Working in the Emergency Department at Valley View, I have seen the impact stroke has had on our community of patients. As the stroke medical director, it has been my privilege to be a part of Valley View’s stroke team in the pursuit to become the first Acute Stroke Ready Hospital in the state of Colorado, as designated by our accrediting body. Valley View obtained this designation earlier this year. Ensuring the most current techniques and timeliness of care makes stroke treatment effective and decreases long-term disability and even death.
Stroke is the fifth-leading cause of death and disability in the United States. Further, stroke is the second leading cause of death and disability worldwide, according to the American Heart Association. When it comes to stroke recognition and treatment, every minute counts, as immediate action can assist with preventing brain damage and disability. When signs and symptoms of stroke are first recognized, it is imperative that emergency services are called for rapid diagnosis and treatment to take place.
Stroke is an attack on the brain affecting the arteries leading to and within the brain. A stroke occurs when one of these arteries is blocked or bursts. Ischemic strokes, more commonly referred to as blocked arteries, represent 87 percent of all strokes. Hemorrhagic strokes occur when an artery is ruptured, leading to bleeding in the brain. The disruption in blood flow, either ischemic or hemorrhagic, prevents the brain from receiving necessary oxygenated blood leading to cell damage and death.
Uncontrolled risk factors for stroke include age, race, gender and family history. One out of five people under the age of 55 has a stroke, and this statistic only increases with age. African Americans, Asian and Hispanic populations have an increased risk for stroke. More women than men die from stroke, and more women die from stroke than from breast cancer every year. A person is at greater risk for stroke who has a family history. Controllable risk factors include high blood pressure, atrial fibrillation, high cholesterol, smoking, diabetes, poor circulation, lack of physical activity and obesity. Knowing your risk factors and discussing these with your primary care provider is necessary to decrease your risk of a debilitating stroke. One in four stroke survivors are at risk for a second stroke; however with proper management, 80 percent of these recurrences are preventable.
Symptoms of an ischemic stroke coincide with the area of brain that is disconnected from proper blood flow. Recognizing the symptoms utilizing the BEFAST (balance, eyes, face, arms, speech, time) mnemonic is key to early detection and activation of emergency services. Lack of coordination or difficulty walking represents balance issues. Complaints of blurry vision or visual changes in one or both eyes represent eye symptoms. Drooping to one side of the face with inability to smile evenly represents facial symptoms. Weakness to arms and legs, usually involving only one side, represents arms. Slurred speech or difficulty forming words represents speech. Finally, time in this mnemonic simply means to act quickly and call 911 immediately. If any of these symptoms occur suddenly and is not normal for someone, stroke is indicated and emergency medical care is imperative. It is important to note the time of onset of symptoms and not wait for spontaneous improvement.
Although hemorrhagic stroke does not represent a large number of patients treated nationwide, it is appropriate to understand the presentation of this disease process as well. In addition to ischemic stroke symptoms, a sudden, unexplained, severe headache could be indicative of a brain bleed. This headache is usually characterized as the worst headache of one’s life. High blood pressure or taking blood thinning medications can increase a person’s risk for this type of stroke.
The biggest concern we as health care providers face for our community is timely treatment. Time is brain. It is imperative that emergent care be taken when someone is presenting with signs and symptoms of a stroke. Join us in taking stroke care to the community with prompt recognition and urgent action.
Charlie Abramson, DO, is a board-certified emergency medicine physician in the Emergency Department at Valley View is the Stroke Medical Director of Valley View’s Stroke Committee. For more information on Valley View, visit http://www.vvh.org.