A stroke is an emergency that needs to be treated immediately by a professional. But how do you detect a stroke in a loved one, a friend, or yourself? Why is time so critical when it comes to stroke treatment? And what exactly is a stroke?
"Time is of the essence," says Jens Witsch, MD, Assistant Professor of Neurology at Penn Medicine. "Stroke symptoms start suddenly, and with every minute that passes more brain cells die. Luckily, we have effective treatments for stroke that can make a big difference. Sometimes they can even reverse the stroke symptoms. But these treatments are only effective soon after stroke symptoms have become noticeable. What does that mean? If you suspect a stroke, do not wait. Pick up the phone and call 911 immediately."
How to detect a stroke “FAST”
In a survey conducted by the Centers for Disease Control and Prevention (CDC), only a little more than two thirds of respondents recognized major stroke symptoms and knew to call 911 to get help. Luckily, there are a few simple steps that can be used to recognize a stroke, which can be remembered using the FAST acronym.
FAST helps us remember the signs of a stroke and how to react. If possible, try to remember the first symptoms you see. Is the Face drooping? Is the Arm weak? Is the Speech slurred or garbled? If so, call 911 quickly (Time).
Every single minute counts
In the United States, stroke is among the leading causes of death. "As stroke neurologists, we are working towards improving outcomes after stroke," says Dr. Witsch. "In many cases, people's lives can be saved and their quality of life can be preserved if the patient gets to the hospital as early as possible. Each minute thousands of brain cells die. Our goal is to save the brain by treating the stroke as quickly as possible. Every single minute counts."
What is a stroke?
A stroke occurs when a blood vessel in the brain or in the eye has a clot, or when a blood vessel ruptures and bleeds into the brain tissue.
Regardless of what type of stroke a person has — a stroke due to a blood clot, or a stroke due to bleeding — the brain cells are deprived of oxygen. Some brain cells die immediately. Many other brain cells might still be salvageable, but are at high risk of dying. The more time that passes, the more brain cells die. For that reason, it is so important to seek medical attention immediately.
Ischemic stroke
87 percent (about nine out of 10) of all strokes are ischemic. An ischemic stroke occurs when a clot has blocked off a blood vessel in the brain.
There are two types of treatments for ischemic strokes: intravenous rTPA and endovascular thrombectomy.
Intravenous rTPA
rTPA is a clot-busting medication that stands for recombinant tissue plasminogen activator. This medication can be given up to 4.5 hours from symptom onset and can dissolve the blood clot. "It is important to know that although rTPA can be given up to 4.5 hours after stroke onset, it is much more effective and more likely to help the patient if it is given early," says Dr. Witsch. "In 2021, the majority of eligible stroke patients at Penn Medicine received rTPA within one hour from arrival at the hospital."
Endovascular thrombectomy
The other treatment for ischemic stroke is called endovascular thrombectomy. A trained physician uses a small guidewire to advance a specialized device all the way to the blood clot to remove the clot from the blocked vessel. This procedure requires an entire team of trained nurses, technicians, and physicians, and can only be performed at a Comprehensive Stroke Center. The Hospital of the University of Pennsylvania is a center capable of providing this type of advanced stroke care.
"Similar to rTPA treatment, mechanical thrombectomy is most effective early after stroke symptom onset," Dr. Witsch says. "In some cases, we perform the procedure up to 24 hours after symptom onset, but for the best chance of helping the patient, it is best to remove the blood clot from the clogged vessel as soon as possible."
Hemorrhagic stroke
When doctors talk about hemorrhagic stroke, they refer to a blood vessel rupture inside the head.
Most often this bleeding happens in the brain itself, meaning that the blood leaks out of a vessel into the brain tissue. This is called intracerebral hemorrhage.
Another hemorrhagic stroke type is subarachnoid hemorrhage. Subarachnoid hemorrhage is bleeding into the space surrounding the brain, between the brain and the skull. Frequently the bleeding originates from an outpouching in one of the brain vessels called aneurysm. After the first bleed, such aneurysms carry the risk of bleeding again, and therefore timely aneurysm treatment is crucial.
Both types of hemorrhagic stroke can become noticeable with the same symptoms discussed above (F.A.S.T. = face, arm, speech, time), and sometimes patients with hemorrhagic stroke also have an intense, relentless headache that just won't go away. Like ischemic stroke, hemorrhagic stroke can severely injure brain cells and is often life-threatening, requiring immediate attention and treatment.
Patients with intracerebral hemorrhage or subarachnoid hemorrhage often have elevated blood pressure, which can make the brain injury worse. One early treatment is blood pressure control.
In some cases of intracerebral hemorrhage, it is reasonable to consider surgical removal of the blood clot. For subarachnoid hemorrhage, if an aneurysm is the cause of the bleeding, this aneurysm needs to be treated. Surgery might be conducted to place a metal clip on the blood vessel to stop the bleeding. Other endovascular procedures may be needed as well. These are less invasive treatments performed within the blood vessels using a catheter or other devices.
The takeaway
Stroke symptoms are often very similar, regardless of what kind of stroke one is having. If you are showing symptoms of a stroke or think a friend is, don't wait even a few minutes. Call 911 right away. Quick treatment could save someone's life and greatly improve their quality of life later. The earlier stroke is detected, the more treatment options can be considered to help you or a loved one.
Penn Medicine has been a Comprehensive Stroke Center for about a decade. Our stroke patients have access to the most advanced treatment resources available. Our team of stroke physicians evaluate, diagnose and treat stroke and other diseases affecting the blood vessels in the brain in Philadelphia and surrounding regions. The Penn Stroke Team also has partnerships with many area hospitals who transfer stroke patients to our Comprehensive Stroke Center. In 2021, through the NeuroRescue Program, Penn Medicine accepted neuroscience transfers from over 100 different hospitals. In addition, Penn stroke physicians provide stroke consultations through telestroke to area hospitals as needed.