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Act F.A.S.T.: Quick Diagnosis and Treatment for Stroke

Approximately 800,000 people have a stroke each year; about one every 40 seconds. MedStar Washington Hospital Center is the first hospital in the Washington region to be certified as a Comprehensive Stroke Center by The Joint Commission. The Hospital Center joins an elite group of only 73 medical centers nationwide to receive this prestigious certification.

Listen as Amie Hsia, MD, Medical Director of the Comprehensive Stroke Center at MedStar Washington Hospital Center, discusses what exactly happens in your body during a stroke, the ways we can stop it and the importance of receiving diagnosis and treatment quickly.
Act F.A.S.T.: Quick Diagnosis and Treatment for Stroke
Featured Speaker:
Amie W. Hsia, MD
Amie Hsia, MD, is a board-certified vascular neurologist and medical director of the MedStar Washington Hospital Center Comprehensive Stroke Center, associate professor of neurology at Georgetown University, principal investigator of the NIH Stroke Program at MWHC, and co-principal investigator of the NIH-funded StrokeNet regional coordinating center - Stroke Capital Area Network for Research (SCANR). Dr. Hsia received her undergraduate degree from Harvard University and her medical degree from Duke University. She completed her neurology residency at Stanford University, where she also served as chief resident. She remained at Stanford for her fellowship training in stroke and neurocritical care. Born and raised in the D.C. metropolitan area, Dr. Hsia returned to Washington for the opportunity to provide advanced stroke care to area residents. Dr. Hsia serves as an advocate of the Greater Washington Region American Heart and Stroke Association to support governmental policies related to stroke care. She is a founding member and was the first physician chair of the D.C. Stroke Collaborative, working to improve the level of stroke care through collaboration among the D.C. hospitals and EMS. With the NIH Stroke Program, she works on developing and evaluating acute stroke treatments with advanced neuroimaging.

Learn more about Amie W. Hsia, MD
Transcription:

Melanie Cole (Host): Approximately 800,000 people have a stroke each year, one about every forty seconds. Medstar Washington Hospital Center is the first hospital in the Washington region to be certified as a comprehensive stroke center by the Joint Commission. My guest today is Dr. Amie Hsia. She's the medical director of the Medstar Washington Hospital Center Comprehensive Stroke Center. Welcome to the show Dr. Hsia. What is a stroke?

Dr. Amie Hsia (Guest): A stroke is a disruption of blood flow to the brain either due to blockage or a rupture of a blood vessel, and when this happens, symptoms happen all of a sudden. In the blockage type of stroke, it's been shown that for every minute that passes, two million brain cells actually die during that period of time which is why you've probably heard the saying, time is brain or every minute counts when it comes to stroke.

Melanie: What are the symptoms, being most important red flags?

Dr. Hsia: The symptoms of the stroke, the common element is that they do happen all of a sudden and so it could be sudden onset of difficulty with your speech, understanding what people are saying, or actually expressing yourself, sudden onset of weakness or numbness on one side of the body, sudden onset of unsteadiness or uncoordination, and sudden onset of a vision problem, often on one half of your vision. If any of these things occur, then the important thing is to call 911 to get medical emergently.

Melanie: Dr. Hsia, people may notice a person is slurring their words, or their face is drooping, they think maybe they've had too much to drink, or if they are concerned they say, "I'll drive you to the hospital." Is that recommended?

Dr. Hsia: Certainly not recommended. If someone were to have sudden onset of these type of symptoms, one thing that we have trained the public to do in addition to medical providers and EMS specialists is to use the acronym of FAST which stands for “face, arm, speech and time”. You can look at their face to see if one side of the face is drooping. Have them raise both of their arms, is one arm drifting down? Ask them to speak. Is it unclear? Are they having difficulty? And then, time being, call 911, so that you can get evaluated as quickly as possible. It's been shown that patients to arrive to an emergency department by ambulance are evaluated more quickly than patients who arrive through the door, brought by a family member or a friend.

Melanie: What's the diagnostic process at a local hospital when they get to a stroke center?

Dr. Hsia: The things to expect when you show up in an emergency department are, they'll ask questions including when did the symptoms come on? When was the onset of your symptoms? Or, what time was the last time you were known to be normal? Then, they'll assess you to briefly understand what are the problems that you're having with your function? Other things that you can expect in terms of very quick testing include some blood tests that are drawn and, also, importantly, brain imaging, usually with a CAT scan, to determine if you're having a blockage type or a bleeding type of stroke.

