Stroke: F.A.S.T Action Could Save a Life

Kathleen Burger, DO, discusses risk factors for the two major types of stroke (ischemic and hemorrhagic), including high blood pressure, high cholesterol, diabetes, sedentary lifestyle, obesity, and smoking. Dr. Burger explains these risk factors can be reduced by lifestyle changes and medication if necessary. Dr. Burger also describes the internal differences between the two strokes, despite the external symptoms appearing similar. You will also learn the symptoms to be aware of through the acronym FAST (Facial drooping, Arm weakness, Speech difficulties and Time to call emergency services).
Stroke: F.A.S.T Action Could Save a Life
Featured Speaker:
Kathleen Burger, DO
Kathleen Burger, DO is a Neurologist and the Director of the Comprehensive Stroke Center at GW Hospital.

Learn more about Kathleen Burger, DO


Mike Smith, MD (Host): Welcome to GW Hospital Health Cast. I’m Dr. Mike Smith. The topic today is Stroke 101. My guest is Dr. Kathleen Burger. Dr. Burger is the Director of the Comprehensive Stroke Center and a member of the medical staff at the George Washington University Hospital. Dr. Burger, welcome to the show.

Dr. Kathleen Burger, DO (Guest): Thank you for having me.

Dr. Smith: So, Stroke 101. Let’s just start with the basics. Why don’t you tell us what is a stroke, are there different types of stroke and is this really a huge issue for people in the United States?

Dr. Burger: Well a stroke is when a blood vessel is suddenly blocked in the brain and that means an area of the brain will have no blood flow and if this lasts for a significant amount of time; the cells in the brain supplied by that blood vessel will die. Death of cells in the brain leads to significant number of symptoms which can be different in every patient, including weakness on one side or paralysis on one side of the body. Types of stroke are either this blood vessel is blocked as I just described called an ischemic stroke or it’s when a blood vessel bursts and that’s the bleeding type of stroke known as a hemorrhagic stroke.

Dr. Smith: When you look at those two types of strokes, I think people – when you say the ischemic type and there is a blockage; is that similar to what happens say in the arteries that feed the heart when someone has a heart attack?

Dr. Burger: That’s a perfect analogy. A blood clot in your heart causing a heart attack is very similar. It is not identical to a blood vessel being blocked in the brain and causing a stroke.

Dr. Smith: But very similar to. What about you mentioned the hemorrhagic or the – where the vessel kind of bleeds out; what’s the main connection there? Why does that happen to people?

Dr. Burger: Well there are many reasons why it happens but the reason the two types of stroke look the same are one in the ischemic stroke the blood vessel suddenly has a clot and there is no blood flow going to the brain and those cells die. The hemorrhagic stroke a blood vessel bursts and there is so much bleeding in an area and it pushes on the huge area of the brain. That increased pressure causes those cells to die. So, on the outside, the patients look very similar, but on the inside the two types of stroke are very different. I could list a number of reasons why patients are at risk for both types of stroke, if you would like.

Dr. Smith: Yeah, I would like to definitely get into the risk factors for them but before we do that, what stroke is most common in this country? Is it the ischemic stroke or the hemorrhagic stroke?

Dr. Burger: The ischemic strokes are more common. About 80% of strokes are ischemic and 20% are hemorrhagic.

Dr. Smith: So, Dr. Burger, let’s go ahead and get into what are the risk factors for both kinds of strokes because then I think that naturally leads into a conversation about then prevention, right. So, let’s start with risk factors for both kinds.

Dr. Burger: Sure. I think I’ll start with the most common risk factors for both strokes that is yet modifiable would be high blood pressure. Managing your blood pressure and reducing your blood pressure with lifestyle, with or without medication can reduce your risk of both ischemic and hemorrhagic stroke.

Dr. Smith: And you mentioned, the word modifiable, meaning that this is risk factor that we can actually do something about. Is that what you mean by that?

Dr. Burger: That’s exactly what I mean.

Dr. Smith: Okay so blood pressure is a modifiable risk factor that’s actually increasing the risk if it is high for both types. Okay so let’s go on to some additional risk factors.

Dr. Burger: Most other risk factors are identified closely with ischemic stroke and these include high cholesterol, high blood sugar or diabetes, inactivity or lack of exercise, obesity, and smoking. And if you notice, all of these things can be treated or improved with lifestyle modification.

Dr. Smith: Right, that’s that term modifiable.

Dr. Burger: Exactly.

Dr. Smith: Okay and so that was for the hemorrhagic stroke a nice list of risk factors and so obviously when we talk about prevention, Dr. Burger of the hemorrhagic stroke we are really talking about a lot of just improvements in lifestyle, diet, exercise, weight loss, stop smoking, all that kind of stuff, right?

Dr. Burger: Yes, that’s a perfect list for prevention of both ischemic and hemorrhagic stroke.

Dr. Smith: Is there any specific risk factors to the ischemic type of stroke that’s maybe different from hemorrhagic?

Dr. Burger: I think the list that I mentioned, the longer list, is more for ischemic stroke. The risk factors that unifies the two strokes is high blood pressure. The remaining risk factors are more closely related to ischemic stroke.

