Hershey Medical Center, this is ask
us anything about stroke. I'm Scott
Gilbert. What you may not realize is that
stroke is the leading cause of serious
long-term disability it's also the fifth
leading cause of death. You may not also
realize that experts say 80 percent or
maybe even 90% of strokes are actually
preventable. We'll be talking about these
issues today with two of our physicians,
the co-directors of the Penn State
Stroke Center. They are Dr. Ray Reichwein,
he's a neurologist. And Dr. Kevin
Cockroft, a neurosurgeon. Thanks for being
here today guys, appreciate it. Let's
start by talking about what a stroke is
what goes on in the brain when a stroke
happens. So a stroke basically is when a
blood vessel to the brain becomes
disrupted in some fashion. There are two
major types. An ischemic stroke is when
the blood vessel becomes blocked and a
hemorrhagic stroke or bleeding stroke is
when the blood vessel bursts and you get
blood around or in the brain itself. Okay
well which type is more common. The
ischemic stroke or the clot blocking of
a blood vessel is most common and it
accounts for about 85% of all strokes.
Let's talk a bit about the risk factors
and I'm curious to see whether the
causes of each of these strokes and the
risk factors differ depending on the
types. What are some of the most
common risk factors . So there's a acronym
out in society and we can hold up the
cup that walks through it but the common
symptoms fit into an acronym called
BE FAST and the B stands for a balanced
problem. The E stands for an eye problem
either visual loss or double vision. The
F stands for facial droop and or
numbness. The A stands for arm arm
weakness or numbness The F stands for a
speech problem
so just slurred speech probably getting
your words out or even understanding
what's going on. And then the T
emphasizes the importance of time, time
is brain. That the calling 9-1-1 and
getting the EMS system to bring you in
provides the best likelihood of
acute stroke care. You're watching ask us
anything about stroke from Penn State
health I'm Scott Gilbert along with
Reichwein, Dr. Cockroft. We all welcome
your questions and your comments on this
Facebook post. Whether you're watching it
live or even on playback, we can get some
answers to your questions. If you again,
you would just post them in the comment
field and also of course we encourage
you to share this
post. We're talking a bit about the
symptoms, the possible signs that someone
is seeing a stroke as suffering
a stroke and the BE in the BE FAST is new
Balance, Eyesight. Why were those added?
Well it turned out that the original
FAST acronym was missing a couple of
important areas and so the idea was to
add those in and try and cover now about
95 percent of those symptoms that people
will have when they're experiencing a
stroke. And the T stands for time and I
know I've heard you say many times both
of you "time is brain." Correct,
earlier the treatment, generally, the
better the outcome. And there's clear
established literature that supports
that there is a commonly available
clot buster called TPA and the quicker
you get it particularly under ninety
minutes from symptom onset the better
the outcome and the lower the risk and
there's some endovascular treatments
that Dr. Cockroft can talk about that
again also emphasized earlier treatment
is associated with better outcomes. So
you delay that care that could prevent
you from receiving the clot busting drug.
And it turns out that only about 30% of
people received the IV clot Buster
medication and the main reason they
don't receive it is because there's a
time delay they often get to the
emergency department
beyond the treatment window
unfortunately. Again, you're watching ask
us anything about stroke from Penn State
Health. Feel free to add your questions
and comments in the field below.
We will definitely pass
those along here to Dr. Ray Reichwein
and Dr. Kevin Cockroft. Dr. Cockroft, were
talking about TPA as one intervention as
a surgeon can you tell us about any of
the other options out there for breaking
up those clots. Sure! So if the TPA
does not work or if it turns out that
you actually have a very large blood
vessel that's blocked closing the stroke
and there's some other things we can do
and those things are usually device
or procedures that involve using a
device to go in and pull out or fish out
the clot and actually brought one of
these with me today and this is an
example of what this device looks like.
