Las Colinas Medical Center provides 24/7 neurology care to the communities that we serve. Our Partner - http://texasstrokeinstitute.com/
What is Stroke?
Stroke is a disease that affects the arteries leading to and within the brain. It is the No. 3 cause of death in the United States, behind diseases of the heart and cancer. Each year more than 795,000 Americans suffer a new or recurrent stroke. That means someone in the United States has a stroke every 40 seconds. A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts. When that happens, part of the brain cannot get the blood (and oxygen) it needs, so it starts to die.
There are two basic types of strokes. The most common (87%) is an ischemic stroke where a blood vessel in the brain becomes blocked by plague or a blood clot and prevents oxygen and blood to getting to the area of the brain. When this occurs within 4-6 minutes blood vessels begin to die. Every minute after a stroke 1.9 million brain cells die.
The other type of stroke is hemorrhagic or bleeding type of stroke, which occurs 13% of the time and can occur because of an aneurysm that ruptured or a weak blood vessel in the brain that ruptured.
Stroke Risk Factors
- High blood pressure
- High cholesterol
- Family history of stroke
- Previous Strokes / Transient Ischemic Attacks
- Atrial Fibrillation / Atrial Flutter
- Sickle Cell Anemia
- Congestive Heart Failure
- Coronary Artery Disease
Knowing what your risk factors are can help to prevent strokes.
Stroke Signs and Symptoms
When you have a stroke the symptoms begin suddenly with little warning. Every minute after your stroke 1.9 million brain cells die, so every minute counts. Knowing how to recognize a stroke and immediately calling 911 will save brain cells and give you a chance for a complete recovery.
What are the symptoms of a stroke?
The symptoms of stroke are distinct because they happen quickly:
- Sudden numbness or weakness of the face, arm, or leg (especially on one side of the body)
- Sudden confusion, trouble speaking or understanding speech
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking, dizziness, loss of balance or coordination
- Sudden severe headache with no known cause
As easier way to remember the signs of a stroke is using the FAST method
The F.A.S.T. Test is:
F = FACE
Ask the person to smile. Does one side of the face droop?
A = ARMS
Ask the person to raise both arms. Does one arm drift downward?
S = SPEECH
Ask the person to repeat a simple phrase. Does the speech sound slurred or strange?
T = TIME
If you observe any of these signs, it’s time to call 9-1-1.
Treatment Options for Acute Ischemic Stroke
Intravenous (IV) Tissue Plasminogen Activator (tPA)
English and Spanish
THROMBOLYTIC PATIENT INFORMATION
Your doctor(s) believe that you are having an ischemic stroke. An ischemic stroke happens when a clot that forms either in a vessel or another part of the body, travels through the bloodstream to the brain. This clot lodges in the vessel and blocks the flow of blood and oxygen to a part of the brain. When brain cells do not get the oxygen and nutrients carried in blood that they need to function, they begin to die. The longer the brain cells are not getting blood and oxygen that the need, the greater the damage to the brain. This leads to disabilities such as weakness, numbness, inability to speak or understand, loss of vision, or even death. The exact symptoms depend on which area of the brain is affected.
Activase, t-PA (tissue plasminogen activator), is a clot buster that works by dissolving the clot that is blocking the vessel and causing the stroke. It is the only drug approved to treat stroke. To date, more than 100,000 people have been treated with t-PA. Patients can only be given t-PA during the first 4 ½ hours after symptoms starting. After 4 ½ hours, too much brain damage may have already occurred making it less effective and more risky.
For certain patients, t-PA may improve the chances of recovery from stroke with little or no disability. The major risk of t-PA is bleeding. The most serious bleeding may occur in the brain leading to more damage and possibly death. Patients who receive t-PA have a small but significant (6.4%) risk of developing a brain hemorrhage within the first day and a half after treatment. Despite this risk, overall there is less chance of severe disability or death when patients are treated with t-PA.
We evaluate your history, examination, blood tests and brain CT scan results to determine if t-PA is right for you. If the doctors think that you are a candidate for t-PA it will be given through your vein over 1 hour. After that you will be sent to an appropriate area of the hospital where you will be monitored very closely over the next 24 hours. This will include frequent examinations to see your response to treatment. During this time you will be kept in bed and connected to heart monitors. It is very important to let the staff know if you experience a headache, nausea, trouble breathing, swelling of your tongue or mouth, or any new symptoms during and after treatment.
