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The Differences in Hemorrhagic and Ischemic Strokes
Dr. Branko Huisa discusses the difference between a Hemorrhagic and Ischemic stroke, the warning signs of a stroke, and why it's important to call 911 when you see someone having a stroke.
Featured Speaker:
My research interests include cerebral small vessel disease, brain aging and vascular cognitive impairment. There are more than 30 peer-reviewed articles, book chapters, and reviews for several medical journals in neurology and neuroscience I have personally written or in collaboration with other doctors. You will find some of my research work published in PubMed.
Currently I am the neurology Director at Temecula Valley Hospital and the director of The Neuron Clinic in Temecula. I belong to many medical associations, including the American Medical Association, American Heart Association/American Stroke Association (AHA/ASA), the American Academy of Neurology and the American Neurological Association.My goal is to do provide the best care for my patients, understand and seek new cures for complex neurological conditions and educate patients family and physicians for the common health.
Branko Huisa, MD
I am a board-certified neurologist and vascular neurologist who specializes in treating stroke, dementia, traumatic brain injury, vascular dementia and vascular cognitive impairment. Since my graduation in 2003, I have accumulated 15 years of experience in seen and treating a vast array of neurological conditions. I earned my medical degree from Cayetano Heredia University in Lima, Peru. My neurology training was at University of New Mexico followed by a fellowship in stroke and cerebrovascular disease at University of California San Diego. After completing my training and education, I joined the neurology Department at the University of New Mexico in Albuquerque, where I served as Director of the Stroke Center. In 2015 I was appointed as Assistant Professor at the UC Irvine Neurology Department and I relocated to Southern California. In 2016 I became Faculty at the UCSD Neurosciences Department. During my time as Faculty, I had the honor to train many medical students, medical residents and fellows. Recently, I directed the Stroke Fellowship Program at UC San Diego School of Medicine for two years training eight successful stroke neurologists. I still enjoy teaching younger physician.My research interests include cerebral small vessel disease, brain aging and vascular cognitive impairment. There are more than 30 peer-reviewed articles, book chapters, and reviews for several medical journals in neurology and neuroscience I have personally written or in collaboration with other doctors. You will find some of my research work published in PubMed.
Currently I am the neurology Director at Temecula Valley Hospital and the director of The Neuron Clinic in Temecula. I belong to many medical associations, including the American Medical Association, American Heart Association/American Stroke Association (AHA/ASA), the American Academy of Neurology and the American Neurological Association.My goal is to do provide the best care for my patients, understand and seek new cures for complex neurological conditions and educate patients family and physicians for the common health.
Transcription:
Melanie Cole (Host): If you have a stroke, getting medical care as quickly as possible can help prevent death or minimize the lasting effects of stroke so it’s really important for you to know the signs of a possible stroke and learn your risk factors and identify what you need to do if you or a loved one is suffering a stroke. My guest today is Dr. Branko Huisa. He’s the stroke medical director at Temecula Valley Hospital. Dr. Huisa, I’m so glad to have you with us. Tell us what is a stroke and are there different types?
Dr. Branko Huisa (Guest): Thank you for the introduction. Well stroke, there are two types of stroke. One is what we call ischemic stroke and is the most common form. It happens about 80% to 85% of the time and is due to a blood clot. The blood clot goes and blocks one of the arteries of the brain so there is not enough blood flow to the specific part of the brain and symptoms happen and then the second type of stroke is what we call hemorrhagic stroke, which is a bleed that happens inside the brain and is due to a burst of one of the arteries of the brain, and the blood leaks into the brain and there is some what we call edema or increase of pressure on the brain due to the blood. What kind of symptoms people have when these two conditions happen is usually they get weakness on one side of the body, the face can look droopy, speech can be slurred, they cannot comprehend sometimes what other people are saying, they look confused, they have other walking. Other symptoms like numbness, double vision, and headaches can occur as well.
Host: It’s interesting. So tell us who is at risk for a stroke and I know that there is an acronym that we use, BE FAST or FAST and I’d like you to tell us those symptoms so that people can recognize them, but first tell us who’s at risk.
Dr. Huisa: Well people who are at risk is well – basically we have risk factors. Risk factors for stroke, the most important risk factor is hypertension, having high blood pressure. People who have sustained high blood pressure for many years, what the blood pressure does is damage the arteries and the brain is very sensitive to changes in blood pressure. The arteries can break or they can develop some plaque and clotting due to constant high blood pressure. The other risk factors include having high cholesterol, lack of physical activity, smoking, and having diabetes or elevated sugars. Those are the classic risk factors for stroke.
Host: So then tell us about the symptoms that we might recognize so that people know and are aware.
