A stroke, or a “brain attack,” is a sudden loss of brain function
and can happen to anyone at anytime. It occurs when blood flow to an area
of the brain is cut off. This interruption causes brain cells to be deprived
of oxygen and begin to die. Abilities controlled by that area of the brain,
such as speech, movement and memory, can be affected. The severity of
the stroke is determined by where the stroke occurs in the brain and how
much the brain is damaged.
Stroke is a medical emergency. It is the leading cause of disability and
fifth cause of death in the United States. Georgia is one of the 11 stroke
belt states, putting our community at a 34 percent higher risk of having
a stroke than other areas around the country.
Launched in August 2016, in partnership with Baptist Health Jacksonville
and physicians in Florida and Southeast Georgia, our Telestroke Program
is designed to deliver 24/7 lifesaving care by ensuring patients can be
seen by a neurologist via videoconferencing technology within minutes
after arriving at the hospital.
How the Telestroke Program works:
- A patient arrives at the Emergency Care Center with stroke symptoms.
- An internal code is activated, alerting the Emergency Care Center team
to expedite treatment.
- The mobile telestroke cart is moved to the patient’s bedside, enabling
video access to a neurologist for assessment within minutes.
- The patient is evaluated for treatment options based on duration of symptoms.
According to the American Heart Association, each 15-minute span between
the onset of an ischemic stroke and the delivery of clot-busting medication
is an average of one month of disability-free life lost for the patient.
Since the Health System’s Telestroke Program launched, there has
been a dramatic 30-minute drop in “door-to-needle time,” or
the window between when patients arrive and are given tPA intravenously.
This means patients are receiving tPA 30 minutes earlier and experiencing
fewer disabilities as a result.
Types of Stroke
The Health System is equipped and prepared to care for patients suffering
all types of strokes including a Transient Ischemic Attack (TIA), or warning
stroke; an ischemic (clotting) stroke; or a hemorrhagic (bleeding) stroke,
also called a “brain bleed.”
Transient Ischemic Attack
Transient Ischemic Attack (TIA) is a warning sign that a stroke may occur
in the next few days or months. This is caused by a lack of oxygenated
blood flow to an area of the brain that causes stroke-like symptoms. However,
blood flow improves fast enough that brain cells do not die.
Ischemic (clotting) Stroke
Ischemic (clotting) stroke occurs when blood flow to the brain is blocked,
preventing oxygen and nutrients from getting to the cells. They are usually
caused by blood clots, but there are other causes. Types of clots include:
- Thrombus - a clot that forms on the wall of a blood vessel in the brain
and can stop the flow of blood.
- Embolus - a clot in a blood vessel that travels to the brain where it can
block blood flow.
An important cause of an embolus is an irregular heartbeat, known as atrial
fibrillation (A-fib). This abnormal heart rhythm can cause blood clots
to form in the heart and travel to the brain. People with atrial fibrillation
are five times more likely to have a stroke.
Ischemic strokes account for about 83 percent of all cases and are the
most common type of stroke.
Hemorrhagic (bleeding) Stroke
Hemorrhagic (bleeding) strokes, also called “brain bleeds,”
are caused by bleeding in the brain which causes pressure on the brain
cells. This happens when a blood vessel bursts and stops the oxygen supply
to the surrounding areas of the brain. The most common cause for a brain
bleed is high blood pressure and it often occurs in younger people. There
are two kinds of bleeding strokes (not caused by trauma):
- Intracerebral hemorrhage (ICH) occurs when a blood vessel bleeds into the
tissue deep within the brain.
- Subarachnoid hemorrhage (SAH) occurs when a blood vessel on the surface
of the brain bursts and bleeds into the space between the brain and the
skull. A common cause is an aneurysm (blood filled pouch that balloons
out from an artery wall).
About 17 percent of all strokes are hemorrhagic. ICH is more common than SAH.
Stroke Warning Signs
The first step to treat a stroke is to recognize the signs and symptoms
as soon as they happen. Every minute counts. The longer blood flow is
cut off to the brain, the greater the damage. About two million brain
cells die every minute during a stroke, affecting functions like memory
and muscle control. With swift action, treatments are available to preserve
brain cells and greatly reduce the damage caused by a stroke.
If you experience any of these sudden symptoms, call 911!
- Numbness or weakness of the face, arm, or leg — especially on one
side of the body
- Confusion, trouble speaking or understanding
- Trouble seeing in one or both eyes
- Trouble walking, dizziness, loss of balance, or coordination
- Severe headache with no known cause
Hemorrhagic strokes may have other additional warning signs including:
- Neck stiffness
- Light sensitivity
- Nausea and vomiting
- Loss of consciousness
This is an easy test to use if someone may be having a stroke:
Stroke Care and Treatment
Whether a patient comes through our Emergency Care Center with stroke symptoms
or has a stroke while a patient in the hospital, we provide stroke assessment,
diagnostic tests, treatment, and recovery and rehabilitation services.
Our objective is to improve the quality of care and outcomes for every
Because time is brain, the treatments available to patients must be administered
within the first few hours of the onset of stroke symptoms to improve
outcomes. Treatment will depend on the type of stroke, location, size
and cause of the stroke. A Computed Tomography (CT) scan of the brain,
and possibly other tests, will be ordered to determine the type of stroke
Treatments for ischemic (clotting) stroke may include medications that
can dissolve the blood clot, or procedures that can mechanically remove
the clot. The gold standard stroke drug, tissue plasminogen activator,
more widely known as tPA, can be injected to help dissolve a clot and
improve blood flow, but it must be given within three hours of stroke
onset (up to four-and-a-half hours for certain eligible patients). A mechanical
thrombectomy, where physicians insert a catheter into an artery in the
groin to reach and remove the clot, can be performed following tPA and
should occur within six hours of acute symptoms.
Treatment for hemorrhagic (bleeding) stroke may include surgery or medications
to stop the bleeding or reduce pressure on the brain. Patients are usually
admitted to the Intensive Care Unit (ICU) where they can be closely observed,
tested and treated. Supportive treatment may include a breathing machine
and medications to control blood pressure.
Stroke Patient Guide
Coping with the effects of a stroke can be confusing and stressful, but
this book will help you to understand your brain, post-stroke care and
what to expect during your hospital stay.
Stroke Patient Guide
Stroke Team Members
Our team includes neurologists, neurosurgeons, hospitalists, nurse practitioners,
physician assistants, pharmacologists, nurses, rehabilitation therapists,
social workers, a stroke coordinator and many more. Our team’s goal
is to develop an appropriate treatment and discharge plan, coordinate
services and monitor progress, ensure the stroke patient and family understand
what is happening and provide quality care throughout the patient’s
Healthy Partners Article
Healthy Partners, Winter 2019
When blood stops flowing to part of the brain because of a clot or a bleed,
millions of brain cells begin to die within minutes. And while dead brain
cells can’t regenerate, new protocols are helping people get treatment
sooner and improving outcomes for stroke victims who receive care within
24 hours of first having symptoms.