Stroke is the fifth-leading cause of death in the United States and the leading neurological cause of disability in adults. While most people think of stroke as an older person’s disease, stroke affects people of all ages and everyone should know the signs. If you or a loved one experiences a stroke, getting treatment fast can be the difference between recovery and long-term disability or death.
Tufts Medicine stroke experts and stroke directors Dr. Lester Y. Leung (certified Comprehensive Stroke Center at Tufts Medical Center), Dr. Sarah Nelson (MelroseWakefield Hospital, certified Acute Stroke Ready Hospital), and Dr. Meg VanNostrand (Lowell General Hospital, certified Primary Stroke Service hospital), walk you through what you need to know about stroke—from prevention and detection to treatment and recovery.
What is a stroke?
A stroke occurs when blood vessels supplying the brain, spinal cord or eyes are blocked or rupture. This leads to an injury to the brain where it can't tell your body to do certain things like move your face or limbs, see, speak or understand what others are saying. There are 2 main types of strokes:
- Ischemic stroke: this is caused by a blockage of a blood vessel supplying a specific portion of the brain, resulting in loss of oxygen and nutrient delivery to that area. This is the most common type of stroke.
- Hemorrhagic stroke: this is caused by a rupture of a blood vessel supplying the brain, resulting in bleeding into the brain tissue or onto the surface of the brain. These are less common types of stroke, but they often tend to be severe and are more likely to be lethal.
Preventing stroke
In the US, leading causes of stroke include high blood pressure, high cholesterol, diabetes and smoking. “The most effective way to prevent stroke is by maintaining as healthy a lifestyle as possible, controlling any risk factors you may have for stroke, and establishing a lifelong commitment to regular physical activity,” says Dr. Nelson. “Doing whatever is in your power to live a healthy life now will help avoid development of a stroke and the potential disabling neurologic deficits that can come with it later.” In addition to exercising and eating a healthy diet, visit and talk to your doctor. If you have high blood pressure, high cholesterol or diabetes, take all of the steps you need to manage them properly. Take your prescribed medications and have your recommended lab work and screenings. If you smoke, stop! Director, Stroke and Cerebrovascular Disease Clinic
BE FAST
According to the Centers for Disease Control and Prevention, stroke affects more than 795,000 U.S. adults every year — but many strokes go undiagnosed, and therefore untreated, because people fail to recognize the symptoms and seek medical attention. Dr. VanNostrand emphasizes that time is of the essence. “When a stroke occurs, your brain is deprived of oxygen and the sooner you get medical attention, the greater chance you have of recovery and avoiding permanent disability. Even if you’re unsure whether your symptoms indicate a stroke, call 911 or get to your nearest emergency room as soon as possible.” The most common signs of stroke include:
B = Balance – falling repeatedly to one side
E = Eyes – loss of vision or double vision
F = Face – weakness or drooping on one side of the face
A = Arm – loss of strength in an arm, leg, or both, especially on one side
S = Speech – difficulty speaking or understanding others
T = TIME = Stroke is a treatable emergency!
Remember, when you notice any of these symptoms to BE FAST.
The first 24 to 48 Hours
When you first arrive at the hospital after stroke, your doctors and nurses will work to stabilize your condition and prevent early recurrence. At most stroke centers, if you get there within 4.5 hours of first noticing symptoms, you might be able to receive intravenous thrombolysis, a medication that supplements proteins in your body that can break up blood clots that might be causing the stroke. Tufts Medical Center is the only hospital in Massachusetts to have a standardized “late presenter thrombolysis” protocol for treating patients with suspected ischemic stroke up to 24 hours after onset. If your stroke is caused by a large blockage in an artery, you might receive a mechanical thrombectomy, a minimally invasive surgery that removes the obstruction from your bloodstream. You will also receive medication, such as aspirin and clopidogrel, to prevent clots from forming and reduce the chances of an early recurrent stroke.
A life after stroke: prevention, rehabilitation and recovery
Two-thirds of individuals who have a stroke require rehabilitation therapies to minimize chances of lasting disability. The process of maximizing recovery through rehabilitation and effectively preventing future stroke requires expertise and a lot of individualized help for each stroke survivor. “Just like with emergency treatments for stroke in the hospital, your care after a stroke is a team effort,” says Dr. Leung, who also directs the Stroke and Cerebrovascular Disease Clinic at Tufts Medical Center, a multi-pronged outpatient program centered on the therapeutic alliance between a patient and their neurology clinician. “One of the most impactful things we can do is help you figure out why you had a stroke and to directly reduce future risk from that cause, as well as address any other competing risks. We work alongside you to:
- Identify the cause of your stroke and your risk of having another one.
- Determine the best treatment plan to prevent a future stroke.
- Identify any persistent symptoms or deficits that might benefit from rehabilitation.
- Identify and treat any late complications emerging after a stroke.
- Help you improve your overall health to reduce the risk of recurrence.
- Navigate your path after a stroke.
At Tufts Medical Center, a Stroke Nurse Navigator works with the team to ease the transition between the hospital and home. For instance, the navigator will follow up via phone to review a patient’s medications, answer questions, and provide additional education. Your care team might also determine that you need in-home services or would benefit from a stay in a stay in a skilled nursing facility (SNF) or long-term acute care facility (LTAC). You might also need some combination of physical therapy (PT), occupational therapy (OT), or speech-language pathology (SLP). And because strokes occur in people of all ages, Tufts Medical Center’s Stroke and Young Adults (SAYA) Program was designed to meet the specialized needs of stroke survivors under 50.
The takeaway
“Stroke can happen to anyone, at any age at any time” is Dr. Leung’s motto. “No matter the situation, we’re committed to delivering personalized care and compassionate treatment that best suits every patient.”
If you think you might be having a stroke, call 911 and get to your closest Emergency Room.
