Ask Us Anything About… Stroke and Mini-strokes

Description – The video begins inside a conference room at Penn State Health Milton S. Hershey Medical Center. Three people are standing next to each other. Standing from left to right are Scott Gilbert, Alicia Richardson and Cesar Velasco.

Scott Gilbert – From Penn State Health, this is Ask Us Anything About Stroke and Mini-Strokes, I’m Scott Gilbert. While the term mini-stroke may not sound serious, such an episode can be a clear warning sign that a stroke may happen in the future. As most mini-strokes produce temporary symptoms, they are often ignored, and that can be dangerous. We’ll learn about mini-strokes as well as strokes and why all of this should have you thinking, BE FAST. We’ll tell you what those letters mean. We’ll learn more from Penn State Stroke Center program coordinators, Alisha Richardson and Cesar Velasco. Thanks to both of you for being here today. Let’s start by talking about mini-strokes, the more clinical term, transient ischemic attacks. What are they exactly? And you know, let’s compare those to full-blown strokes.

Cesar Velasco – Well Scott, like you had mentioned, they’re temporary episodes of a neurological event. Someone might have some symptoms of facial droop or slurred speech, or confusion. And they go away within minutes or up to a couple of hours, and maybe resolve within the first 24 hours.

Scott Gilbert – Yeah, sounds like a lot of the same symptoms as a stroke, but the difference is how long they last.

Alicia Richardson – Exactly, so they are short and like Cesar said, it’s the same exact symptoms as you would have in a normal stroke, but they’re very important. They’re our warning sign that a stroke may be occurring later on and it’s important to imagine whatever risk factors you have so that you can prevent a future stroke.

Scott Gilbert – A potentially helpful warning sign. Do patients always view them that way though?

Cesar Velasco – Unfortunately, they don’t. Unfortunately we have seen patients come into our hospital, hours beyond the window of time that it actually started and that can cause us to have concerns as to what treatment options are available to them.

Scott Gilbert – So when it comes to a mini-stroke though, people may say oh, well this, this episode happened, like you say transient by its nature means it goes away. Why, you know, how hard is it to drive home the point that these are symptoms you still should be seen for, even after they go away?

Alicia Richardson – Right, because there’s a high percentage of patients who actually will go on to have a stroke. It’s really important even if the symptoms disappear, that they be seen and not by their primary care doctor or not by their, an urgent care. They really need to be seen by an emergency room provider who can rapidly evaluate them for future stroke risk and modify all those risk factors.

Scott Gilbert – And how likely is it that a mini-stroke will lead to a stroke? Either in the short or long-term?

Cesar Velasco – There’s always that possibility. Risk factors are contributing concern, someone who has risk factors like hypertension, uncontrolled high cholesterol, diabetes, they’re probably going to be at a high risk of having a recurrent stroke sometimes in the first 24 hours.

Scott Gilbert – You’re watching Ask Us Anything About Stroke and Mini-Strokes, from Penn State Health. We welcome your questions for Penn State Stroke Center program directors, Alisha Richardson and Cesar Velasco. They’re here to take your questions, not just mine, so be sure to add yours in the comment field below this Facebook post. Even if you’re watching this video on playback, you can add your questions and we will respond as a text reply as well. So, you know, if someone were to ask you if TIAs or mini-strokes are dangerous, harmless, or somewhere in between, I guess the answer is, you don’t really know, so that’s why you get them checked out.

Alicia Richardson – Exactly, so we view them as very dangerous. They’re your sign that something’s going to happen if you don’t modify whatever risk factors you have. So, like Cesar said about managing if you have high blood pressure, or high cholesterol, or diabetes, or there’s many risk factors, but if you modify those, then your chances are less that you’re going to have a stroke in the future. But if you don’t change those things and make those lifestyle changes, then chances are higher that you’ll have a future stroke.

Scott Gilbert – I could see someone asking though, because the symptoms are transient, they go as well as, what can you do about the situation after the fact, if the symptoms aren’t still there?

