Stroke is the fifth-leading cause of death in the US. Getting treatment as soon as a stroke occurs can make a huge difference in survival and recovery.
At UK HealthCare, we offer treatment, prevention, research and rehabilitation for stroke patients. Our experienced experts use leading-edge technology and clot-busting drugs to provide personalized care for each patient. We are available 24 hours a day to treat patients immediately, before strokes cause brain damage.
Here to tell us why it is so important for you to know the signs of a stroke and to get medical care as quickly as possible if you suspect you or a loved one is having a stroke is Justin Fraser, MD, FAANS, FAHA. He is the Director, Cerebrovascular Surgery; Surgical Director, UK Comprehensive Stroke Center.
Stroke Symptoms: Time is Brain!
From the Show: UK HealthCast
Summary:
Air Date: 11/12/17
Duration: 10 Minutes
Transcription:
Melanie Cole (Host): According to the NIH and the American Stroke Association, stroke is the leading cause of death and disability in the United States. If you have a stroke getting medical care as quickly as possible to help prevent death or minimize the lasting effects of stroke, it's important for you to know the signs of a possible stroke, learn your risk factors and identify what you need to do if you suspect you or a loved one is having a stroke. My guest today is Dr. Justin Fraser. He's the director of the cerebrovascular surgery and the surgical director for UK Comprehensive Stroke Center. Welcome to the show. What is a stroke? Are there different types and why is it so important for the Kentucky population to be informed about stroke?
Dr. Justin Fraser, MD, FAANS, FAHA (Guest): As you said, stroke is one of the leading causes of death in the United States and actually one of the leading causes of disability. The problem is that if you don’t die from a stroke, often times, you're left seriously disabled and unable to carry out your normal activities of living. It is a major problem for our community, for the nation as a whole and especially for Kentucky. There are several kinds of stroke. They tend to be broken into two categories. The first category is something we call a hemorrhagic stroke. That simply means spontaneous bleeding into the brain often due to high blood pressure or due to an aneurysm in the brain or other blood vessel malformations. That's a small piece of stroke, usually representing about 13% to 15% of strokes.
The main type of stroke though is what we call the ischemic stroke. Ischemia is simply defined as lack of blood supply, causing lack of oxygen and nutrients to the brain. It essentially is a blockage or narrowing or obstruction in one of the blood vessels that feed the brain. When that happens, that part of the brain parts to undergo damage, and it's that damage that most people recognize and see as a stroke.
Melanie: Is there a way to prevent or reduce someone’s risk of stroke? Are there certain actions that the general population can take to reduce the risk?
Dr. Fraser: Absolutely. Some of the main risk factors in our country, some of them are controllable, others are not. The ones that a patient can control are certain risk factors such as smoking. Smoking is a huge risk factor when it comes to causing hemorrhagic stroke as well as contributing to ischemic stroke. Other issues that become important are making sure that you are visiting with your primary care doctor so that they can run tests to make sure that the aspects of your health are taken care of in a preventive way. An example of that would be making sure they monitor and control your cholesterol, making sure that if you need to be on a baby aspirin, which is a daily small dose of medication that costs pennies, that can reduce your risk of stroke in a significant way. Other factors that are important, there's certainly a genetic component that you can't control, but most things that are risk factors for strokes are things that we can impact on a daily basis.
Melanie: It is so important that people know their vital signs as you say and see their doctors regularly. Does having one stroke put you at risk for another?
Dr. Fraser: Certainly. Once you’ve had a stroke, it’s very important to pay attention to those risk factors, to visit with your primary care doctor, if you have appointments as you often would after a stroke, with a type of specialist such as a vascular neurologist. These are neurologists or brain doctors whose specialty is helping you reduce your risk of a stroke and helping you to make sure that if you have another stroke you know what to do, but more importantly, what things you can do to prevent the next stroke from happening.
Melanie: Let’s talk about symptoms because we know that time is brain and people need to understand the symptoms so if somebody is having something, they know what to do. Speak about those symptoms.
