How Do I Know If I'm Having a Stroke?
Emergency Department Physician Zachary Gray, MD Explains the Signs
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 Center designation?
"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.