INFORMACIÓN PARA EL PACIENTE CON TROMBÓLISIS
Su médico cree que usted sufre un derrame cerebral isquémico. Éste se produce cuando un coágulo, que se forma en un vaso sanguíneo u otra parte del organismo, viaja a través del torrente sanguíneo hacia el cerebro. Este coágulo se aloja en el vaso sanguíneo y bloquea el flujo de sangre y oxígeno hacia una parte del cerebro. Cuando las células cerebrales no reciben el oxígeno y los nutrientes transportados por la sangre que necesitan para funcionar, éstas comienzan a morir. Mientras mayor sea el tiempo en que las células cerebrales no reciban la sangre y el oxígeno que necesitan, mayor será el daño al cerebro. Esto provoca discapacidades, tales como debilidad, entumecimiento, incapacidad para hablar o comprender, pérdida de la visión o, incluso, la muerte. Los síntomas exactos dependen de qué área del cerebro haya sido afectada.
Activase, t-PA (activador del plasminógeno tisular), es un medicamento que se usa para disolver el coágulo que bloquea el vaso sanguíneo y provoca el derrame cerebral. Es el único medicamento aprobado para tratar un derrame cerebral. A la fecha, se ha tratado a más de 100,000 personas con t-PA. Sin embargo, sólo se puede administrar t-PA a los pacientes durante las primeras 4 ½ horas después de la aparición de los síntomas. Después de 4 ½ horas, se puede haber producido demasiado daño cerebral, lo que lo hace menos eficaz y más riesgoso.
En ciertos pacientes, el t-PA puede mejorar las probabilidades de recuperarse de un derrame cerebral con poca o ninguna discapacidad. El principal riesgo del t-PA es el sangrado. El sangrado más grave se puede producir en el cerebro, provocando más daño y, posiblemente, la muerte. Los pacientes que reciben el t-PA tienen un pequeño (6.4%) pero importante riesgo de desarrollar una hemorragia cerebral dentro del primer día y medio después del tratamiento. A pesar del riesgo, en general hay menos probabilidad de discapacidad grave o de muerte cuando se trata a los pacientes con t-PA.
Evaluamos sus antecedentes, los resultados de los exámenes, los exámenes de sangre y la tomografía cerebral para determinar si el t-PA es indicado para usted. Si el médico considera que usted es candidato para recibir el t-PA, éste se le administrará a través de la vena durante 1 hora. Después lo enviarán a un área adecuada del hospital donde lo controlarán de cerca durante las siguientes 24 horas. Esto incluirá exámenes frecuentes para observar su respuesta al tratamiento. Durante este tiempo, deberá estar en cama y conectado a monitores cardíacos. Es muy importante informar al personal si experimenta dolor de cabeza, náuseas, problemas para respirar, hinchazón de la lengua o boca, o cualquier síntoma nuevo durante y después del tratamiento.
Infórmeles a los médicos y las enfermeras si tiene preguntas sobre su derrame cerebral o su tratamiento.
For additional information related to acute stroke treatments and to see how we will use telemedicine to treat your acute stroke
What to Expect During Your Stroke Recovery
Swallowing Difficulties (Dysphagia)
- 7-10% of persons > 50 yrs experience Dysphagia
- 22-42% of stroke patients experience Dysphagia
- 5-10% likelihood for a stroke patient to develop a chest infection first few days following a stroke
- Stroke patients with swallowing problems increase the chance for malnutrition & poor outcomes
- Undetected swallowing problems may lead to aspiration pneumonia
- Aspiration pneumonia ranks 2nd in illnesses & 1st in deaths from hospital acquired (nosocomial) infections
To prevent you from having a chest infection caused from aspirating food/liquid, your nurse or physician will screen you for swallowing difficulties. Do not eat or drink anything until your nurse verifies that you can safely swallow food/liquid.
Once you have been cleared to eat and drink, follow these general swallowing precautions to reduce your risk of aspiration.
General Aspiration and Swallowing Precautions
- Sit at 90 degrees for al meals and for 30 minutes after meal completion
- Take SMALL bites of food and small sips of liquid
- Eat slowly
- Avoid using straws
Do not eat or drink anything until your nurse verifies that you can safely swallow food/liquid. If you or your family notices any of the following signs and /or symptoms of dysphagia, let your nurse know as soon as possible.
- Coughing, choking, clearing your throat
- Wet vocal quality
- Need to swallow two to three times
- Difficult to initiate a swallow
- Tearing of eyes
Facts on Falls
- Falls are a common cause of injury in stroke patients, with hip fractures being the most prevalent injury
- Hip fractures within 7 days after a stroke are associated with a poor prognosis.
- Right-sided strokes can cause the patient not to recognize the left side of their body making the patient at high risk of falling.
