How Do I Know If I’m Having a Stroke?
A stroke can be one of the most terrifying emergencies to cope with, whether
you are experiencing it or you think someone you’re with is having
one. It pays to know what those signs are and what to do. Advantage spoke
to Zachary Gray, MD, a Torrance Memorial physician and a medical director
of the emergency department, about how to recognize a stroke and what
to do about it and how Torrance Memorial is better equipped than ever
to handle even the most complex strokes. Remember, surviving a stroke
means acting FAST (see box at bottom of the page).
What causes a stroke?
"There are actually two major kinds of stroke,” says Dr. Gray.
“An ischemic stroke occurs when a blood clot keeps blood from flowing
to your brain, and as a result the brain becomes deprived of oxygen and
stops functioning. A thrombotic stroke is an ischemic stroke caused by
a clot forming in a blood vessel actually in the brain. A hemorrhagic
stroke results when a blood vessel in your brain ruptures or breaks, spilling
blood into the surrounding tissues. The majority of strokes, about 8 out
of 10, are ischemic."
What are the signs of a stroke?
"The most important symptom is a sudden loss of neurological function,
a loss of strength and/or a loss of feeling on one side of the body. This
can manifest as a sudden difficulty speaking, slurring words and/or an
inability to form words.
Strokes can affect either side of the brain, but because most people (90%)
handle language on the left side of the brain, strokes involving speech
problems typically result in right-sided weakness. This is because the
left (dominant) side of the brain controls the function of the right side
of the body. When the large vessels of the left side of the brain are
affected by stroke, both language processing and function of the right
side of the body will be affected for most people.
A hemorrhagic stroke is often accompanied by a sudden headache as well.
There also can be a loss of balance, dizziness, an inability to walk and
vertigo. There could also be visual disturbances.
Sometimes a stroke is subtle, if it’s small or in a different part
of the brain. Any kind of sudden neurological change should be concerning
and should be evaluated quickly. What can be tricky is tyou might notice
something that’s off when you first wake up in the morning, which
means a stroke might have occurred overnight.
It is really important you call 911 immediately, for yourself or for someone
you think might be having a stroke. Don’t wait for regular doctor’s
office visit. I can’t tell you how many times I’ve seen patients
have a ‘little thing’ happen and regret not coming sooner."
Can't someone just drive me?
"I can’t emphasize this more: If you think you’re having
a stroke, you need to call 911. For one thing, if you come by ambulance
the paramedic crew will call the ED and tell us they are transporting
a patient with acute stroke. Once you get to the emergency department
you’ll be seen by a doctor and a nurse, and they will do an assessment
in fewer than 10 minutes, which is crucial.
I’m also concerned about family and/or friends driving. They might
get distracted by everything that’s going on. And they might not
know the best hospital for stroke. The ambulance crew will."
What happens next?
"Within 30 minutes the ED team will have evaluated, performed diagnostic
tests, consulted with a stroke neurologist and determined a specialized
treatment plan. The most important factor to establish is, if it is a
stroke, whether it’s caused by a clot (an ischemic or thrombotic
stroke) or whether it’s a hemorrhagic or bleeding stroke. We have
to get to that determination right away so we can start therapy within
the 4.5-hour time frame, so the patient can be treated with tissue plasminogen
activator (tPA) to dissolve the clot if necessary."
What is Telestroke?
"If a patient is experiencing a stroke, we at Torrance Memorial have
the capability to quickly diagnose using the Telestroke program, which
offers 24/7 access to Cedars-Sinai stroke neurologists via teleconferencing
technology. The Telestroke machine is a special two-way monitor allowing
a doctor at Cedars-Sinai to ask the patient several questions to help
diagnose the stroke.
While this interaction takes place, the ED team is waiting for test results
and determining the best therapy. It’s clearly very advanced technology,
and people have been responding well to the interaction with the neurologist
through the Telestroke monitor. They recognize the sophistication and
excellence of the Cedars-Sinai neurologists, and the combination has been
very effective in saving lives. We’ve gotten great feedback from
patients and their families."
What does it mean that Torrance Memorial is getting a Certified Stroke
"The designation as a comprehensive stroke center means, most importantly,
that patients can get the latest available treatment locally without having
to go across town, so the crucial time initiation will be better. This
designation also means we can keep patients at Torrance Memorial and treat
them more quickly, which is very important if they are experiencing a
complex stroke that requires newer interventions.
For the past 15 to 20 years, tPA has been essentially the sole therapy
for acute stroke. However, tPA must be administered within the first several
hours for it to be effective. Sadly, because most stroke patients used
to arrive at the hospital outside the tPA treatment window, prevention
and rehab were the mainstays of management.
In the last year or two, mechanical thrombectomy (analogous to angioplasty
for heart attack) has become a more widely available and validated treatment
for acute stroke. This is important, because it can provide benefit up
to 24 hours after a stroke in properly selected patients.
We have already been providing these therapies, and being a designated
CSC expands our coverage and broadens the scope of neurosurgery services
available to our patients."
Zachary Gray, MD, Torrance Memorial Medical Center Emergency Department
The National Stroke Association recommends the FAST method to help identify
the warning signs of a stroke:
- Face: When you smile, does one side of your face droop?
- Arms: When you raise both arms, does one arm drift down?
- Speech: Is your speech slurred? Are you having trouble talking?
- Time: If you experience any of these symptoms, call 911 immediately.
Additional symptoms that don’t fit in the FAST description include:
- Sudden confusion, such as difficulty understanding what a person is saying,
difficulty walking, sudden dizziness or loss of coordination
- Sudden, severe headache that doesn’t have any other known cause,
difficulty seeing in one or both eyes
Torrance Memorial Recognized as a Designated Comprehensive Stroke Center
When someone has a stroke, every second counts. The Los Angeles County
Emergency Medical Services Agency has developed a Comprehensive Stroke
System to ensure patients with acute stroke are taken to the closest appropriate facility.
Through advanced training, adherence to the highest standards of patient
care, and the continued addition of highly trained neurosurgical experts,
Torrance Memorial was recently recognized by the Los Angeles County EMS
as a designated Comprehensive Stroke Center (CSC). This designation is
further recognition of Torrance Memorial’s ongoing commitment to
the expansion of its stroke program, already one of the most comprehensive
in the South Bay area.
For instance, Torrance Memorial’s highly trained staff was first
in the South Bay to begin performing the often life-saving thrombectomy
years ago and expanded the program further in 2015 with purchase of a
biplane imaging suite in the recently built Lundquist Tower. Biplane imaging
is the most advanced interventional medical imaging technology available,
and it is essential to conduct the procedure soon after onset. The digital
x-ray technology uses two mounted rotating cameras, one on either side
of the patient, to take simultaneous pictures brought together on a computer
screen to form a three-dimensional portrait for doctors to study. Biplane
imaging also allows doctors to follow the path of blood flow through the
vessels and to create a “roadmap” for reaching and treating
the precise location of clots and other malformations in the brain and
neck. The CSC designation means that emergency services are directed to
take acute stroke patients directly to Torrance Memorial for care.