KNOW KNOW STROKESTROKE

Community Community Outreach & Outreach & EducationEducation

• Martha Power FNP-C Martha Power FNP-C

• Tanya Smith FNP-BC Tanya Smith FNP-BC

• Angela J. Schaffer RNAngela J. Schaffer RN

Reduce:Reduce: stroke risk stroke risk

Recognize: Recognize: stroke symptomsstroke symptoms

RespondRespond:: at the first sign of stroke, at the first sign of stroke, Call 911 immediately!Call 911 immediately!

Be Be StrokeStroke Smart Smart

Why people don’t Why people don’t respond to stroke respond to stroke

symptomssymptoms• Don’t recognize Don’t recognize

symptomssymptoms• DenialDenial• Think nothing can be Think nothing can be

donedone• Worry about costWorry about cost• Think symptoms will Think symptoms will

go awaygo away• Fear or don’t trust Fear or don’t trust

hospitalshospitals

Perceptions of Perceptions of StrokeStroke

MythsMyths• Stroke is not Stroke is not

preventablepreventable• Stroke cannot be Stroke cannot be

treatedtreated• Stroke only strikes Stroke only strikes

the elderlythe elderly• Stroke happens in Stroke happens in

the heartthe heart• Stroke recovery ends Stroke recovery ends

after 6 monthsafter 6 months

RealityReality• Up to 80% percent of Up to 80% percent of

strokes are strokes are preventablepreventable

• Stroke requires Stroke requires emergency treatmentemergency treatment

• Anyone can have a Anyone can have a strokestroke

• Stroke is a “Brain Stroke is a “Brain Attack”Attack”

• Stroke recovery can Stroke recovery can last a lifetimelast a lifetime

Stroke FactsStroke Facts

• A leading cause of death in the United StatesA leading cause of death in the United States

• 795,000 Americans suffer strokes each year795,000 Americans suffer strokes each year

• 134,000 deaths each year134,000 deaths each year -From 1996 to 2006 stroke deaths fell by 18.4%-From 1996 to 2006 stroke deaths fell by 18.4%

• 6,400,000 stroke survivors6,400,000 stroke survivors

Stroke FactsStroke Facts

• A leading cause of adult disabilityA leading cause of adult disability

• Up to 80% of all strokes are Up to 80% of all strokes are preventable through risk factor preventable through risk factor managementmanagement

• On average, someone suffers a On average, someone suffers a stroke every 40 seconds in Americastroke every 40 seconds in America

The Cost of StrokeThe Cost of Stroke

• The estimated direct The estimated direct and indirect cost of and indirect cost of stroke was 73.7 stroke was 73.7 billion in 2010billion in 2010

• The mean lifetime The mean lifetime cost of ischemic cost of ischemic stroke per person is stroke per person is about $140,048 in about $140,048 in AmericaAmerica

Types of StrokeTypes of Stroke

• T.I.A.T.I.A.

• IschemicIschemic

• HemorrhagiHemorrhagicc

Transient Transient Ischemic AttacksIschemic Attacks

• Warning Strokes or Warning Strokes or “mini strokes”“mini strokes”

• Blood clot, vasospasm, Blood clot, vasospasm, etc. etc.

• Occurs for a short timeOccurs for a short time• Symptoms resolve in 1-Symptoms resolve in 1-

24 hours24 hours• Indicates possible Indicates possible

major stroke in the major stroke in the futurefuture

• 1 in 9 will have stroke 1 in 9 will have stroke within 3 monthswithin 3 months

Ischemic StrokeIschemic Stroke

Caused by aCaused by ablocked blood blocked blood vessel in the vessel in the

brainbrain

8 out of 108 out of 10 Strokes are Strokes are

ischemicischemic

Risk Factors Risk Factors for Ischemic Strokefor Ischemic Stroke

• HypertensionHypertension• DiabetesDiabetes• Heart DiseaseHeart Disease• SmokingSmoking• High CholesterolHigh Cholesterol• Atrial FibrilationAtrial Fibrilation• History of previous History of previous

strokestroke• AgeAge• ObesityObesity• Poor DietPoor Diet• Lack of exerciseLack of exercise