Dr. Fraser: Before I do that, you did mention something that I think is absolutely critical here, and that is time is brain. People say that but to give you an idea of what that means, if you have an occlusion or blockage that suddenly occurs in one of the blood vessels in your brain, you can lose as many as 1.8 million neurons, or brain cells, for every minute that ticks by. When people say time is brain, it’s a short little phrase, but it actually means something real. It means you're actually losing brain tissue as that time ticks by. It’s very important to know that. You asked about symptoms though and I know it’s hard if you’ve never seen a stroke patient before, known a loved one or a friend and seen the way they look, but there are some very simple things that can be done that you can take and remember to try to recognize a stroke.
The acronym we like to use at the University of Kentucky is called BEFAST. BEFAST, which was originally published by our chairman of neurology Dr. Goldstein, and he and his team came up with this, it’s an add-on if you will of the original FAST acronym and this is what it stands for. B is balance, meaning if there's sudden loss of balance, if you're sitting there with your loved one or family member of your friend and they have a sudden loss of balance. E is for eyes. Do you see sudden double vision or is the person looking in one direction and can't move their eyes? F is for face. Can the person smile or is half of their face not working? A is for arms. Can the person move both arms or does one arm not work or is it weak or numb? S is for speech. Is the person having trouble speaking? Do they look at you and not understand what you're saying? An example of that is if you ask a certain type of person who’s having a stroke that's affecting their speech and you ask them a question, they may give you an answer but it may not make sense. For example, if you say is the sky blue, they might say "ball is tree." Makes absolutely no sense, but that could be an indication that they're having a stroke or a problem with their speech. T is for time. Time is so important. As soon as you see these symptoms, time is brain, and you want to call 911 immediately. Don't drive the patient to the hospital yourself. It's much better to call 911. They have the ability to get the patient to the hospital as quickly as possible. As important, it’s knowing when the symptoms started or when you saw the patient last normal. If you're sitting there with your loved one and they suddenly have the symptoms and you can make a note of that time, making a note of that time is very helpful because for us as doctors and nurses taking care of the patient, we really want to know that time. That’s why time is so important. That’s BEFAST.
Melanie: I'm so glad that you mentioned EMS and calling 911 instead of trying to drive your loved one to the hospital because EMS has the ability to start treatment right away.
Dr. Fraser: What they can do and what they are doing in our state is figuring out where to take the patient. There are some aspects of treatment that can begin in the ambulance, but in terms of reopening the blood vessel, getting that blood vessel reopened so that brain can get perfused again, we're not currently doing that in an ambulance in Kentucky. The most important role the EMS plays is triage, and what I mean by that is to come and see the patient to diagnose the stroke in its very early moment and to know I need to get that patient to a stroke center. Here at UK, we have ambulances that bring us patients from the surrounding community but also from around the state. We also have choppers that will fly patients directly to us if an ambulance will take too long depending on the location of the patient. That's what EMS can do and that's the most important thing they do. They evaluate the patient in a very controlled way and we actually have a statewide protocol now that is in place that helps them figure out where should I take this patient, which hospitals have the tools and have the accreditation necessary so the patient can get treated in the best possible way.
Melanie: Let’s talk about that accreditation before we even get into what happens at the ER. What does it mean? We hear that UK Healthcare Kentucky's Neuroscience Institute received the Get with the Guidelines-Stroke Plus Quality Achievement Award by the American Heart Association.
Dr. Fraser: Those are two separate things and it’s important to make a distinction. The award that you mentioned is an award for us being an outstanding stroke center for tracking our data, for taking care of patients in the best possible way. It’s part of but not really the accreditation itself. The way hospital accreditation works for stroke, at least in our area of the country, is we go through a body called JCOH, which is the Joint Commission of Hospitals. This is an organization that monitors and helps improve care at hospitals and accredits them as centers of excellence for particular diseases. In the case of stroke, there are right now three types of accreditations and there's a fourth that's starting up. At the most basic level, you have your acute stroke-ready hospital. These are hospitals that often times are small hospitals, often times in communities that don't have other more advanced care, and they're good points of entry for stroke. For example, if you're out in a rural community and you start having a stroke, the EMS provider can bring you to that hospital and they can start TPA, which is a clot-busting drug. Often times and almost always, the patient will be transferred to a more advanced care facility for the rest of their stroke care.