And I think you're stepping on it! And so
this is called a clot retriever device
this is one's called a solitaire and you
can see as I push it out there this is
kind of like a stent on a stick we call
it and this is going to go and grab a
hold of that clot
that's sitting in the blood vessel and
then once it's got ahold of the clot
takes about a couple of minutes then we
will pull this entire thing out while
applying suction on a larger catheter
down in the patient's neck. And that is
going to effectively remove the clot and
restore blood flow to that area . Now what
determines whether you would go with an
intervention like this versus TPA. So if
a patient has a large blood vessel
blocked in the brain and they are in
generally within six hours of the stroke
onset then we will contemplate doing
this we do some other advanced imaging
studies to look at the brain to see if
there's tissue that's salvageable so
sometimes we can go even longer than six
hours and unfortunately some people even
that are within the six-hour window are
not going to benefit from this because
they've already had too much damage. So
it's a bit of a complicated process just
because it can go out to six hours does
not mean you can show up at five hours
and 55 minutes. It really takes a little
bit of assessment beforehand to make a
judgment whether this is really going to
be useful or not so I would as Dr. Reichwein
said encourage you really just show
up as soon as possible to give you the
best options for treatment and the best
chance of making a good recovery. And
time is brain and these are treatments
we're talking about for ischemic strokes,
the blockage is 87% of all cases. The
remaining are those hemorrhagic strokes
you talk about interventions to treat
those. Yeah, so hemorrhagic strokes these
are things that are caused by brain
aneurysms by weakening blood vessels
that burst usually people that have
chronic high blood pressure or
hypertension can also be caused by
vascular malformations in the brain. A
lot of these these disorders can
actually be prevented so hypertension by
treating the hypertension and managing
your blood pressure well that can really
reduce your risk of that those the most
common type of hemorrhagic stroke which
is an intercerebral, or intercerebral
hemorrhage. The other ones aneurysms,
blood vessel malformations, if those are
found early or incidentally then many of
those can be treated to prevent a
rupture, prevent bleeding and then that
that's the best case scenario in terms
of improving outcome for those. You're
watching ask us anything about stroke
from Penn State Health. I'm Scott Gilbert
along with Dr. Ray Reichwein. Dr. Kevin
Cockroft. We welcome your questions in
the comment field below this post. Again,
whether you're watching it live or on
playback, well make sure we get you some
answers. We were talking a bit about the
BE FAST acronym. The signs that people
that someone could be suffering a stroke
but there's one sign that's not in there
it's a headache and we actually got a
email from someone who had read our
Medical Minute this week at
PennStateHealthNews.org that's Penn State Health News .org
where you can check out a Medical
Minute on the BE FAST acronym and she
noted that headache is not in there and
she says, her name's Mary and she's from
Texas, she says, one evening after work I
was standing in the kitchen when the
sharpest headache I ever had forced me
to lean on the counter the only way I
could describe it is a sharp knife
stabbed me from my right nostril through
my sinuses through the top of my brain
and into my skull. I had no other
symptoms. So how common is a severe
headache? as she says, the worst headache
of your life.
So only probably a few percent of people
have the worst headache of your life or
a very severe atypical headache and it's
classically associated with brain
hemorrhages. It can also be associated
sometimes with the torn blood vessel
what's called an arterial dissection. But
it's only a few percent and that's why
it's not part of the acronym the acronym
accounts for about 95 percent of the
most common symptoms other patients
going to have. But it's important to
recognize that if it's very severe,
a-typical, unusual for that patient that patient,
they do seek attention and one should
focus on those two possibilities as
being the most important. Again, a brain
hemorrhage and/or a torn blood vessel.