Cesar Velasco – Well, like Alisha had mentioned, seeking medical attention promptly. Also, if you are seen at the emergency department and/or evaluated at the hospital and discharged. Following up with your family doctor, they’re going to know that you’ve been admitted to the hospital and might require some changes in your medical management, if you do have high blood pressure, making sure that you’re taking your medication accordingly, managing your stress levels, quitting smoking if you’re a smoker, if you’re diabetic, watching your sugars, and also being concerned for your numbers if you’re high cholesterol.

Scott Gilbert – So there are a lot of ways you can actively prevent stroke deaths.

Alicia Richardson – Mm hmm, yes.

Scott Gilbert – Lifestyle choices it sounds like.

Alicia Richardson – Right, exactly.

Scott Gilbert – Alright, again, we welcome your questions for Alisha Richardson and Cesar Velasco, just add them to the comment field below this Facebook post and if you find this information helpful, please share this post on your Facebook page so we can help to get the word out about this important information. You know, we want to talk a little bit about the two types of stroke, there’s ischemic and hemorrhagic. These are both kind of medical words, they mean different things, kind of break that down for us. Why, what is, let’s start with an ischemic stroke. What’s that?

Alicia Richardson – Sure, so an ischemic stroke is the majority of strokes that we see. About 85% of them are ischemic and that is the blood clot forming kind. So basically, a clot is somewhere in your brain, depriving that area of oxygen and nutrients, it’s blocking the pipe basically. And the hemorrhagic kind is ether a ruptured vessel, a popped vessel or bleeding into the tissue of the brain. Both basically causing a lack of oxygen or nutrients to that area of the brain.

Scott Gilbert – So very different things are happening inside the body but they’re both considered strokes.

Cesar Velasco – That’s correct.

Scott Gilbert – We have a question now, Jo Lynn is asking, well she mentioned locked in syndrome in a comment. Wondering if you can explain what that is.

Alicia Richardson – Sure, so locked in syndrome is a type of stroke that can occur in like your pons, which is part of your brainstem. So if you have that area of ischemic damage or hemorrhage to that specific location, it can create this locked in syndrome. It’s pretty rare, but basically it’s essentially a paralysis of your body and only the ability to blink your eyes in order to communicate with people. It’s a very severe type of stroke that can occur with a specific location in the brainstem.

Scott Gilbert – So the brainstem stroke. How common are those? Do you see those very often?

Cesar Velasco – We’ve had a couple of occurrences but it’s not a very common issue that arises. And let’s talk a bit about the causes of ischemic and hemorrhagic strokes. Obviously ischemic caused by the clot. Hemorrhagic is when there is a rupture of the blood vessel. So you know, let’s talk about the hemorrhagic stroke, though it’s a little bit less common, what can lead to that type of situation if there’s not a clot involved?

Alicia Richardson – So hypertension is the number one risk factor for both kinds of strokes actually, but hemorrhages specifically. So uncontrolled high blood pressure is the number one risk factor for a bleed type of stroke.

Scott Gilbert – And let’s talk about that acronym, we referred to BE FAST earlier. It used to be the advice was FAST, a four-letter word. Now we’ve added a B and an E before it. Let’s run those down and we will also add information about this in the comment field because we’ve got some stories at Penn State Health News dot org that will help to explain this. But let’s tell our viewers what BE FAST stands for.

Cesar Velasco – So B stands for balance changes, so a sudden loss of balance or inability to walk straight. E would be a sudden loss of vision, or double vision. F is your facial droop. A is arm weakness, S is speech disturbance, and T is for time.

Scott Gilbert – So of those, there are five symptoms, but I imagine you don’t have to be experiencing all five to possibly be having a stroke.

Alicia Richardson – Right, that’s correct. It could be any one or a combination of multiple, those are the most common ones. And so that’s why we use that acronym to teach people so they can try to remember what those symptoms look like.

Scott Gilbert – And the T stands for time. Cesar, why is that so vital that you get attention right away?

Cesar Velasco – Time is of the essence as we mentioned earlier and time and time again, that the sooner that you reach medical treatment, the sooner that we can help you, and there’s a higher chance that we could help salvage some of that brain tissue that’s being impacted by either a clot or a disruption of blood vessel bursting into the brain.

