to remember the signs and symptoms of a potential stroke.

  • B—balance issues
  • E—eye/vision changes or difficulties
  • F—facial drooping
  • A—arm weakness or unevenness
  • S—speech, as in trouble speaking/forming sentences
  • T—time is of the utmost importance, as brain cells are already dying

If any of these symptoms are present, it’s time to call or text 9-1-1 immediately. Do not try to get yourself to the hospital on your own. There are many steps emergency response workers can take to mitigate the effects of stroke and prepare physicians for your arrival at the emergency department.

“There are a lot of things they do pre-arrival to the emergency department that really helps my assessment and management; things you could not do yourself in a private vehicle heading to the emergency department. This includes checking blood sugar, blood pressure, assessing and documenting your symptoms at time of onset. Those are all very helpful,” states Dr. Jay Biessel, emergency department professional and stroke champion at Skagit Regional Health.

What Happens in the Aftermath of Stroke?

Upon arriving at the emergency department, one of the first actions is to do a quick neurologic assessment, take vitals and a trip to the imaging department to get a CT of the patient’s brain. This is important to differentiate between an ischemic stroke and a hemorrhagic stroke. The treatment and management plan is different for each—but both require timely intervention.

With hemorrhagic strokes, it’s crucial to stop the bleeding and control the patient’s blood pressure. Dr. Biessel connects with a neurologist to determine the next steps.

Ischemic strokes are much more common, comprising approximately 87% of stroke occurrences. This type of stroke involves a clot blockage, which can be resolved with a “clot-busting” medication. However, the stroke needs to be identified and medication administered within about four hours of the stroke’s onset. So, as soon as the clock starts ticking, every minute matters.

“It's very important to get to the hospital as soon as you can because these drugs work best and open the vessel without complications if they're done very close to the onset of symptoms. The faster you can get there, the better these drugs are going to work,” explains Dr. Patti Brettell, Stroke Medical Director at Skagit Regional Health. “We also have the opportunity with our stroke affiliate, Swedish Providence in Seattle. The faster you're in our facility, the faster we can arrange for you to be transferred if you do have a large vessel occlusion that would be amenable to this.”

In some cases, and at high-level stroke centers, individuals may be eligible for a longer timeline for intervention to occur. “I don't want anyone to feel that just because their symptoms are outside of that four-and-a-half-hour time window, there's nothing we can do,” adds Dr. Biessel.

Tactics to Prevent Stroke

Education is an integral part of stroke awareness. This includes a number of preventative measures. For example, controlling blood pressure, eating a healthy diet, regular exercise, smoking cessation—as well as cardiac monitoring when appropriate. When using these measures, and staying educated, research indicates that 82-90% of strokes are preventable.

“They're simple things. Simple, but hard for us to do sometimes. Women particularly have not been guided well about stroke prevention and what to do about it,” shares Dr. Brettell. “Women don't put themselves first. I believe we know when something's not right with our body, and we need to tell someone about it and do something about it.”

Again, should a stroke occur, time is of the essence. “We can potentially do something about the stroke and turn it around. Obviously, the medications and the intervention, they're not a golden bullet. They don't work on everybody, but it's something,” assures Dr. Biessel. “And there's definitely benefit and a better chance for survival and a return to baseline.”

Click here to learn more about the Skagit Regional Health telestroke program.