The next level is something called primary stroke centers. These centers have neurologists, vascular neurologists that take care of stroke, they have imaging capabilities to look at the stroke, they can give TPA and they monitor and track how good of a job they're doing with that. They make sure that they try to give the drug as quickly as possible, that they have protocols in place to get the patient treated as quickly as possible. The next current level, the highest level, is something called the comprehensive stroke center. There are four in Kentucky right now and the University of Kentucky is one of them. The way to think about it is when it comes to stroke, the buck stops with us. We have to demonstrate on a continual basis that we can care for every single stroke patient, that we’re constantly improving how we take care of our stroke patient, we achieve outstanding outcomes and we make sure that any type of stroke, no matter how complex or complicated, we can care for. We can care for those patients 24 hours a day, seven days a week, 365 days a year. It doesn’t matter what time you come in. You get the same type of treatment. That’s really what it’s about. It doesn’t mean that every patient with any kind of stroke should come to a comprehensive stroke center, but the most complex and complicated patients do need to come. What we’ve designed in Kentucky through the Kentucky Board of EMS is a protocol for our EMS providers to follow so that they can decipher where does this patient need to go and how do we get them there correctly and quickly. The idea here is we want to get patients into a treatment pathway as soon as possible.
Melanie: In summary, wrap it up for us with your best advice about prevention of a stroke, about the comprehensive stroke center of UK Healthcare and what people can expect as far as I know it depends on which type of stroke, but what they can expect on life after a stroke, like rehab?
Dr. Fraser: I think you're asking a great question, which is this overarching system of care, the stroke system of care, which is really what we are about at the University of Kentucky when it comes to this. I think if you see a patient who’s having a stroke, if your loved one is having a stroke, call 911, ask to be taken to a stroke center. When you get to the comprehensive stroke center, things are going to move very fast. You're going to be seeing something extremely fast unfold in terms of the care of the patients, in terms of treatment, in terms of determining a treatment pathway. The patient will go to an ICU and be monitored. We get physical therapy involved in the patient’s care and occupational therapy almost immediately, as soon as they can safely work with them. Often times, patients might go home but need rehab at home. Often times, they may go to an acute rehab facility to recover. The idea is the entire system is designed to recognize the stroke quickly, try to undo the damage and then try to deal with whatever damage has been done and help the patient return to the community as normally as possible.
Melanie: Such great information and so well put. Thank you so much for being with us today. This is UK Healthcast with the University of Kentucky Healthcare. For more information, you can go to ukhealthcare.uky.edu. That’s ukhealthcare.uky.edu. I'm Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): According to the NIH and the American Stroke Association, stroke is the leading cause of death and disability in the United States. If you have a stroke getting medical care as quickly as possible to help prevent death or minimize the lasting effects of stroke, it's important for you to know the signs of a possible stroke, learn your risk factors and identify what you need to do if you suspect you or a loved one is having a stroke. My guest today is Dr. Justin Fraser. He's the director of the cerebrovascular surgery and the surgical director for UK Comprehensive Stroke Center. Welcome to the show. What is a stroke? Are there different types and why is it so important for the Kentucky population to be informed about stroke?
Dr. Justin Fraser, MD, FAANS, FAHA (Guest): As you said, stroke is one of the leading causes of death in the United States and actually one of the leading causes of disability. The problem is that if you don’t die from a stroke, often times, you're left seriously disabled and unable to carry out your normal activities of living. It is a major problem for our community, for the nation as a whole and especially for Kentucky. There are several kinds of stroke. They tend to be broken into two categories. The first category is something we call a hemorrhagic stroke. That simply means spontaneous bleeding into the brain often due to high blood pressure or due to an aneurysm in the brain or other blood vessel malformations. That's a small piece of stroke, usually representing about 13% to 15% of strokes.
The main type of stroke though is what we call the ischemic stroke. Ischemia is simply defined as lack of blood supply, causing lack of oxygen and nutrients to the brain. It essentially is a blockage or narrowing or obstruction in one of the blood vessels that feed the brain. When that happens, that part of the brain parts to undergo damage, and it's that damage that most people recognize and see as a stroke.
Melanie: Is there a way to prevent or reduce someone’s risk of stroke? Are there certain actions that the general population can take to reduce the risk?