Scott Gilbert – Right, and there’s a certain particular type of drug referred to as the clot buster drug, but it has to be administered within a certain time frame. What is that time frame and kind of how does that work?

Alicia Richardson – Sure, so it’s up to 4 1/2 hours from when the symptoms started or when you were last seen at your normal baseline. So that’s up to 4 1/2 hours, and then we have an additional treatment that’s called a thrombectomy, where we can go in through your groin and basically up to your brain and the location of the clot and pull that, remove that clot out. And that’s a procedure that can happen up to 24 hours now, but we always try to emphasize that you should not wait 24 hours until the very last, you know, time. You should be here as soon as possible because the sooner we get that open, the more chances for recovery.

Scott Gilbert – Right, I know that some have said the phrase, time is brain, right?

Cesar Velasco – That’s correct. Time is brain and we’re finding also time is tissue. So the longer that this tissue is losing vital nutrients like oxygen that’s traveling through the blood, the greater the brain actually ages. For every hour that goes unchanged in treatment, the brain actually ages almost up to 4 years.

Scott Gilbert – It’s so important to try to avoid strokes, even mini-strokes through lifestyle changes like we’ve talked about, yet it’s something that I think we all know somebody who’s probably been affected by a stroke. So that’s why we welcome your questions for stroke center program coordinators, Alisha Richardson and Cesar Velasco. They are here with us on Ask Us Anything About Strokes and Mini-Strokes, from Penn State Health, so add your comments, your questions, in the comment field below this Facebook post for them. Any other treatments? You talked about the thrombectomy, the so-called clot busting drug. Any other treatments that we should know about because, and there are a lot of options out there for people, depending on the type of stroke and severity and that type of thing.

Alicia Richardson – I mean those are the two most common for the ischemic type of stroke. There are certainly treatments for hemorrhagic strokes as well. If you’ve got an aneurism that caused the bleed, the subarachnoid hemorrhage is the type of bleed that would occur if you had an aneurism, then we can do treatments like coiling that aneurism or clipping that aneurism, it’s all kind of technical then, but there are definitely treatments outside of just the ischemic patients.

Scott Gilbert – Now Penn State Health Milton S. Hershey Medical Center is a comprehensive stroke center. That’s a designation, there are other types of stroke centers out there for example, primary, but what does comprehensive mean compared to the other types?

Cesar Velasco – It means that our hospital actually provides some advanced care treatment that’s not found at the primary level. We have neurosurgical intervention capability, not only do we provide a clot busting agent, but as Alisha mentioned, we have the capability of retrieving the clot mechanically through the groin, as well as advanced treatment and care after post treatment or acute post treatment. So the management of these patients are key, we have trained medical staff and nursing that are trained in neuroscience and so for that reason, we’ve received that certification from the joint commission.

Scott Gilbert – And so, comprehensive stroke center means you’re going to receive the highest level of stroke care possible essentially.

Alicia Richardson – Yeah, that’s correct that we take care of the most complex stroke patients and not to say that primary centers can’t take care of them, they just don’t always have all of the resources that a primary, or that a, sorry, that a comprehensive center would have.

Scott Gilbert – Sure, and let’s talk about who’s at risk for stroke. I know Alisha, you mentioned earlier, some of the lifestyle choices people make. Age wise, people may have the misconception that stroke only effects older people. That is increasingly not the case though, right?

Cesar Velasco – That’s true, I think over the years we’ve seen that statistically, 65 years or older would be your age range at risk for stroke. But in the last decade, we’ve actually seen a 44% surge increase in the under 65 population.

Scott Gilbert – Do we know why that is?

Cesar Velasco – Continued issues with the management of disease process like diabetes, high blood pressure, heart disease, there’s also the potential risk factor of inactivity, being on our electronics a lot, not getting enough exercise.

Scott Gilbert – So, balance, eyesight, face, arm, speech, people may say, I’m experiencing a couple of those symptoms, but I’m too young to have a stroke so it’s got to be something else, I’m just dizzy.

Alicia Richardson – Right, not the case. Stroke can happen to anyone at any age, it can even happen to children. So we really need to make sure that we’re not being biased when we think about stroke. It can happen to 25 year olds, 30 year olds, any age. And we’re seeing it happen more and more.

