How to Diagnose and Treat a Stroke (video/podcast)

Do you know the signs of stroke ― and what to do if you see them?

Approximately 800,000 people suffer a stroke in the United States every year, and for more than 100,000, stroke is fatal. Getting to the ER immediately when you notice stroke symptoms can determine whether someone survives and what their quality of life may be like.

In this video, San Diego Health host Susan Taylor talks about diagnosing and treating stroke with Mary Kalafut, MD, a neurologist at Scripps Clinic and stroke medical director for Scripps.

Simply put, a stroke is a lack of blood flow to the brain. There are two major types of stroke. Ischemic stroke happens when a vessel that supplies blood to the brain is blocked by a clot; about 60 to 70% of strokes are ischemic. The less common type, hemorrhagic stroke, occurs when a blood vessel in the brain breaks open and blood seeps out.

“Many things can cause this type of clot, whether it’s a little piece of cholesterol breaking off from one of the blood vessels in the neck and going to the brain, or a clot inside the heart going to the brain,” says Dr. Kalafut.

When the blood supply is cut off, the nerve cells in that area of the brain start to die. The longer these cells are deprived of oxygen from blood, the more likely stroke is to result in permanent disabilities. This is why it is crucial to recognize the signs of stroke and get medical treatment right away.

How do you know if someone is having a stroke? BEFAST is a mnemonic that can help you understand stroke signs and take immediate action. BEFAST includes:

• Balance problems, such as suddenly feeling unsteady or being unable to walk
• Eye or vision problems, like suddenly losing partial or all vision in one or both eyes or developing double vision
• Face abnormalities, such as drooping or not moving as much on one side when smiling
• Arm weakness when both arms are extended straight out and one doesn’t extend or starts dropping
• Speech problems, such as slurred speech, using the wrong words or difficulty speaking
• Time, while not a symptom, reminds you to call 911 immediately

“The most important thing to understand is time is brain. If you are noticing signs of stroke, call 911 and get into the emergency room immediately, because we do have treatments that can reopen the blood vessel and restore blood flow,” says Dr. Kalafut. “You don’t want to drive. Going by 911 is the best way to get treatment that you need.”

Stroke is usually diagnosed with a CAT scan or an MRI. Both imaging exams show what is happening in the brain.

If a stroke is confirmed, doctors can give intravenous clot-busting medication to break up the clot and restore blood flow to the brain. This medication must be given within 90 minutes of the onset of stroke to be effective ― which is why immediate treatment is so important.

If a very large blood vessel is blocked, surgery may be necessary to remove the clot. This is typically done by inserting a long, thin tube called a catheter into one of the large veins in the leg and guiding it up to the clot.

“This is why it is very important to get to the hospital as soon as you can, so that the doctors can pull out the clot, restore blood flow, and have there’s less injury to the brain,” says Dr. Kalafut.

Scripps Memorial Hospital La Jolla has been designated as a comprehensive stroke center. This designation is given only to certain hospitals that have the technology, physicians and specialized stroke rehabilitation teams to care for the most complex stroke patients.

Both Scripps Mercy Hospital Chula Vista and Scripps Memorial Hospital Encinitas are primary stroke centers, which are certified to take care of an acute stroke patient. Scripps Mercy Hospital San Diego, a thrombectomy-capable center, offers some higher-level care.

Risk factors for stroke include:

• Diabetes
• High blood pressure
• High cholesterol
• Smoking
• Excessive use of alcohol

In addition, people who have an irregular heartbeat, called atrial fibrillation, have a higher risk of blood clots and may need medication to reduce the risk.

“Make sure your blood pressure, cholesterol and blood sugars are under control,” says Dr. Kalafut. “Also being physically active, being involved in an exercise program, as well as making sure you follow a Mediterranean type of diet, limiting red meat and increasing your vegetables. Those would be the most important things to help decrease your risk of stroke.”

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