Dr. Fraser: Absolutely. Some of the main risk factors in our country, some of them are controllable, others are not. The ones that a patient can control are certain risk factors such as smoking. Smoking is a huge risk factor when it comes to causing hemorrhagic stroke as well as contributing to ischemic stroke. Other issues that become important are making sure that you are visiting with your primary care doctor so that they can run tests to make sure that the aspects of your health are taken care of in a preventive way. An example of that would be making sure they monitor and control your cholesterol, making sure that if you need to be on a baby aspirin, which is a daily small dose of medication that costs pennies, that can reduce your risk of stroke in a significant way. Other factors that are important, there's certainly a genetic component that you can't control, but most things that are risk factors for strokes are things that we can impact on a daily basis.
Melanie: It is so important that people know their vital signs as you say and see their doctors regularly. Does having one stroke put you at risk for another?
Dr. Fraser: Certainly. Once you’ve had a stroke, it’s very important to pay attention to those risk factors, to visit with your primary care doctor, if you have appointments as you often would after a stroke, with a type of specialist such as a vascular neurologist. These are neurologists or brain doctors whose specialty is helping you reduce your risk of a stroke and helping you to make sure that if you have another stroke you know what to do, but more importantly, what things you can do to prevent the next stroke from happening.
Melanie: Let’s talk about symptoms because we know that time is brain and people need to understand the symptoms so if somebody is having something, they know what to do. Speak about those symptoms.
Dr. Fraser: Before I do that, you did mention something that I think is absolutely critical here, and that is time is brain. People say that but to give you an idea of what that means, if you have an occlusion or blockage that suddenly occurs in one of the blood vessels in your brain, you can lose as many as 1.8 million neurons, or brain cells, for every minute that ticks by. When people say time is brain, it’s a short little phrase, but it actually means something real. It means you're actually losing brain tissue as that time ticks by. It’s very important to know that. You asked about symptoms though and I know it’s hard if you’ve never seen a stroke patient before, known a loved one or a friend and seen the way they look, but there are some very simple things that can be done that you can take and remember to try to recognize a stroke.
The acronym we like to use at the University of Kentucky is called BEFAST. BEFAST, which was originally published by our chairman of neurology Dr. Goldstein, and he and his team came up with this, it’s an add-on if you will of the original FAST acronym and this is what it stands for. B is balance, meaning if there's sudden loss of balance, if you're sitting there with your loved one or family member of your friend and they have a sudden loss of balance. E is for eyes. Do you see sudden double vision or is the person looking in one direction and can't move their eyes? F is for face. Can the person smile or is half of their face not working? A is for arms. Can the person move both arms or does one arm not work or is it weak or numb? S is for speech. Is the person having trouble speaking? Do they look at you and not understand what you're saying? An example of that is if you ask a certain type of person who’s having a stroke that's affecting their speech and you ask them a question, they may give you an answer but it may not make sense. For example, if you say is the sky blue, they might say "ball is tree." Makes absolutely no sense, but that could be an indication that they're having a stroke or a problem with their speech. T is for time. Time is so important. As soon as you see these symptoms, time is brain, and you want to call 911 immediately. Don't drive the patient to the hospital yourself. It's much better to call 911. They have the ability to get the patient to the hospital as quickly as possible. As important, it’s knowing when the symptoms started or when you saw the patient last normal. If you're sitting there with your loved one and they suddenly have the symptoms and you can make a note of that time, making a note of that time is very helpful because for us as doctors and nurses taking care of the patient, we really want to know that time. That’s why time is so important. That’s BEFAST.
Melanie: I'm so glad that you mentioned EMS and calling 911 instead of trying to drive your loved one to the hospital because EMS has the ability to start treatment right away.
Dr. Fraser: What they can do and what they are doing in our state is figuring out where to take the patient. There are some aspects of treatment that can begin in the ambulance, but in terms of reopening the blood vessel, getting that blood vessel reopened so that brain can get perfused again, we're not currently doing that in an ambulance in Kentucky. The most important role the EMS plays is triage, and what I mean by that is to come and see the patient to diagnose the stroke in its very early moment and to know I need to get that patient to a stroke center. Here at UK, we have ambulances that bring us patients from the surrounding community but also from around the state. We also have choppers that will fly patients directly to us if an ambulance will take too long depending on the location of the patient. That's what EMS can do and that's the most important thing they do. They evaluate the patient in a very controlled way and we actually have a statewide protocol now that is in place that helps them figure out where should I take this patient, which hospitals have the tools and have the accreditation necessary so the patient can get treated in the best possible way.