Ischemic Ischemic Stroke SymptomsStroke Symptoms

• Facial DroopFacial Droop• Slurred Speech, dysarthriaSlurred Speech, dysarthria• Difficulty swallowing, dysphagiaDifficulty swallowing, dysphagia• Expressive or receptive aphasiaExpressive or receptive aphasia• Gaze preferenceGaze preference• Weakness, numbness, loss of Weakness, numbness, loss of

sensationsensation• Symptoms on one side of the Symptoms on one side of the

face or bodyface or body• Visual changes or loss of part Visual changes or loss of part

or all of visionor all of vision• Confusion Confusion • Reduced or loss of Reduced or loss of

consciousnessconsciousness• Vertigo, dizziness, ataxiaVertigo, dizziness, ataxia• Nystagmus (wiggling eyes)Nystagmus (wiggling eyes)

CALL 911!CALL 911!

t-PA, thet-PA, the“Clot Buster”“Clot Buster”

• t-PA is recommended for t-PA is recommended for treatment of ischemic treatment of ischemic stroke in selected patientsstroke in selected patients

• However, t-PA is only However, t-PA is only administered to administered to less than less than 3%3% of ischemic stroke of ischemic stroke patientspatients

• Delay in seeking medical Delay in seeking medical care contributes care contributes significantly to significantly to underutilization of t-PA for underutilization of t-PA for stroke.stroke.

• Extending time window for Extending time window for t-PA administration beyond t-PA administration beyond the current recommended the current recommended 3 hrs3 hrs might be beneficial. might be beneficial.

t-PA t-PA RecommendationsRecommendations

• t-PA should be administered to eligible patients within 3.0-t-PA should be administered to eligible patients within 3.0-4.5 hours after stroke4.5 hours after stroke

• Eligibility criteria in this time period are similar to those for Eligibility criteria in this time period are similar to those for persons treated at earlier time periods with the following persons treated at earlier time periods with the following additional exclusion criteria:additional exclusion criteria:

– Age > 80 years; Oral anticoagulant use with INR ≤ 1.7*; Age > 80 years; Oral anticoagulant use with INR ≤ 1.7*; baseline NIH Stroke Scale score > 25; a history of stroke and baseline NIH Stroke Scale score > 25; a history of stroke and diabetes (*For the 3.0 – 4.5 hr window all pts receiving oral diabetes (*For the 3.0 – 4.5 hr window all pts receiving oral anticoagulant are excluded whatever their INR). anticoagulant are excluded whatever their INR).

• 04/10/23© 2009, American Heart Association. All rights reserved. Information from the Expansion of the Time Window for Treatment of Acute Ischemic Stroke with IV TPA – Science Advisory

Merci Clot Merci Clot Retrieval DeviceRetrieval Device

Meri Clot Removal Video Meri Clot Removal Video 1:101:10http://youtu.be/http://youtu.be/MGX7deuFkhcMGX7deuFkhc

Penumbra Device and Penumbra Device and Restored Restored

Cerebral CirculationCerebral Circulation

Penumbra Clot Retrival Video 1:45 Penumbra Clot Retrival Video 1:45 http://youtu.be/lyfzNgrVOOkhttp://youtu.be/lyfzNgrVOOk

Solitaire Solitaire Revascularization Revascularization

DeviceDevice

The Latest in The Latest in NeurointerventioNeurointerventio

nalnalRadiologyRadiology

Solitaire Revascularization Device Video Solitaire Revascularization Device Video 1:431:43http://youtu.be/0DQPD5TTS5Yhttp://youtu.be/0DQPD5TTS5Y

Brain Attack!Brain Attack!• Stroke is a “Brain Stroke is a “Brain

Attack.”Attack.”

• Stroke happens in the Stroke happens in the brain not the heartbrain not the heart

• Stroke is an emergency. Stroke is an emergency. Call 911 for emergency Call 911 for emergency treatment.treatment.

Carotid Artery Carotid Artery StentStent

CarotidendarterectomyCarotidendarterectomy

Case StudyCase Study• A 59 year old male working at his desk.A 59 year old male working at his desk.

• He sends a coworker an email that does He sends a coworker an email that does not make sense.not make sense.

• He is confused, has a left facial droop,He is confused, has a left facial droop, and his left arm and leg are weak.and his left arm and leg are weak.