Fall Prevention Strategies
To reduce the likelihood of patient falls, the team may implement the following strategies:
- Do not get out of bed without assistance.
- Bed Alarms are used to notify the nurse when you are at risk for falling out of bed.
You will be evaluated by Physical and Occupational Therapy. They will post how much assistance you need getting out of bed on the marker board in your room. This will also be shared with your physician and nurses.
- Upon admission you will be issued a gait belt which will be used to help you get out of bed and move from bed to chair.
- Upon admission you will be issued special socks to help prevent slipping on floor.
- Nurses or other staff members will check on you frequently.
- Family members are encouraged to stay with patient who is at high risk of falling.
- Rehabilitation Bulletin Board located on 5 South will provide rehab and safety tips.
HCA North Texas Support Groups
DENTON REGIONAL MEDICAL CENTER
DIABETES SUPPORT GROUP
A monthly support group for individuals and family members is held on the first Thursday of each month. Diabetes professionals will present different topics to help people learn ways to manage diabetes such as diet, exercise, medications, reducing complications, new treatments and research. The Diabetes Support Group is FREE and no registration is required. For a current schedule of topics, call (940) 384-3809.
STROKE SURVIVORS (and families),
1st Thursday of Every Month, 12:00 noon - 1:00 p.m. in the Community Room, Professional Office Building, Denton Regional. Please contact Valerie at (940) 384-3973 for more information.
BRAIN INJURY SUPPORT GROUP
Meets the first Thursday of Each Month at 12:00 noon and lunch is provided. Meetings are held in the Professional Office Building, Suite 310B. For more information, please call (940) 384-3969 or (940) 384-3973.
MEDICAL CENTER OF ARLINGTON
STROKE SUPPORT GROUP
When: 4th Thursday of every month 6pm – 7pm
Where: 3301 Matlock Road, Arlington, TX 76015, Cafeteria (map)
Description: MCA Stroke Support Group Monthly meeting Thursday April 22 6:00pm 3301 Matlock Rd., Arlington MCA Cafeteria FREE - This is open to the public and no reservations are required. Light refreshments will be served. For more information, contact Renee Miller, R.N., at #(8170 465 3241 ext. 4015.
Diabetic Support Group
When: 2nd Thursday of the Month 12pm-1pm
Where: 3211 Omega, Professional Bldg. B, Suite B, Arlington, TX 76015
Contact Cathy Florence at 817-465-3241 X 1366
Introduction to Diabetes Education
When: 3rd Saturday of the month 8am-12pm
Where: 3301 Matlock Rd, Arlington, TX 76015, Cafeteria
Contact Cathy Florence at 817-465-3241 x 1366
MEDICAL CITY DALLAS HOSPITAL
EPLILEPSY SUPPORT GROUP
2nd Thursday of the month (except for December)
Classroom 3E or 4E
Contact Robbie Nelson or Irene Wooley at 972-566-7411
TURTLE CLUB STROKE SUPPORT GROUP
2nd Wednesday of the month
Cafeteria Classroom, Building A, 1st floor
Contact Theresa Neal at 972-566-6710
PLAZA MEDICAL CENTER
THE MEDICAL CENER OF PLANO
CARING FOR OURSELVES
Meets as needed in the IRU Conference Room (1620 Coit Road, Building II, 2nd Floor)
Facilitated by Laura Kahn, LMSW
This is a support group for family or friends who are caring for a loved one. The Medical Center of Plano cares about families as well as patients. If you are providing care for a loved one, please come to our next meeting and share your experience, strength and support. For information call 214. 473.7717.
DIABETES SUPPORT GROUP SWEEN N’ SENSIBLE
3rd Thursday - Monthly - 7:00pm; DOB 2, Surgery Center of Plano Waiting Room.
For information call 972-59-1207 or 972-473-7717
STROKE SUPPORT GROUP
2nd Thursday - Monthly - 6:00pm
IRU Gym (1620 Coit Road, Building II, 2nd Floor)
Facilitated by Laura Kahn, LMSW
This is a support group for patients, family and friends of those who have experienced a stroke.
New topics each month. For information call 214.473.7717.
Stroke is the leading cause of disability in the United States. Through modification of your life styles can help prevent you from having a stroke.
Let's Talk About Stroke is a series of downloadable patient information sheets, created by the American Stroke Association, that presents information in a question-and-answer format that's brief, easy to follow and easy to read. They also provide room for you to write down questions to ask your doctor. This can help you prepare to get the most out of your next visit with your healthcare professional.
Recent advances in technology provide for many methods of testing. These tests range from the traditional physical exam measurements of blood pressure to sophisticated imaging of the brain and blood vessels. Your physician will decide which tests will be most helpful in determining the cause of your stroke.