Melanie: Let’s talk about that accreditation before we even get into what happens at the ER. What does it mean? We hear that UK Healthcare Kentucky's Neuroscience Institute received the Get with the Guidelines-Stroke Plus Quality Achievement Award by the American Heart Association.
Dr. Fraser: Those are two separate things and it’s important to make a distinction. The award that you mentioned is an award for us being an outstanding stroke center for tracking our data, for taking care of patients in the best possible way. It’s part of but not really the accreditation itself. The way hospital accreditation works for stroke, at least in our area of the country, is we go through a body called JCOH, which is the Joint Commission of Hospitals. This is an organization that monitors and helps improve care at hospitals and accredits them as centers of excellence for particular diseases. In the case of stroke, there are right now three types of accreditations and there's a fourth that's starting up. At the most basic level, you have your acute stroke-ready hospital. These are hospitals that often times are small hospitals, often times in communities that don't have other more advanced care, and they're good points of entry for stroke. For example, if you're out in a rural community and you start having a stroke, the EMS provider can bring you to that hospital and they can start TPA, which is a clot-busting drug. Often times and almost always, the patient will be transferred to a more advanced care facility for the rest of their stroke care.
The next level is something called primary stroke centers. These centers have neurologists, vascular neurologists that take care of stroke, they have imaging capabilities to look at the stroke, they can give TPA and they monitor and track how good of a job they're doing with that. They make sure that they try to give the drug as quickly as possible, that they have protocols in place to get the patient treated as quickly as possible. The next current level, the highest level, is something called the comprehensive stroke center. There are four in Kentucky right now and the University of Kentucky is one of them. The way to think about it is when it comes to stroke, the buck stops with us. We have to demonstrate on a continual basis that we can care for every single stroke patient, that we’re constantly improving how we take care of our stroke patient, we achieve outstanding outcomes and we make sure that any type of stroke, no matter how complex or complicated, we can care for. We can care for those patients 24 hours a day, seven days a week, 365 days a year. It doesn’t matter what time you come in. You get the same type of treatment. That’s really what it’s about. It doesn’t mean that every patient with any kind of stroke should come to a comprehensive stroke center, but the most complex and complicated patients do need to come. What we’ve designed in Kentucky through the Kentucky Board of EMS is a protocol for our EMS providers to follow so that they can decipher where does this patient need to go and how do we get them there correctly and quickly. The idea here is we want to get patients into a treatment pathway as soon as possible.
Melanie: In summary, wrap it up for us with your best advice about prevention of a stroke, about the comprehensive stroke center of UK Healthcare and what people can expect as far as I know it depends on which type of stroke, but what they can expect on life after a stroke, like rehab?
Dr. Fraser: I think you're asking a great question, which is this overarching system of care, the stroke system of care, which is really what we are about at the University of Kentucky when it comes to this. I think if you see a patient who’s having a stroke, if your loved one is having a stroke, call 911, ask to be taken to a stroke center. When you get to the comprehensive stroke center, things are going to move very fast. You're going to be seeing something extremely fast unfold in terms of the care of the patients, in terms of treatment, in terms of determining a treatment pathway. The patient will go to an ICU and be monitored. We get physical therapy involved in the patient’s care and occupational therapy almost immediately, as soon as they can safely work with them. Often times, patients might go home but need rehab at home. Often times, they may go to an acute rehab facility to recover. The idea is the entire system is designed to recognize the stroke quickly, try to undo the damage and then try to deal with whatever damage has been done and help the patient return to the community as normally as possible.
Melanie: Such great information and so well put. Thank you so much for being with us today. This is UK Healthcast with the University of Kentucky Healthcare. For more information, you can go to ukhealthcare.uky.edu. That’s ukhealthcare.uky.edu. I'm Melanie Cole. Thanks so much for listening.
