ENID — Every 40 seconds, someone in the United States suffers a stroke, and time lost means brain loss.

The first thing doctors want people to know about stroke are the symptoms because the sooner a stroke is identified the sooner help can arrive and the more likely a victim can make a full recovery.

Symptoms are sudden numbness or weakness of face, arm or leg; confusion or trouble speaking and understanding; vision problems; trouble walking, dizziness and loss of balance or coordination; and sudden onset of a severe headache.

Once it is determined a stroke is possible, it is important to get the victim to a hospital quickly because brain cells are dying.

Community education about strokes is important, said Edward Herrman, assistant administrator of patient care for Integris Bass Baptist Health Center.

“There is short time frame — we have a three- to four-hour window after the onset of symptoms to give (certain medication),” he said. “As a community we need to be aware of the signs or symptoms (of a stroke) and when you need to get someone to the emergency room. The early you do the better the results ...”



Signs, symptoms can be unique



Not every stroke presents with the same signs and symptoms, said Dr. Jay Knapik, staff neurologist and medical director of inpatient rehabilitation services at St. Mary’s Regional Medical Center.

“Signs and symptoms of the stroke are variable depending on the what type and where the stroke occurs. If it is in the dominant side, usually the left, it may result in right-side weakness, numbness in the arm, face, loss of vision in the eye. There is also non-dominant neglect syndrome where they don’t recognize the left half of their body. ... They don’t even know anything is wrong,” Knapik said.

For health care providers, the first priority is to determine the stroke type.

“There are several types of stroke,” Knapik said. “Ischemic stroke is when there is no blood flow to an area of the brain. A hemorrhagic stroke means there is blood in the brain. Those types of strokes differ greatly in how we treat them.”

An ischemic stroke usually involves narrowing of blood vessels, due to plaque. A CT scan or MRI will show the narrowing.

“In some cases, we can shunt the area of the narrowing and greatly reduce the risk of stroke. I describe it as if you have cut a 50-year-old water pipe open, there will be build up, they have plaque build up,” he said.

A hemorrhagic stroke can occur for several reasons.

“... Usually high blood pressure, brain aneurysm, head injury or occasionally clots flipping from the heart,” Knapik said.



Technology enhances care



Evaluation begins in the emergency room with several tests including brain scans, heart monitors and neurological consultation.

Bass has implemented a new program, TeleStroke, in its emergency room to ensure a neurologist always is available to evaluate a potential stroke victim, Herrman said. It augments existing on-site coverage to provide consistent care.

TeleStroke uses videoconferencing to allow doctors from Oklahoma City to remotely examine a patient, confirm the diagnosis, interpret brain images and provide recommendation to the hospital’s staff.

“We have a flat-screen TV with kind of a Web cam, but better. You can see the physician’s face close up, and the physician can see you,” said Herrman. “If we think they are having a stroke we use TeleStroke. We are all digital, so the doctors in Oklahoma City can see everything in real-time and diagnose. He will make the call based on the CT scan and the physical examination with the staff.”

Herrman said TeleStroke already has helped patients.

“We had one gentleman who presented with total right-side paralysis. Our in-house neurologist was out of rotation for vacation,” said Herrman.

Using TeleStroke the patient was diagnosed and treatment started.

“Before we sent him (to another hospital in the Integris network), he regained full mobility and had a full recovery,” said Herrman. “It is very good, cutting-edge technology.”

The treatment plan



Once the stroke type is determined, risk factors are investigated.

“Stroke risk factors include age, diabetes, blood pressure, elevated cholesterol, smoking, family history and certain types of cardiac irregularities (atrial fibrillation). One of the risk factors is heart disease. People who have had heart attacks are at an increased risk for strokes,” Knapik said.

“When someone comes in with an ischemic stroke, we look at the risk factors. Certain ones we can’t change, like family history, but some are modifiable. There has been a strong push to controlling the risk factors,” he said.

The type of stroke also determines the treatment.

“The most exciting new thing is a “block buster.” Activase (clot buster) may reverse or partially reverse a stroke, but it must be within the first three to four hours. We’ve been doing it since the early 2000s. There are risks to the use of that medicine, primarily bleeding, because it is a strong blood thinner,” Knapik said.

“Block busters” cannot be used on hemorrhagic stroke patients because it can cause a patient to bleed out in their head.

“If we can’t use that medicine (block buster), generally, we use a group of medicines called anti-platelet medicines: Plavix, aspirin Aggrenox or Ticlid,” Knapik said.

Even after a treatment plan is determined, the patient has a long road ahead.

“The hard part is rehabilitating patients,” Knapik said. “It takes weeks and months. Some patients are still getting better a year after the stroke. Age and the type of stroke are all parts of the prognosis. It takes a team approach: physician, speech pathologist, neuropsychologist, dietitian, social worker, stroke nursing team, occupational therapists and physical therapists. The support doesn’t end when they leave the unit.

Often they still need home help and rehab, and health care teams will help reintegrate them into society.

“The goal,” Knapik said, “is to go home and to get them back to where they were before it all happened.”