• He is on Coumadin for an irregular heart He is on Coumadin for an irregular heart rhythm. He has no other medical rhythm. He has no other medical history.history.

• He says, He says, “I am not going to the “I am not going to the hospital, because they can’t do hospital, because they can’t do anything for me.”anything for me.”

What do you do?What do you do?

Case Study Continued…Case Study Continued…

• You call 911You call 911 and your coworker is rushed to a and your coworker is rushed to a Primary Primary Stroke CenterStroke Center Emergency Department Emergency Department

• The Stroke Team meets him at the door,The Stroke Team meets him at the door, and after and after imaging, diagnose him with an acute R MCA stroke with imaging, diagnose him with an acute R MCA stroke with a a large large penumbrapenumbra..

Case Study Continued…Case Study Continued…

• He takes Coumadin for Atrial He takes Coumadin for Atrial Fibrilation, but a blood test and Fibrilation, but a blood test and the fact that he arrived so soon the fact that he arrived so soon after onset of his symptoms, after onset of his symptoms, meets criteria for him to receive meets criteria for him to receive tPA, the tPA, the “clot busting” “clot busting” medication for stroke.medication for stroke.

• His His stroke symptoms stroke symptoms completely resolvecompletely resolve with the with the tPA.tPA.

• When he returns to work without When he returns to work without any neurological deficits, he any neurological deficits, he Thanks YouThanks You for calling an for calling an ambulance and getting him ambulance and getting him medical treatment so medical treatment so quickly!quickly!

Hemorrhagic StrokeHemorrhagic Stroke

Caused by Caused by a ruptured a ruptured blood blood vessel in vessel in the brainthe brain

Risk Factors Risk Factors for Hemorrhagic Strokefor Hemorrhagic Stroke

• HypertensionHypertension

• Bleeding disordersBleeding disorders

• Aneurysm ruptureAneurysm rupture

• Vascular Vascular malformationmalformation

• Excessive alcohol useExcessive alcohol use

• Cocaine useCocaine use

Hemorrhagic Stroke Hemorrhagic Stroke SymptomsSymptoms

• Focal neurological Focal neurological deficitsdeficits

• Headache, “worst Headache, “worst headache ever”headache ever”

• Neck painNeck pain• Light intoleranceLight intolerance• Nausea, vomitingNausea, vomiting• Decreased level of Decreased level of

consciousnessconsciousness

Two Categories of Two Categories of Hemorrhagic StrokeHemorrhagic Stroke

• ICHICH: bleeding into brain : bleeding into brain tissue as a result of tissue as a result of bleeding or rupture of a bleeding or rupture of a small, deep cortical artery small, deep cortical artery that is damaged by chronic that is damaged by chronic hypertensionhypertension

• SAHSAH: subarachnoid : subarachnoid hemorrhage is the result of hemorrhage is the result of bleeding into the bleeding into the subarachnoid space, most subarachnoid space, most often in relation to often in relation to ruptured aneurysm or AVMruptured aneurysm or AVM

Aneurysm ClippingAneurysm Clipping

• Performed by Neurosurgery

• Incision and removal of skull bone

• Surgical clip prevents blood

from entering aneurysm

Coiling Procedure Coiling Procedure for Aneurysmfor Aneurysm

• Performed by Performed by Neurointerventional Neurointerventional RadiologistRadiologist • Catheter guided to aneurysm Catheter guided to aneurysm sitesite • Coil is packed into aneurysmCoil is packed into aneurysm

• Blood no longer enters siteBlood no longer enters site

• Associated with improved Associated with improved outcomesoutcomes

Stroke RecoveryStroke Recovery• 10% of stroke survivors recover almost completely10% of stroke survivors recover almost completely

• 25% recover with minor impairments25% recover with minor impairments

• 40% experience moderate to severe impairments 40% experience moderate to severe impairments requiring special carerequiring special care

• 10% require care within either a skilled-care or other 10% require care within either a skilled-care or other long-term care facilitylong-term care facility