Sue is asking a question. Is it advisable
to give someone suspected of suffering a
stroke aspirin to chew? If so, is that
baby or adult aspirin and how much? So a
bunch of facilities out there do do that
so keep in mind most strokes are the
ischemic strokes and it would be safe to
do so generally similar to cardiology
some people recommend taking four
chewable aspirin. In reality, when you
look at subsequent literature it really
doesn't add that much benefit and
unfortunately if you happen to be that
15 percent that could have a brain
hemorrhage it could make you worse. So
usually we've not recommended that
routinely other than emphasizing get
promptly, call 9-1-1, get promptly to an ED (Emergency Department)
get an assessment and a CAT scan and
then make the decision and I wish I
could say it was more effective unlike
cardiology but it adds a little bit but
there's some risk if you have a brain
hemorrhage so again it's probably better
recommended not to do so,
get timely help and then let the experts
sort it out. Now, Mary mentions later in
her story she was later diagnosed with a
stroke but she actually thinking it was
a headache took medication and went
right to bed it wasn't until several
hours later when she got up she knew
something much worse was going on.
How often does that happen? So well the the
description the Mary gave of the worst
headache of her life that is absolutely
classic symptom for what's called a
subarachnoid hemorrhage which is a
subtype of a bleeding type of stroke
usually caused by a brain aneurysm
rupturing. So those that situation you
definitely do not want to take aspirin
so if the headache is the predominant
symptom and you don't have weakness in
your arm face or trouble with your
speech then that's something you
probably want to avoid the aspirin.
Unfortunately the description of going
to sleep after any of these symptoms is
very common and that's why we have the
problem not being able to give the clot
busting drug not being able to use our
devices because people come in too late.
They have a vague symptom, they think
it'll get better if I could just take a
nap and take some aspirin and so they
don't come to the hospital. And so
unfortunately it's absolutely the wrong
thing to do.
But many thought, it's not all cases
early treatment can lead to good things
absolutely you know the sooner we can
get there the more options you have for
treatment and the more likely you are to
do better later on.
You're watching, Ask Us Anything About
Stroke from Penn State Health. I'm
Scott Gilbert along with Dr. Ray Reichwein,
Dr. Kevin Cockroft, we've been talking
about the treatments for stroke, we've
been talking about the signs and the
symptoms and I mentioned up top, that
experts believe that between 80 and 90
percent of strokes may actually be
preventable. How could that be the case?
So there are many common risk factors
out there and very modifiable risk
factors if one is aware of them and gets
treatment. Also
and those include high blood pressure,
diabetes, high cholesterol as well as
behavioral things; smoking and excessive
alcohol use. And at least focused on high
blood pressure diabetes high cholesterol
these people walk around feeling okay
even though those problems are sitting
there so the importance is again to seek
medical professionals and if they do
have them get on the right medications.
If you smoke, alcohol emphasize the
importance of that as to avoiding those
bad behaviors. And again, with doing so
the literature is produced
that upwards of 80 to 90% of strokes can
be prevented. So I would always say in
our world, we can do some very good
things acutely to try and undo the
damage but the best cure
is again, not to have the event in
the first place. The other thing is there
are some other common risk factors that
shouldn't be ignored that that are
important in today's time. In younger
people, women with migraine with aura and
the use of birth control pills have a
higher incidence of stroke and in older
individuals an irregular heart rhythm
atrial fibrillation many times is
unnoticed other than some heart
palpitations but has a strong
correlation to subsequent stroke as one
gets older so if you have heart
palpitations in your older you should
get screened for this abnormal heart
rhythm. And the final thing that's near
and dear to me is mini strokes about one
in four people are lucky enough to have
a mini stroke or a transient episode
before they get to the hospital and this
is a great opportunity. So this is the
calm before the storm. If they ignore it
because they're back to normal, the same
symptoms that we talked about before
within a few days, their highest risk
period, they can have a devastating
stroke and now their world is different.
So don't ignore mini strokes is my my
other statement. These's are TIA's. Sure, sure
and then the other component of this and
not only are there many medical things
to do to try and prevent a stroke but
they're also surgical procedures or
invasive procedures and that would
include for the carotid disease which is
very common cause of stroke. Doing
procedures either surgery to clean out
that artery or using a stent and an
angioplasty balloon to open up the
artery and then as we talked about for
the hemorrhagic strokes, aneurysms, blood
vessel malformations, doing surgical
procedures or procedures with catheters
inside the blood vessel to fix those
problems so that they do not lead to a
stroke later on. Those carotid arteries,
we all have one on each side.