Dr. Huisa: So the symptoms are usually – I mentioned having problems with speech first, patients are not able to comprehend or to talk. There is a problem with weakness on one side of the body, numbness on one side of the body or the other, problems with balance, walking, sometimes very intense headache can be related to a bleed on the head. Sometimes these symptoms are difficult to recognize by the patient or the person who’s suffering the stroke, and most of the time is that somebody else was noticing that. The reason is that it’s happening in the brain and the weakness and numbness doesn’t happen actually in the muscles or the nerves but inside the brain so it’s hard for yourself to recognize something wrong is happening in your own brain. So it’s very well known that even doctors or scientists who study stroke are having a hard time to recognize their own symptoms when they have them.
Host: Well it is certainly difficult. Should somebody, if they recognize those symptoms with that acronym FAST, should they call 911? Should they try and drive their loved one to the hospital? Why is time so important doctor and what does the EMS have the ability to do?
Dr. Huisa: Yes, so from that acronym as you mentioned the last letter is T for time and time is of the essence for stroke. The faster you get somebody into the emergency room, the better the outcome for that patient. We do have some therapy that can act quickly on the blood clot and sometimes in the bleed that the patient has. The brain gets damaged very quickly so we need to act as fast as possible. We can remove the clot with medications. One medication that we have is called IV tPA and that’s a medication that we use within the 3 hours and we can push it up to the 4.5 hours sometimes and the medication removes clot from the brain. The other one is a small surgical procedure which we advance a catheter through the groin of the patient. We advance the catheter through the body and the neck and to the brain and we remove mechanically a large clot that might be causing the stroke. For that surgical procedure, the best outcomes occur on patients who are treated fast, usually within the 6 hours. Once the stroke stalls, it’s very difficult to get a good outcome and our therapies usually don’t respond.
Host: So it’s really all about the time factor. So tell us a little bit about what happens after. If you can do tPA or you do mechanical thrombectomy, tell us what is life like for someone after that stroke?
Dr. Huisa: Well after the stroke there are two essential things that doctors work on patients. One is that we try to understand the cause of the stroke and prevent further stroke and complications from the stroke and the second is the body is still in a process of recovery from the stroke. The brain is trying to what we say, to rewire after the stroke happened and what we offer is some rehabilitation therapies that improves that recovery process. So we have, after the stroke, a rehab process that we help with and then a prevention, what we call secondary prevention, to prevent complications from the stroke and new stroke. The recovery phase usually takes one or three months initially and that’s the rapid phase, and then there is a slow process or slow phase that goes up to a year from the stroke.
Host: So as we wrap up, please give your best advice to preventing a stroke in the first place, but what you want people to know about recognizing those signs because time is brain and getting the help that they need as quickly as possible.
Dr. Huisa: Yes, so stroke is an emergency and is not very stable condition. If you see somebody or you notice you are experiencing some signs of stroke, slurred speech, loss of vision, weakness, numbness, problems with your balance, you need to call 911 immediately and come to the emergency room. At Temecula Valley Hospital, we have an excellent group of physicians and all the latest technologist to provide an acute emergency care for patients with stroke and we can reverse the symptoms if the patients presents early with our therapy. So time is of the essence again. For preventing a stroke, important to go to your primary care doctor, take care of your blood pressure, take care of your diabetes, and try to get your life as close as possible to that healthy lifestyle.
Host: Thank you so much doctor for joining us and giving us such great information about the ways to prevent a stroke and what happens and the symptoms so that we are well aware. That wraps up this episode of TVH Health Chat with Temecula Valley Hospital. Head on over to our website at temeculavalleyhospital.com for more information and to get connected with one of our providers. If you found this podcast informative, please share with your friends and family and on social media it’s so important that we all learn these signs together, and be sure to check out all the other interesting podcasts in our library. Physicians are independent practioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole.
Melanie Cole (Host): If you have a stroke, getting medical care as quickly as possible can help prevent death or minimize the lasting effects of stroke so it’s really important for you to know the signs of a possible stroke and learn your risk factors and identify what you need to do if you or a loved one is suffering a stroke. My guest today is Dr. Branko Huisa. He’s the stroke medical director at Temecula Valley Hospital. Dr. Huisa, I’m so glad to have you with us. Tell us what is a stroke and are there different types?
Dr. Branko Huisa (Guest): Thank you for the introduction. Well stroke, there are two types of stroke. One is what we call ischemic stroke and is the most common form. It happens about 80% to 85% of the time and is due to a blood clot. The blood clot goes and blocks one of the arteries of the brain so there is not enough blood flow to the specific part of the brain and symptoms happen and then the second type of stroke is what we call hemorrhagic stroke, which is a bleed that happens inside the brain and is due to a burst of one of the arteries of the brain, and the blood leaks into the brain and there is some what we call edema or increase of pressure on the brain due to the blood. What kind of symptoms people have when these two conditions happen is usually they get weakness on one side of the body, the face can look droopy, speech can be slurred, they cannot comprehend sometimes what other people are saying, they look confused, they have other walking. Other symptoms like numbness, double vision, and headaches can occur as well.