High cholesterol levels may contribute to the narrowing of the arteries that supply blood to your head and neck. A simple blood test can measure your cholesterol level.
These tests are used to evaluate the ability of your blood to clot. After the stroke, these tests may be ordered to monitor the effectiveness of medication used to help prevent further strokes.
Blood Glucose (sugar)
High blood sugar may contribute to the injury and narrowing of the arteries that supply blood to your head and neck. Simple blood tests can measure your current and recent glucose levels.
With modern imaging technology, all the structures inside the skull can be imaged including the brain; the brain’s supporting structures, and the blood vessels. Imaging can help differentiate a stroke from other brain pathology such as a tumor. Brain imaging can also determine the exact size and location of brain injury due to the stroke, and this information can help determine the cause and chance of recovery. Vascular imaging can identify any problems within the blood supply to the brain such as blocked or narrowed vessels, aneurysms or other abnormal blood vessels.
Computerized Tomography (CT) Scan
What is CT scanning?
CT scanning, also called computed tomography or computerized axial tomography CAT scan), is an X-ray test used for diagnosis. X-rays are taken from a series of different angles and arranged by a computer to show a cross-sectional view of organs in the body.
When is it used?
CT scanning of the brain is often the first imaging test of the brain done in the Emergency Department. CT scan is best used to identify hemorrhage (bleeding) and large ischemic strokes. Damage from an ischemic stroke may not show up on a CT scan for several hours or days. CT is sometimes used to perform follow-up imaging after a hemorrhage or large stroke.
How do I prepare for a CT scan?
No preparation is necessary unless your healthcare provider gives you special instructions. For example, if you are allergic to CT dye then you may have to take certain pre-medications to prevent an allergic reaction.
What happens during the procedure?
CT scanning can be done in either the Emergency Department or Radiology Department. You will lie down on a moving table, which will slide you into the tunnel-like scanning machine. The scanner can move around you to change the angles of the X-rays.
Inside the scanner, multiple X-ray beams are passed very quickly through your body at different angles. The images are projected onto a TV screen and prepared for your healthcare provider to examine.
A solution of dye (also called contrast) may be injected into a vein. This allows the scanner to show any abnormal areas as the dye passes through your body.
Scans usually last about 5 to 15 minutes. They are painless, but your may get uncomfortable from lying in the scanner if the scan takes more than a few minutes. You can talk to the technologist at any time during the procedure. Because of the small, enclosed space, some people became anxious. If you start feeling panicky, the procedure may be stopped.
What happens after the procedure?
If you were given dye for the scan, drinking a lot of fluids after the procedure may help your body get rid of the dye. Rarely so people have an allergic reaction to the dye. Most reactions happen right away, but you could have a delayed reaction. After a CT scan that uses dye, watch for signs of a reaction. These signs include itching, rash, or sweating. If you start having these symptoms, call your nurse.
What are the benefits of this procedure?
A CT scan provides detailed pictures to help your healthcare provider diagnose your problem.
What are the risks associated with this procedure:
In this procedure your body is exposed to a very small amount of radiation. Exposure to radiation can be dangerous if you are exposed to it often or in large amounts. However, the amount of radiation you receive in a CT scan is less than you might receive in many other X-ray tests.
If you are pregnant, you should not have a CT scan without first discussing the possible risks with your healthcare provider.
There is a small risk that you will have an allergic reaction to the dye. For example, there is a chance you will be allergic to the dye if you have a shellfish allergy. Even if you are not allergic to the dye, the dye may cause warm feelings, a flushed face, headache, or salty taste in the mouth. Rarely, it can cause nausea and vomiting.
CT Angiography (CTA)
Using the same technology as a plain CT scan, the blood vessels in the neck going to the brain and the larger blood vessels in the skull can be visualized. This test requires an injection of contrast dye into a vein. It is very useful for looking for blocked or narrowed arteries or abnormal arteries that may cause bleeding inside the head.
Magnetic Resonance Imaging (MRI)
What is magnetic resonance imaging (MRI?)
Magnetic resonance imaging (MRI) is a special test that produces very clear, detailed pictures of the organs and structures in your body. The test uses a powerful magnetic field, radio waves, and a computer to create images in cross-section. While an X-ray is very good at showing bones, an MRI lets your healthcare provider see much more detailed images of the brain.
When is it used?
MRI can diagnose both ischemic and hemorrhagic strokes, determine size and location of stroke, as well as rule out other problems such as tumors. A stroke will show up on an MRI within an hour on symptom onset.