Right. What are signs that I might have
issues there and I should see a
physician? Well the the sort of the
screening test for that is even just
listening to the Audrey and if you hear
an abnormal noise that can suggest that
there's turbulent blood flow which
suggests a narrowing of the artery and
then more sophisticated tests will
determine how exactly narrow that artery
is. Now, at the moment, it's controversial
whether if you've not had any stroke
symptoms of the arteries narrow whether
you should have just medicine
whether you should have the artery
cleaned out. But certainly if you've had
a TIA like Dr. Reichwein mentioned or
you've had a small stroke, and you
have narrowing than those people we know
do better with having the artery cleaned
out and taking medicine rather than just
taking medicine alone. We welcome your
questions for Dr. Ray Reichwein,
Dr. Kevin Cockroft here on Ask Us Anything
About Stroke from Penn State Health.
Here's a question from Deyna. She says,
when having symptoms like chest pain and
being short of breath, how rapid can that
turn into becoming a permanent damage to
the heart? More of a heart question
probably than a stroke question but any
insights to share with her? I would only
say again when people have sudden onset
chest pain and more so if they have any
risk factors you could presume it's
cardiac in origin till proven otherwise
and not ignore it, seek medical attention
and people have done the same as to
stroke stayed at home thinking it's
heartburn or something else
musculoskeletal and found out they had a
significant heart attack that nothing
could be done about hours or days later.
So rarely, I will tell you as part of a
stroke you can have pain syndrome so you
can have arm pain and chest pain
generally not in isolation but also
associated with weakness or some other
neurological symptom but the emphasis
point I would have to her is it still
could be a vascular event but of the
heart and time is still the relevant
feature there and early evaluation and
early intervention. Just like we, just
like we talked about stroke, there
are plenty of interventions that can be
done acutely or emergently for a heart
attack and again to get the get evaluate
as soon as possible going to give you
the best options for treatment. I was
going to say, the only other thing
and there are still people out there
that think a stroke is in the heart so
again we want to emphasize a stroke is
of the brain in neurological symptoms
and again you know chest pain is often
the heart but but I just recently talked
to somebody who still thought the stroke
was a problem with the heart and not the
brain so we're talking brain. I've heard
it referred to as a brain attack.That's correct.
And that again focuses on again the
aggressive or the concern and hopefully
pursue an aggressive care just like
would pursue for a heart attack. As we
kind of talked about a lot about
headache but headache ends up being a
minority of
patience actually have that as a strong
symptom so the because strokes are not
painful, people don't treat them as
emergently as they would a heart attack
where they have this crushing chest pain
and they know where they need medical
attention right away. With most stroke
symptoms not being painful as we said
you know a lot of people will think oh
I'll just go to sleep it'll get better
and they don't take it as seriously and
that's a big problem. We're talking about
about risk factors that affect young
people and in fact about 200,000 people
under the age of 65 have a stroke every
year. There's a big Misnomer that
it's just older folks who have who deal
with strokes but in fact a lot of
younger people do. Some people in their
20s do. What are what are some things to
keep in mind for people in that age
group? I should say, the other
question wanted to ask was, the
numbers of strokes in that age group are
going up. Do we know why? So I think a
chunk is related to better awareness so
now that people are more aware of what
signs and symptoms are if they seek
medical attention they get imaging we
find the strokes before they ignored
them they were milder many people can
recover fairly well and it's not
uncommon for us to find people that have
had strokes and ignored the symptoms. So
one is just better awareness, better
imaging and now we're finding things.