Dr. Smith: What would be some other causes of the hemorrhagic type stroke other than blood pressure?

Dr. Burger: Blood pressure is the most common. Other rarer causes would be certain medications that make you prone to bleeding and possibly an aneurysm.

Dr. Smith: So, Dr. Burger to summarize kind of what we have said. There are two basic types of stroke here. We have a type of stroke that is what we call ischemic which is a blockage and a hemorrhagic type stroke which is there is bleed and there is pressure and there is death of those brain cells. But one of the things we had said is that unifying risk factor is blood pressure so that’s obviously extremely important, right to keep track of. What are some healthy blood pressure numbers?

Dr. Burger: Well, the ideal blood pressure is actually controversial depending on what literature physicians review you can see many different numbers. The best and most common blood pressure to probably live by would be the accepted normal of 120/80. So, that would be a systolic blood pressure of 120 and a diastolic blood pressure of 80. Even if patients are much higher than that, and they improve or lower their blood pressure slightly, any movement in the right direction begins that reduction of risk of stroke.

Dr. Smith: Alright and that’s what I’m hearing from you Dr. Burger, is that even though stroke is very common in this country and it causes a lot of debilitation and death; the good news is there are things we can do to prevent, right? There are those modifiable risk factors, lifestyle changes, keep track of your pressure, so that gives us some hope into that. But let’s move the conversation on to what if somebody is actually having a stroke. What are some of the things that I can look for in somebody. When should I be concerned either in myself or it may be in a coworker who I think might be having a stroke?

Dr. Burger: Sure. The best pneumonic that has been successful in public education is FAST. The letters F-A-S-T each stand for an important symptom of stroke. F stands for facial weakness. So, if a patient looks in the mirror and see that one side of their face is drooped, that is what facial weakness looks like. A stands for arm weakness. If somebody is moving their arms and suddenly one doesn’t move very well, again, this is a common symptom of stroke. S stands for speech changes. If a person suddenly cannot speak at all or has significant slurring of speech that happens suddenly, this is also a common symptom of stroke. And T is time to act, call 911. These are the most common warning signs of stroke and if people remember just those few, they will be able to recognize over 80% of all strokes either in themselves or possibly in a family member or friend.

Dr. Smith: And of course, the key thing there is fast. Tell us a little bit about how important it is if you think you are having a stroke or if a family member or a friend is having a stroke to get to them to the hospital quickly.

Dr. Burger: Well, it is extremely important to call 911 immediately. Because one of our favorite statements on the stroke team is “time is brain”. Every few minutes millions of brain cells die. Once a brain cell dies, there is no possible recovery. However, what is happening immediately from the time of stroke onset is that brain cells continue to die for several hours and the earlier you seek treatment, and call for help, the earlier treatment can be provided and save many brain cells.

Dr. Smith: Right.

Dr. Burger: Disability will be less if not cured.

Dr. Smith: So, time is brain. FAST, FAST, FAST. That’s probably our take home message for the conversation. Let’s kind of end our discussion here Dr. Burger with a little bit about the Comprehensive Stroke Center at GW Hospital. Tell us a little bit about that.

Dr. Burger: A Comprehensive Stroke Center is the highest level of designation that any stroke center could achieve. And despite the thousands of hospitals throughout our country, there are currently around, when I last checked, 150 or 160 stroke centers in the country. So, this high designation is something that we are very proud of at our hospital. What that means is that comprehensive team approach of care is provided to every single patient. A good example I could provide of a comprehensive level of care is just if you sat with us during our daily rounding of patients. Even if I see 20 people, every patient is receiving care and thought from a large group of people and that includes of course the doctor, and the nurse, but also includes the pharmacist, the physical therapist, occupational therapist, speech therapist, nutritionist, a number of rehab specialists that are already trying to help us prepare our plans for when the patient goes home successfully, a case manager, a social worker, and several others that I just cannot think to list right now. Those, every day we have a hard stop, the fifteen of us get together and we talk about every one of our 20 or 25 patients and what makes them unique and what journey they have ahead of them to continue – to be successful after they leave the hospital.

Dr. Smith: Right, so Dr. Burger, in summary, what would you like people to know about Stroke 101?

Dr. Burger: I want everybody to know that they have the power to prevent most strokes, that looking at the American Heart and Stroke Association’s website, they can look at Life’s Simple 7 and how they can prevent stroke by remembering seven simple things. And that is managing blood pressure, controlling cholesterol, reducing blood sugar, get active, eat better, lose weight, and stop smoking. If you do everything your doctors tell you amongst that list, you can prevent four out of five strokes. And there are really no better odds with any other disease, basically that we treat as physicians. And then of course if you think you or your loved one could potentially be having a stroke, then please call 911 immediately. We love a false alarm, that’s much better than missing an opportunity to treat a patient.

Dr. Smith: Well Dr. Burger, I want to thank you for the work that you are doing and also thank you for coming on the show today. You’re listening to GW Hospital Health Cast with the George Washington University Hospital. For more information you can go to that’s . Physicians are independent practitioners who are not employees or agents of the George Washington University Hospital. The hospital shall not be liable for actions or treatments provided by physicians. This is Dr. Mike Smith. Thanks for listening.