Melanie: What's it like for the patient once you've determined which type of stroke? Does it move quite as quickly as they see on TV?

Dr. Hsia: It moves fast in order to do all of these tests quickly. The goal for treatment these days that is the entire reason why all of this evaluation is done as quickly as possible is to evaluate patients to see if there are potentially treatment candidates for a clot busting medicine called “TPA”. This is a medicine that has been proven to be a benefit for patients. It's delivered through the vein, and it's proven to be a benefit for patients who are having a blockage type of stroke if it can be caught early. Early enough means within that first four and a half hours of the onset of the symptoms, or the time the patient was last known to be normal. Therefore, the goals for treatment time are to treat patients as quickly as possible under sixty minutes from the time that the patient arrived in the emergency department and even now, pushing those times to be even shorter, they're treating patients under 45 minutes, if that's possible.

Melanie: If you've given them the TPA, which is recognized as the gold standard clot busting medication, then what happens afterwards? They get into recovery based on whatever damage was done. Are they then on medication for the rest of their lives? Do they have a risk of a recurring stroke? Speak about after that.

Dr. Hsia: Typically, the patients after the clot busting medication treatment are admitted to hospitals. The other thing that I want to make sure that I do mention is that now, in addition to this intravenous clot busting medication, clot retrieval treatment or it is also referred to as endovascular treatment, is also now the standard of care for patients who, in the civic situations are having a very large stroke with a large vessel in the brain that's blocked. If patients are eligible for this treatment, it may immediately follow that IVTPA treatment that is given. But, once any of these acute treatments are given or that initial acute evaluation is done in the emergency department, whether or not someone is eligible for these treatment, then patients are typically admitted to the hospital for further monitoring and diagnostic testing to try and sort out as best as possible what was the underlying cause of the stroke. Once those tests can be done, then the medication regimen can be determined as to what are the best medications for the patient to be on in order to reduce their risk of having another stroke in the future. This medication is done in conjunction with certainly any lifestyle management or changes that need to be made with a person's diet or exercise in order to reduce their risk of having another stroke in the future.

Melanie: Let's speak about prevention. Are there some things you like to tell people on a regular basis? Lifestyle modifications that they can do to, hopefully, prevent a stroke?

Dr. Hsia: Certainly, if someone smokes, then making a very concerted effort to quit smoking. We can give all of the medications but if someone continues to smoke in addition to taking the medications, then you're kind of fighting against yourself. Blood pressure control is incredibly important and it can be difficult because having high blood pressure is something that typically doesn't cause pain or discomfort on a day to day basis but it does require management and being compliant with medications and following your blood pressure on a day to day basis. Same kind of idea for blood sugar. If you have diabetes or elevated blood sugar, then it's incredibly important to stay on top of maintaining and managing your blood sugar. Cholesterol management, a cholesterol panel and those tests and levels are checked during a hospitalization. If someone is placed on cholesterol lowering medication, then those levels need to be followed as an out-patient in close conjunction with your physician.

Melanie: Dr. Hsia, please give us your best advice for stroke: what you want people to know, what you tell them every day about symptom recognition, and what you want them to know about stroke.

Dr. Hsia: When it comes to stroke, one of the first things is identifying those symptoms as potentially being a stroke because that really starts off the chain reaction and the chain of events of identifying the stroke symptoms. Remember that FAST acronym--face, arm, speech, and time. Call 911 and get to your local emergency department as quickly as possible, so that you can be evaluated. Remember that there are treatments that are available that can change the course of your stroke and, therefore, of your life. We have a clot buster IVTPA. We have clot retrieval treatment to pull out large clots that may be stuck in the brain. Then, there is also the co-ordination of care across the community. It's important to remember while your local hospital may not be able to offer all treatments, they are connected with other hospitals such as comprehensive stroke centers which is what Medstar Washington Hospital Center is. Comprehensive stroke centers can offer higher levels of care, where we have 24x7 coverage of being able to offer endovascular clot retrieval treatment, neurosurgical treatment, Neuro ICU, and even beyond the standard treatment clinical trial opportunities when one may not be able to be eligible for standard treatments, there may be another treatment option that's available that's being studied. The important thing from the beginning is awareness of stroke and the awareness that there are treatments available to treat a stroke and improve your outcome.

Melanie: Thank you so much, Dr. Hsia, for being with us today. Such great and so important information. Thank you so much. You're listening to Medical Intel with Medstar Washington Hospital Center. For more information, you can go to www.medstarwashington.org. That's www.medstarwashington.org. This is Melanie Cole. Thanks so much for listening.