The second is, despite lots of advances
people don't have the greatest of diets
with the computer savvy world inactivity
is more common and work-related
stressors or data out there on stress
that contributes. So, so again, with that
being said many people develop their
standard risk factors high blood
pressure, diabetes, cholesterol issues and
then the subsequent blockages and blood
vessels that used to be an older
person's disease and now we can identify
that in teenagers and 20s as compared to
before. The other thing is again we're
seeing a higher incidence of migraine
with aura and many women are still on
birth control pills and and there is a
now more recent association there,
particularly focused on women. A lot of
us have heard of migraines, when you say
migraine with aura what does that mean?
So that's a neurological symptom with or
without a headache that we conclude as
migraine and it's classically a visual
symptom for many to where they notice a
flickering or a flashing light in one
part of their vision it can move around.
It's called a visual aura, It can be
any other symptoms so you can have
tingling and numbness that moves up an
arm or involves your face and
occasionally some people can be confused
or not able to speak it can very much
look just like a stroke. Probably
the key component is it has a gradual
evolution so it tends to evolve over
minutes, if you will, as compared to a
stroke. Strokes are usually sudden onset
boom, negative and you have a major
deficit. We have a lot of opportunities
for you to learn more about stroke
including as I mentioned the Medical
Minute for this week. It's on those
BE FAST of symptoms and you can find that at
PennStateHealthNews.org. Also, coming
up on May 15th, that's Monday, May 15th,
there will be a program on
WHTM abc27 out of Harrisburg,
Good Day PA at 12:30 p.m. The entire
program will be dedicated to the topic
of stroke I'm imagining we'll be seeing
you guys on TV that day. Right? Fantastic.
Anything else you want folks to know or
to keep in mind as we bring this to a
close? I think the most important thing
is to is to be aware of these symptoms,
take them seriously. If you have them, get
medical attention as soon as possible.
And then to work on things to prevent them.
Most of the things that we listed, risk
factors for stroke are actually
preventable. So the things you can do
something about and it's important to
you take that seriously and work on it.
And then I would emphasize that many of
the patients will tell you strokes can
be quite disabling and change your lives
in second. So again, the key is prevent it,
give us the best chance to undo the
damage if that's the case and hopefully
it will lead to better quality of life
down the road and many happy years of
life. Penn State Stroke Center is the
only comprehensive Stroke Center in
Central Pennsylvania. Why is that
important? Well, so comprehensive Stroke
Center means that we really are able to
offer the entire spectrum of care for
stroke patients and that includes being
able to offer interventions that we
described using those retriever devices
to pull out clots as well as treating
the bleeding types of strokes, aneurysms,
blood vessel malformations,
not to mention giving the clot busting
drug taking care of patients all the way
through their intensive care units stay
to rehabilitation and hopefully to a
good recovery. And being able to offer
these different things that allows
patients to get the best options for for
making a good recovery.
My thanks to both
of your time. So we have also
have our Lion Net Telehealth program.
Telestroke program which we provide
a-cute stroke care via special specialized
neurosurgeons and neurologists to
fifteen and soon-to-be sixteen hospital
systems out there. So we've now moved out
into our community in all four
directions to provide acute care
classically in the emergency department
through computer systems and carts and
outside ED facilities and that has
also advanced treatments to where we're
now treating many patients at a distance
and providing that same high-level of
care and giving them a better chance at
a better outcome. We can stay in their
communities for that treatment. Yes and get an
option to get these drugs they would not
been able to get otherwise. Good point
Dr. Ray Reichwein, Dr. Kevin Cochroft,
both co-directors of the Penn State
Stroke Center, the only comprehensive
Stroke Center here in Central
Pennsylvania. We have more information
about the Stroke Center and it's efforts
online at PennStateHealth.org/stroke-Center.
We'll put that URL
in the comment field as well below this
post and we encourage you to add your
questions we can even track down answers
to your questions after this program and
this has been one of our longer Ask Us
Anything About's for sure but a lot of
great information. Thanks to both of you
for the time. Thank you very much for
watching Ask Us Anything About Stroke
from Penn State Health.
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