Stroke, sometimes called a brain attack, is a general name for a variety of disorders that occur within seconds or minutes when the blood supply to the brain is interrupted. Approximately 800,000 Americans suffer strokes every year. Stroke is a leading cause of death and the leading cause of adult disability in the United States.
The quality care provided is effectively managed to meet the unique and specialized needs of complex stroke patients. We have the critical elements to achieve long-term success and improve outcomes for patients. The stroke team is made up of physicians, nurses, advanced practice providers (APP), social workers, dietitians, rehabilitation professionals, therapists, pharmacists and home care specialists. The quality care provided is effectively managed to meet the unique and specialized needs of stroke patients.
When a stroke occurs, our physicians want their patients to receive the most advanced care in the shortest amount of time possible. Every patient deserves the very best treatment by our dedicated team of physicians, including our Neurointerventional Radiology service.
Treatment for stroke can be complex, requiring a robust process and an expert team. To reduce the long-term negative impact of stroke on our community, the Brain & Spine Institute has organized services into a seamless Advanced Comprehensive Stroke Center. We are certified by The Joint Commission and the American Heart Association. This means that our patients are recognized on a national level as receiving the highest-quality of care offered in the health care industry and have better outcomes. In addition, for more than a decade, our team has been recognized annually by the American Heart Association’s Get With The Guidelines-Stroke initiative. This recognition highlights our commitment to providing quality care and improving outcomes.
Types of Stroke
During a stroke, the interruption in blood supply in the brain can be caused by either a blockage in an artery (ischemic stroke) or a ruptured artery (hemorrhagic stroke).
Ischemic stroke is most often caused by a either a thrombus or an embolus, affecting approximately 87 percent of all stroke victims. A thrombus occurs when a clot forms inside one of the arteries supplying blood to the brain, often seen in people with atherosclerosis due to high cholesterol levels, high blood pressure, or smoking. An embolus occurs when a blood clot or a plaque fragment forms elsewhere in the body (usually in the heart) and travels to the brain, lodging in an artery and blocking blood flow. This type of stroke can be seen in people who suffer from atrial fibrillation.
Hemorrhagic strokes are less common than ischemic strokes and happen when an artery ruptures, and accounts for the other 13 percent. There are two types of hemorrhagic stroke: intracerebral hemorrhage and subarachnoid hemorrhage.
Intracerebral hemorrhage happens when an artery ruptures inside the brain causing blood to leak out in the surrounding brain tissue. This bleeding results in brain cells dying from lack of oxygen and glucose, as well as from pressure on the surrounding cells. This type of stroke is often caused by high blood pressure.
Subarachnoid hemorrhage happens when bleeding occurs on the surface of the brain, usually due to a ruptured aneurysm. The blood on the surface of the brain irritates the surrounding brain tissues as well as increasing the pressure on those tissues.
Another condition related to stroke is a transient ischemic attack (TIA). During a TIA, blood flow in the brain is interrupted temporarily causing the same symptoms as stroke. The difference is that a TIA clears up on its own, while a stroke continues leaving lasting damage. Even though TIAs do not cause lasting damage, it’s important that the symptoms are taken seriously. TIAs are a warning sign that the conditions for a permanent stroke are present. Steps should be taken to assess and correct risk factors for stroke as soon as possible.
Stroke Warning Signs
Anyone can have a stroke no matter what age, race or gender. There are some risk factors that you can control by selecting a healthy lifestyle. However, even that is not a guarantee. It is important to be able to recognize the signs of stroke and react immediately to get help.
Everyone should learn to recognize stroke warning signs. Treatment for all types of stroke should be started as soon as possible to limit damage to brain cells. For any sign of stroke, notice the time the symptoms start and activate emergency medical services (EMS) by dialing 9-1-1 right away.
- Sudden weakness, paralysis or numbness of the face, arm or leg, especially on one side of the body
- Sudden onset of double vision, dimness or loss of vision
- Sudden difficulty speaking or understanding language
- Sudden severe headache without apparent cause
- Unexplained dizziness, unsteadiness or loss of balance, especially in combination with other signs
Remember, as soon as stroke warning signs are noted, dial 9-1-1, even if the symptoms clear up on their own.