• 15% die shortly after the stroke15% die shortly after the stroke

Lifestyle Changes for Lifestyle Changes for Survivors and Survivors and

CaregiversCaregivers• Daily living skillsDaily living skills

• Dressing and Dressing and groominggrooming

• Diet, nutrition and Diet, nutrition and eating difficultieseating difficulties

• Skin care problemsSkin care problems

• PainPain

• Sexuality/IntimacySexuality/Intimacy

• BehaviorBehavior

• Depression & Depression & AngerAnger

• Emotional LiabilityEmotional Liability

• One-sided NeglectOne-sided Neglect

• Memory LossMemory Loss

• Communication Communication ProblemsProblems

An An Example Example of Left-of Left-sidedsided

NeglectNeglect

Types of Types of Stroke RehabilitationStroke Rehabilitation

• Physical Therapy (PT)Physical Therapy (PT)– Walking, range of Walking, range of

movementmovement

• Occupational Therapy (OT)Occupational Therapy (OT)– Taking care of one’s selfTaking care of one’s self

• Speech Language TherapySpeech Language Therapy– Communication skills, Communication skills,

swallowing, cognitionswallowing, cognition

• Recreational TherapyRecreational Therapy– Cooking, gardeningCooking, gardening

Well Known Well Known Stroke SurvivorsStroke Survivors

• President Gerald FordPresident Gerald Ford

• Teddy BruschiTeddy Bruschi

• Sharon StoneSharon Stone

• Della ReeseDella Reese

• Kirk DouglasKirk Douglas

• Roy Horn Roy Horn • of of Siegfried & RoySiegfried & Roy

• Mary Kay Ash Mary Kay Ash

• Charles SchultzCharles Schultz

• Harry CarayHarry Caray

• Charles DickensCharles Dickens

• Ed KochEd Koch

• Ted WilliamsTed Williams

How to Lower How to Lower Your Risk for StrokeYour Risk for Stroke

• Stop smokingStop smoking

• Maintain blood pressure below Maintain blood pressure below 140/80140/80

• Keep cholesterol in acceptable Keep cholesterol in acceptable rangerange

• Manage blood sugar if diabeticManage blood sugar if diabetic

• Regular ExerciseRegular Exercise

• Low fat, low salt dietLow fat, low salt diet

• Moderate alcohol useModerate alcohol use

“Everything in Everything in moderation”moderation”

Primary Primary Stroke Care Stroke Care

• A Dedicated Stroke Team A Dedicated Stroke Team Coordinates Stroke CareCoordinates Stroke Care

• Neurology and Neurosurgery Neurology and Neurosurgery Services 24/7Services 24/7

• Cutting Edge Imaging (CT,MRI, Cutting Edge Imaging (CT,MRI, etc.) 24/7etc.) 24/7

• Advanced Vascular Procedures Advanced Vascular Procedures performed by performed by Neurointerventional Radiologists Neurointerventional Radiologists on call 24/7on call 24/7

• Specialty Stroke Trained Nursing Specialty Stroke Trained Nursing CareCare

• Physical Therapy, Occupational Physical Therapy, Occupational Therapy, and Speech TherapyTherapy, and Speech Therapy

• Follow Up Care managed by Follow Up Care managed by Neurology ServiceNeurology Service

• Support Group, Education, Support Group, Education, Research, and Community Research, and Community OutreachOutreach

Healthcare TeamHealthcare Team

Current Current Research TrialsResearch Trials

• SHINESHINE

• POINTPOINT

• CLEAR-ERCLEAR-ER

• STROKE STROKE BIOMARKERSBIOMARKERS

• PEDIATRIC PEDIATRIC STROKESTROKE

Stroke Stroke Support GroupsSupport Groups

Meeting for Meeting for Education, Education, Community, Community, and Healing.and Healing.

Women Women & & StrokeStroke

AHA/ASA Campaign to AHA/ASA Campaign to increase awareness of increase awareness of cardio- and cardio- and neurovascular disease inneurovascular disease in Women ~Women ~

Appalachian Stroke Appalachian Stroke NetworkNetwork

A Regional Cooperative A Regional Cooperative

of Healthcare Providers of Healthcare Providers

coming together to coming together to

improve Stroke Care improve Stroke Care

Throughout AppalachiaThroughout Appalachia

ACT FASTACT FAST

Call 911Call 911

KNOW KNOW STROKESTROKE