How do I prepare for the procedure?
No special preparation is needed. You may eat normally and take any usual medicines. For the test, you will wear loose, comfortable clothing without metal fastenings such as zippers or clasps because metal will interfere with the test. Do not wear jewelry. If you have any metal in your body (such as plates or screws from a previous surgery) tell your healthcare provider. If you have a pacemaker you may or may not be able to have an MRI, depending on the type of pacemaker. If you have any metal fragments in or around your eyes you cannot have an MRI.. If you have anxiety or claustrophobia) difficulty with small or crowded spaces), let your provider know so that an appropriate sedative can be used.
What happens during the procedure?
You lie down on a cushioned bed that moves into a tunnel-shaped magnet that is open on one ends. If you get nervous when you are in a small closed space you should talk to your healthcare provider about this before you have your MRI. He or she may be able to give you a medicine that will help you feel less nervous or may refer you to a site that has an open MRI scanner. You will have to be very still during the procedure so the pictures will not be blurry.
Sometimes you are given a shot of a fluid called gadolinium during an MRI. This causes any abnormal areas to become very bright on the MRI. This makes them easier to see.
Most MRIs take between 25 and 50 minutes. You will hear loud knocking and whirring sound while the pictures are being taken. You may wear earplugs or music will be provided so that the noise doesn’t sound so loud. You will be able to speak with the person doing the test through a sound system so you can let him or her know if you are having any problems. When the test is over you will return to your room. Your healthcare provider will discuss the results with you.
What are the benefits and risks?
An MRI is painless. There is no radiation. If you were given a shot of gadolinium, there is a chance you will have an allergic reaction but this is very rare.
Although there is no evidence that an MRI will hurt a baby during the first trimester of pregnancy, the National Radiologic al Protection Board recommends not using it at this time of pregnancy. MRI may be used safely later in pregnancy.
Magnetic Resonance Angiography (MRA)
Using the same technology as MRI, this test can image the blood vessels of your head and neck. It can be done with or without contrast. It has the advantage of not using x-rays. The disadvantage is that it requires more time and therefore much more patient cooperation.
Duplex Ultrasound (DUS)
Using ultrasound technology, blood vessels and flow in the carotid arteries can be assessed using a handheld wand-like device and gel creating sound waves to detect blocked or narrowed blood vessels. This test has the advantage of being risk-free and pain free. It has the disadvantage of only being useful in assessing a small part of the carotid artery in the neck.
Transcranial Doppler (TCD)
This test also uses ultrasound technology and is safe and pain free. It is used to assess blood flow in some of the larger arteries inside the head. It may also be used to look for small clots traveling through these vessels.
Electrocardiogram (ECG) and Telemetry Monitor
The ECG assesses the electrical activity of the heart using sticky pads connected to a monitor with wires. It is useful for testing for evidence of injury to the heart muscle as well as testing for abnormalities n heart rhythm. It may detect rhythm abnormalities that are a risk for stroke such as atrial fibrillation. Because the ECG monitors the heart for a very brief time, it can miss intermittent irregular beats.
The telemetry monitor assesses the electrical activity of the heart for as long as the box is connected to you through small wires. It allows the hospital staff to assess for any intermittent irregularities in the heart rhythm.
Echocardiogram uses ultrasound technology of a handheld wand and gel to take pictures of the heart. It allows assessment for any structural problems of the heart as well as blood clots within the heart which may be a source of stroke. It is simple, painless and without risk.
Transesophageal Echocardiogram (TEE)
TEE is a more invasive diagnostic test that is able to provide more detailed images of the heart. This test is typically done when the cause of the stroke has not been found by other imaging described above or in people who have a high risk of a cardiac source of stroke. The test is performed by using a flexible probe placed into the esophagus by a cardiologist. This allows imaging of the heart from the backside, where clots are likely to be found. You will be given a mild sedative for the procedure. A more detailed consent will be obtained from you prior to the test.
As you can tell from the list above, there are many tests to evaluate a stroke. Your physician will prescribe the tests that are most appropriate for your specific status.
American Stroke Association
National Stroke Association
American Academy of Physical Medicine and Rehabilitation
American Diabetic Association/National Center for Nutrition and Dietetics
1-800-877-1600 or 1-800-877-0877
American Heart Association
American Occupational Therapy Association
American Physical Therapy Association
Family Care Giver Alliance
Independent Living Research Utilization
National Aphasia Association
National Council on Disability
National Family Care Givers Association
National Institute of Neurological Disorders and Stroke
National Institute on Disability and Rehabilitation Research
The Stroke Network: Online Stroke Support and Informational Resources