Tips to Help You be Prepared in the Event of a Stroke
- Keep an accessible record of any medications you are taking, your doctor’s names and any previous surgical procedures and health conditions.
- Keep a list of emergency phone numbers near the phone or in your wallet or purse.
- Find out which hospitals in your area are certified stroke centers. When you call 911 for stroke symptoms tell the emergency personnel to take you to the nearest certified stroke center. The University of Tennessee Medical Center offers the highest level of technology, the best trained physicians and nurses and a stroke team available on site 24 hours a day, 7 days a week.
While You are Waiting for Emergency Personnel to Arrive
- Record the time the first symptoms began. Timing is critical, because it determines which treatments can be offered.
- Record how the first symptoms began.
- Do not eat or drink anything. One of the problems associated with stroke is difficulty swallowing, so eating or drinking could be dangerous.
- Collect current active medications and bring the bottles in a bag. If the bottles are not available, write the medications down along with the dosages along with the pharmacy name and number. This is valuable information for the paramedics and emergency department staff.
Experiencing a stroke can be frightening. From the onset of stroke symptoms until ongoing stroke rehabilitation, the journey through recovery can be a long process. It may be helpful to know what you can expect if you or a loved one has a stroke.
When you are not sure if you are having a stroke, the safest thing to do is get to the emergency department at a stroke center by activating 911. “Sometimes when people are panic stricken because they or someone they love is sick, they will try to drive to the hospital themselves,” says Karen Pryor, director of the Emergency Department at The University of Tennessee Medical Center. “They think that they cannot wait for the ambulance, and that is a very bad strategy for people with stroke or chest pain. Their condition could get even worse.”
Our paramedics and emergency medical technicians are trained to recognize stroke symptoms, you will be rapidly transported to the stroke center, and they will call ahead to alert the stroke team that you are coming. This allows us to be ready to assess and begin treatment. Our team will ask critical questions such as the time the symptoms first started, which symptoms you have experienced, and which medications you are taking. “The time that the patient was last seen without symptoms is a very important piece of information and would need to be told to the paramedics,” says Jennifer Henry, Stroke Director at UT Medical Center.
In the Ambulance
Once you are on the way to the hospital in the ambulance, there are several things our emergency medical personnel will do to expedite your care. You can expect to receive the following:
- Placement on a monitor
- Placement on oxygen
- IV Line, if necessary
- Blood sugar assessment
- Vital Signs
- Asked a lot of questions
The goal is to get you to a stroke center as quickly as possible for rapid evaluation and treatment.
At the Emergency Department
Once you arrive at the emergency department, you will be evaluated and treated by the stroke team, which includes an emergency physician, emergency nurse, stroke team nurse practitioners, and neurologists. Other specialists, such as neurosurgeons, neurointensivists, and neurointerventional radiologists will be involved if indicated.
Diagnosing a stroke is complicated but critical to determining which types of treatment you will receive. The doctor must determine if the stroke is ischemic or hemorrhagic. Our stroke team will check for various neurologic, motor and sensory deficits. The exam may show changes in muscle weakness, decreased sensation, abnormal reflexes and changes in vision. Tests then will be performed to determine the exact type, location and cause of the stroke—as well as to rule out other conditions. Tests that will be ordered include:
- CT scan or MRI
- Electrocardiogram (ECG)
- CT angiogram or MR angiogram
- Heart Monitor
- Cerebral Angiogram
- Blood Work
When Your Results Come Back
When the results are in, your care team will work with you to determine the best course of treatment, which may include medications, surgery and/or rehabilitation, depending on the type of stroke, its severity and its effects.
Our center offers the latest imaging technology in order to provide minimally invasive treatment. In addition, our center provides rapid medical attention, a stroke coordinator and our team with stroke expertise as well as early identification of stroke rehabilitation needs. We also focus on public education, including stroke prevention and the detection of early warning signs of stroke.