Host: It’s interesting. So tell us who is at risk for a stroke and I know that there is an acronym that we use, BE FAST or FAST and I’d like you to tell us those symptoms so that people can recognize them, but first tell us who’s at risk.
Dr. Huisa: Well people who are at risk is well – basically we have risk factors. Risk factors for stroke, the most important risk factor is hypertension, having high blood pressure. People who have sustained high blood pressure for many years, what the blood pressure does is damage the arteries and the brain is very sensitive to changes in blood pressure. The arteries can break or they can develop some plaque and clotting due to constant high blood pressure. The other risk factors include having high cholesterol, lack of physical activity, smoking, and having diabetes or elevated sugars. Those are the classic risk factors for stroke.
Host: So then tell us about the symptoms that we might recognize so that people know and are aware.
Dr. Huisa: So the symptoms are usually – I mentioned having problems with speech first, patients are not able to comprehend or to talk. There is a problem with weakness on one side of the body, numbness on one side of the body or the other, problems with balance, walking, sometimes very intense headache can be related to a bleed on the head. Sometimes these symptoms are difficult to recognize by the patient or the person who’s suffering the stroke, and most of the time is that somebody else was noticing that. The reason is that it’s happening in the brain and the weakness and numbness doesn’t happen actually in the muscles or the nerves but inside the brain so it’s hard for yourself to recognize something wrong is happening in your own brain. So it’s very well known that even doctors or scientists who study stroke are having a hard time to recognize their own symptoms when they have them.
Host: Well it is certainly difficult. Should somebody, if they recognize those symptoms with that acronym FAST, should they call 911? Should they try and drive their loved one to the hospital? Why is time so important doctor and what does the EMS have the ability to do?
Dr. Huisa: Yes, so from that acronym as you mentioned the last letter is T for time and time is of the essence for stroke. The faster you get somebody into the emergency room, the better the outcome for that patient. We do have some therapy that can act quickly on the blood clot and sometimes in the bleed that the patient has. The brain gets damaged very quickly so we need to act as fast as possible. We can remove the clot with medications. One medication that we have is called IV tPA and that’s a medication that we use within the 3 hours and we can push it up to the 4.5 hours sometimes and the medication removes clot from the brain. The other one is a small surgical procedure which we advance a catheter through the groin of the patient. We advance the catheter through the body and the neck and to the brain and we remove mechanically a large clot that might be causing the stroke. For that surgical procedure, the best outcomes occur on patients who are treated fast, usually within the 6 hours. Once the stroke stalls, it’s very difficult to get a good outcome and our therapies usually don’t respond.
Host: So it’s really all about the time factor. So tell us a little bit about what happens after. If you can do tPA or you do mechanical thrombectomy, tell us what is life like for someone after that stroke?
Dr. Huisa: Well after the stroke there are two essential things that doctors work on patients. One is that we try to understand the cause of the stroke and prevent further stroke and complications from the stroke and the second is the body is still in a process of recovery from the stroke. The brain is trying to what we say, to rewire after the stroke happened and what we offer is some rehabilitation therapies that improves that recovery process. So we have, after the stroke, a rehab process that we help with and then a prevention, what we call secondary prevention, to prevent complications from the stroke and new stroke. The recovery phase usually takes one or three months initially and that’s the rapid phase, and then there is a slow process or slow phase that goes up to a year from the stroke.
Host: So as we wrap up, please give your best advice to preventing a stroke in the first place, but what you want people to know about recognizing those signs because time is brain and getting the help that they need as quickly as possible.
Dr. Huisa: Yes, so stroke is an emergency and is not very stable condition. If you see somebody or you notice you are experiencing some signs of stroke, slurred speech, loss of vision, weakness, numbness, problems with your balance, you need to call 911 immediately and come to the emergency room. At Temecula Valley Hospital, we have an excellent group of physicians and all the latest technologist to provide an acute emergency care for patients with stroke and we can reverse the symptoms if the patients presents early with our therapy. So time is of the essence again. For preventing a stroke, important to go to your primary care doctor, take care of your blood pressure, take care of your diabetes, and try to get your life as close as possible to that healthy lifestyle.
Host: Thank you so much doctor for joining us and giving us such great information about the ways to prevent a stroke and what happens and the symptoms so that we are well aware. That wraps up this episode of TVH Health Chat with Temecula Valley Hospital. Head on over to our website at temeculavalleyhospital.com for more information and to get connected with one of our providers. If you found this podcast informative, please share with your friends and family and on social media it’s so important that we all learn these signs together, and be sure to check out all the other interesting podcasts in our library. Physicians are independent practioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole.