Knowing the Signs of Stroke Improves Outcomes, Saves Lives

Many of us have heard the phrase “time is brain” referring to the aftermath of a stroke. The most common type of stroke occurs when an artery in the brain becomes blocked, cutting off the flow of blood and oxygen to part of the brain. After a stroke, up to 32,000 neurons (brain cells) die every second, or about 1.9 million a minute!

brain-scan“After a stroke, every minute counts,” says neurologist Fatima Milfred, MD. “That’s why my colleagues in Neurology work in close collaboration with Emergency Department physicians to rapidly evaluate and treat stroke. The right interventions delivered quickly will save brain function and improve outcomes.”

Know the Signs

Recognizing the signs of stroke is critical for getting emergency medical help as soon as possible. Remember the letters B.E.F.A.S.T. for spotting a stroke:

  • “B” stands for Balance. Sudden dizziness, loss of balance or coordination.
  • “E” stands for Eyes. Sudden changes in vision or trouble seeing out of one or both eyes.
  • “F” stands for Face drooping. The person’s face or smile appears lopsided.
  • “A” stands for Arms. One arm is weak or numb and can’t stay raised.
  • “S” stands for Speech. Impaired or slurred speech; difficulty repeating simple phrases.
  • “T” stands for Time. Even if signs go away, call 9-1-1 and get to a hospital immediately.

Signs of strokePreparing for the Unexpected

“Most people do not plan ahead for a trip to the hospital for an emergency such as stroke,” says emergency medicine physician Joshua Zwart, MD. “But a few simple, proactive steps can help ensure you receive the best care in this situation.”

Dr. Zwart recommends people create a personal health file in advance and update it regularly. It should fit into a wallet, purse or be readily available on a smart device and include:

  • Chronic health conditions and previous surgeries
  • Results of recent medical tests
  • Medication allergies
  • List of current medications, vitamins or herbal supplements
  • Names and contact information for your doctors, family and friends who may need to be alerted in the event of an emergency health issue
  • Advance directives

Highly Coordinated Care

Emergency departments operate on a triage basis, which means the most serious illnesses or injuries are attended to first. If you are brought to an emergency department with a suspected stroke, you will be rapidly evaluated and treated. A team of clinicians, including emergency medicine physicians, neurologists, nurses and others will coordinate getting your medical history and completing a physical exam. Additional advanced diagnostic testing and treatment may include:

  • CT scan of the head
  • CT angiography (special imaging of arteries and veins)
  • Blood tests
  • Oxygen therapy
  • Acute stroke medications, such as tissue plasminogen activator (tPA – a clot-busting drug)
  • Thrombectomy (mechanical clot extraction) for large vessel occlusion, if indicated

An Ounce of Prevention

It is estimated that 80 percent of strokes could be prevented. Here are some ways to reduce your risk of having a stroke:

  • Treat high blood pressure and diabetes – regular follow-up with a primary care provider is a must.
  • Reduce high cholesterol.
  • Maintain ideal body weight. Losing as little as 10 pounds can have a real impact on stroke risk.
  • Exercise regularly – 30 minutes of moderate intensity aerobic activity at least five days per week, under the supervision of your doctor.
  • Stop smoking.
  • Find activities that reduce stress, such as listening to music, taking a walk, calling a friend, or other “time-out” activities.
  • Eat a well-balanced diet higher in fruits and vegetables and lower in red meat, such as the Mediterranean diet.

To get an idea of your personal risk for heart disease or stroke, try this online calculator from the American College of Cardiology/American Heart Association.

After a Stroke Event

Sometimes symptoms of stroke resolve before treatment is implemented. The patient may have suffered what’s known as a transient ischemic attack (TIA), also called a mini stroke. Up to 40 percent of people who have TIAs will go on to have a stroke, which is why immediate preventive follow-up care is needed. Virginia Mason patients who are able to receive outpatient care are referred to the Rapid Access TIA Clinic, offering both medical and lifestyle interventions to reduce stroke risk.

Nurse Assessing Stroke Victim By Raising ArmsFollow-up care following treatment for stroke is extremely important. Your care team will outline a plan to aid your recovery and help prevent a future stroke from happening. Special programs, like shared medical appointments (Virginia Mason offers one called Brain Health Strategies), help stroke survivors connect with each other for extra support during their time of healing.

Virginia Mason’s Stroke Support Group is offered monthly as another resource for patients, with facilitators who cover helpful topics while providing plenty of discussion time during each session for stroke survivors, their loved ones and caregivers.

Patients treated for stroke in other health systems are welcome to explore follow-up care options and programs with the Virginia Mason Stroke Center. For more information visit our website, or call (206) 341-0420.

Rapid Access TIA Clinic Reduces the Risk of Stroke

What if you suddenly experienced a stroke symptom – weakness, slurred speech, a change in vision or numbness in your body – that completely disappeared after a few minutes? You may have just suffered a transient ischemic attack (TIA), sometimes called a mini-stroke or warning stroke in which the blood supply to part of the brain is cut off for a brief period.

brain-scanWhile TIAs resolve without causing permanent damage, about one in three people who have a TIA will eventually have a stroke, the fifth biggest killer in the U.S. and a top cause of long-term disability. The Rapid Access TIA Clinic, part of the Neuroscience Institute at Virginia Mason, provides fast, comprehensive treatment designed to reduce stroke risk in patients who have had a TIA – all without admission to the hospital.

“Low-risk TIA patients can be well cared for in our Rapid Access TIA Clinic, following the appropriate diagnostic work-up,” says neurologist Nancy Isenberg, MD, medical director, Rapid Access TIA Clinic. “A TIA is a warning sign and we need to act quickly to reduce stroke risk. By seeing these patients in our specialized clinic, we have a real opportunity to substantially impact risk.”

The Rapid Access TIA Clinic combines both medical and lifestyle interventions known to reduce stroke risk, at a time when patients are motivated to make a change.

Many Rapid Access TIA Clinic patients are referred from the Emergency Department, after a diagnostic protocol determines who can be effectively managed in the outpatient setting. Primary care providers whose patients report TIA symptoms can arrange for an expedited appointment in the clinic as well. Patients are seen within 24 to 48 hours of referral by a neurology Advanced Registered Nurse Practitioner (ARNP), with access to any needed diagnostic tool, including MRI/CT scanning, advanced imaging of the arteries, ultrasound, heart studies and a full examination of an individual’s risk factors.

The Rapid Access TIA Clinic combines both medical and lifestyle interventions known to reduce stroke risk, at a time when patients are often motivated to make a change. Medications to lower blood pressure, cholesterol and prevent blood clots can be prescribed,  and are shown in studies to drastically cut the risk of stroke. But lifestyle changes are given equal weight. Patients receive support to quit smoking, eat a healthier diet and find a form of exercise that works for them. Good control of conditions like diabetes and sleep apnea also help to improve vascular health.

Because creating new, healthy habits is difficult for many people, the Rapid Access TIA Clinic will soon introduce group visits, where patients can share experiences and learn from others on the same health improvement journey.

“It’s easy to prescribe medications after a TIA, but we also want to use the opportunity to educate patients,” says Sarah Hermanson, ARNP, Neuroscience Institute. “The sooner we can initiate prevention measures, the better our chances for creating lasting change.”


A version of this article originally appeared in the Virginia Mason Health System 2016 Annual Report.