Scott Gilbert – And we welcome your questions here for Alisha Richardson and Cesar Velasco of the Penn State Stroke Center. They’re program coordinators here and this is really important stuff, so again, we welcome your questions here as we wrap up the interview here on Ask Us Anything About Stroke and Mini-Strokes. So any key takeaways, things that you just, if people could take one thing away, one thing to remember out of this interview, I think I know what you’re going to say, but for Alisha what would it be?

Alicia Richardson – I think the most important thing is the time element to the BE FAST. So that we shouldn’t be waiting around for symptoms to go away. It’s unfortunate that actually 90% of our patients don’t come within the window for treatment. So meaning, they show up too late and cannot get the clot busting drug, cannot get the thrombectomy and essentially, we have no time based treatments to offer them anymore. So it’s really unfortunate to see that. People who have waited, thinking things would go away and they didn’t go away. So that’s the message is just please do not wait. Please come here quick, to an emergency department.

Scott Gilbert – Because that can drastically affect the level to which you recover.

Alicia Richardson – Exactly, and so we’ve had some stroke patients actually after their stroke and say, I thought having a stroke would be kind of like the common cold would be. That I would get over this in a few weeks. And that the symptoms would go away and that I would be able to talk again or I’d be able to move one side of my body again. When in fact, sometimes those deficits are with you for the rest of your life and you’re having to do lots of rehab and therapies to recover from your stroke. And so that’s what we’re trying to reduce is the level of disability from stroke, so with those treatments we can do that.

Scott Gilbert – Okay, and Cesar, how about you? That one concept or one word for folks to remember.

Cesar Velasco – It’s an emergent situation that needs to be identified quickly and acted upon. We encourage folks in the community to call 9-1-1, especially if you don’t have a loved one able to drive you to the hospital. It’s really important to call 9-1-1. The ambulance providers in this area that serve our hospital know everything about our program and the processes that we use to manage these patients. And they are keen on the scene of identifying stroke patients, they are properly trained and know what to do, and how to transport them quickly to a hospital like ours.

Scott Gilbert – Alright, we have a question now from Shawna, she’s asking if her grandfather who was diagnosed previously with a TIA, was later discovered has a 60-70% clogged carotid artery. Does this put him at risk for a stroke and would they unblock his artery?

Alicia Richardson – That’s a great question. So yes, it does put him at risk for a stroke, and it depends on the degree of the, so she said that it’s 70% blocked, so he should be followed by one of our neurosurgeons, or vascular neurosurgeons to see whether the risk benefit of opening that vessel back up and unclogging it essentially. A lot of times medical management, so medications can keep that vessel managed properly, but sometimes you do need a surgical procedure done.

Scott Gilbert – But that starts with a consultation with a physician who can help you determine the best path ahead.

Alicia Richardson – Exactly. Mm hmm.

Scott Gilbert – Alright, great. Alright, it looks like we have another question coming in now. Jewel’s asking what kind of support do you offer patients after a stroke?

Alicia Richardson – So we have a very active support group actually, that meets at the Hershey Rehab facility the third Wednesday, it’s about 50 members large that frequently come and it’s a very fun supportive group. And so that’s the most well-known support that we offer after stroke.

Cesar Velasco – I’d like to add, it’s very unique. There are a lot of good stroke support groups in this area. Ours also provides an opportunity for caregivers to have an opportunity to speak to other caregivers as well as stroke survivors to support each other as they move through the process of rehabilitation, which is so key. Rehabilitation, the mindset, the mental health that requires to endeavor such a disability that could be impacting for life.

Scott Gilbert – Right and regaining a lot of function through that kind of practice of rehab, very important. Great, well we will share some information with you in the comment field below this Facebook post, including a link that tells you a little bit more about what a comprehensive stroke center is and why it’s important as the Milton S. Hershey Medical Center is just that. And also some other information on BE FAST and that kind of thing. But my thanks to Penn State Stroke Center program coordinators, Alisha Richardson and Cesar Velasco, for their time and my thanks to you for watching Ask Us Anything About Stroke and Mini-Strokes, from Penn State Health.