Ischemic Stroke

let’s talk about stroke Pirewention Stroke, TIA and Warning Signs

What are warning signs of stroke? Before you need to take emergency action, create a list of You and your family should recognize the warning emergency phone numbers and keep a copy next to your signs of stroke]. You may have some or all of these signs. phone and with you at all times. Note the time when symptoms start and call 9-1-1 or the emergency medical number in your area. Stroke is a medical emergency!

Don’t ignore these warning signs, even if they go away. Timing is important.

Stroke Warning Signs: 8 Sudden numbness or weakness of the face, arm or leg, especially on one side of the body 8 Sudden confusion, trouble speaking or understanding • Sudden trouble seeing in one or both eyes • Sudden troutjle walking, dizziness, loss of balance or coordination • Sudden severe headache with no known cause EAoS.Tn is anjeasy way to remember how to recognize a stroke and what to do. Spot a stroke FAST. Face drooping. Arm weakness. Speech Difficulty. Time to cab 9-1-1.

My Questions:

Amer can American Heart I Stroke Association I Association. life is why let’s talk about Prevention American American stroke Heart | Stroke Association I Association. life is why

let’s talk about Brain tissue affected by Ischemic Stroke blockage An ischemic stroke The majority of strokes occur when blood occurs when a dot or a mass blocks a blood vessels to the brain become narrowed or vessel, cutting off blood flow to a part of the brain clogged with fatty deposits called plaque. This cuts off blood flow to brain cells. A stroke caused by lack of blood reaching Close-up of a clot inside part of the brain is called an ischemic an artery that provides stroke. High blood pressure is the most blood flow to important risk factor for ischemic stroke the brain that you can change.

Are all ischemic strokes the same? ° get a CT or MRI scan of the brain There are two types of ischemic strokes. a study the results of other diagnostic tests that might ° Thrombotic strokes are caused by a blood clot be needed (thrombus) in an artery going to the brain. The clot How are ischemic strokes treated? blocks blood flow to part of the brain. Blood clots usually form }n arteries damaged by plaque. Acute treatment is the immediate treatment given by the healthcare team when a stroke happens. The goal of ° Embolic strokes are caused by a wandering clot acute treatment is to keep the amount of brain injury as (embolus) that’s formed elsewhere (usually in the heart small as possible. This is done by restoring blood flow to or neck arteries). Clots are carried in the bloodstream the part of the brain where the blockage was quickly. and block a blood vessel in or leading to the brain. The only FDA approved drag to treat ischemic stroke is How are ischemic strokes diagnosed? tissue plasminogen activator (tPA). It is a clot busting When someone has shown symptoms of a stroke or a drag. tPA must be given within 3 to 4.5 hours of the first TIA (transient ischemic attack), a doctor will gather symptoms of stroke. Medication may also be used to information and make a diagnosis. He or she will review treat brain swelling that sometimes occurs after a stroke. the events that have occurred and will: For people with blood clots in larger arteries, tPA • get a medical history from you or a family member often does not dissolve them completely. In this 0 do a physical and neurological examination case, a procedure, called mechanical thrombectomy, • have certain laboratory (blood) tests done should be done within six hours of the first symptoms of stroke. In most cases this is done only after the (continued) let’s talk about stroke Prevention Ischemic Stroke

patient received IV tPA. To remove the clot, doctors reduce fatty buildup clogging a vessel that may make it thread a catheter (thin tube) with a stent through an easy for clots to form in the bloodstream. artery in the groin up to the blocked artery in the brain. Sometimes a stroke is the first sign a person has of The stent opens and grabs the clot. The doctors then other health conditions, such as high blood pressure, remove the stent with the trapped clot. If necessary, diabetes, atrial fibrillation (a heart rhythm disorder), or other devices may also be used. other vascular disease. If any of these are diagnosed, the healthcare team will prescribe appropriate treatment. When someone; has a stroke, they are at risk of another. Once the medical team identifies what caused the stroke, they may prescribe treatments or procedures to reduce the risk of a second stroke, such as: • Antiplatelet agents such as aspirin and anticoagulants such as warfarin, dabigitran, apixabanm rivoraxaban or edoxaban interfere with the blood’s ability to clot. This can play an important role in preventing a stroke. • Carotid endarterectomy is a procedure in which blood vessel blockage (blood clot or fatty plaque) is surgically removed from the carotid artery in the neck. This reopens the artery and the blood flow to the brain. This is only done in people who have a large blockage. • Doctors sometimes use balloon angioplasty and implantable steel screens called stents to treat and Aspirin can play an important role in preventing stroke because it helps keep blood from clotting.

HOW CAN I LEARN MORE? Do you have My Questions: Q Call 1-888-4-STROKE (1-888-478-7653) to questions for the learn more about stroke or find local support doctor or nurse? groups, orvisitStrokeAssociatior8.org. Take a few minutes to Q Sign up to get Stroke Connection write your questions for the next time you see magazine, a free magazine for your healthcare provider. stroke survivors and caregivers at strokeconnection.org. For example: Q Connect with others sharing similar What can I do to journeys with stroke by joining our Support help prevent another Network at strokeassociation.org/ stroke? supportnetwork. What medications may 1 be given?

We have many other fact sheets to help you make healthier choices to reduce your risk, manage American American Heart I Stroke disease or care for a loved one. Visit strokeassociation.org/letstalkaboutstroke to learn more. Association I Association* life is why

1. What is a stroke? Things There are two kinds of stroke: • Ischemic ("is-keem-ik"): this type of stroke occurs when a blood vessel in the brain is blocked and brain cells are damaged because they don't get enough oxygen and nutrients. A Transient Ischemic attack (TIA) resembles an ischemic stroke but consists of

temporary stroke symptoms caused by a temporary blood vessel blockage. You • Hemorrhagic ("hem-o-raj-ik"): this type of stroke occurs when a blood vessel in the brain ruptures and brain cells are damaged by the pressure of the blood. Aneurysms and arteriovenous malformations are specific problems that cause this type of stroke.

The problems experienced after a stroke are the result of this brain damage. The specific Need problems you feel are related to the parts of the brain damaged by your stroke.

2. Warning signs and symptoms of stroke to

Sudden numbness or weakness of the face, arm, Know or leg, especially on one side of the body

About Sudden confusion, trouble speaking or understanding

Sudden trouble seeing in one or both eyes Stroke

Sudden trouble walking, dizziness, or loss of balance or coordination

Sudden, severe headache with no known cause

Dartmouth-Hitchcock MEDICAL CENTER i

of 2

be for

use

the an

of in

occurs artery artery

high high People

artery artery few are for

have

small

your

be start? start? all

a signs

The smoking. sent

in resist disease, smoking.

must

become become

are stroke.

of increases

brain. for

begin. having

also strokes. be

walls.

emergency of blood

carotid

disease

factor

and stroke

than

ways. the A bad artery monoxide

ignore

because

important quitting

for from risk

disease

of high local is greatly disease symptom

muscles

build-ups artery cause symptoms,

person

quickly more smoking

arterial diabetes overweight;

many in this brain. treatments

treatable,

with

symptoms

arm your one carotid Don't in is the carbon

last

can artery

deaths are

vessels causes

cholesterol, sign

stroke answer

with or of hospital, your

(plaque help

smoking

and

these

asked your smoking, and

the

plaque

that

treatments and to an

cigarette

risk

controllable of Expect the symptoms

stroke high Peripheral stroke.

system in be leg

stroke. blood

of number treatment

carotid

9-1-1

diabetes a time people having about or for

The to

Diabetes

warning fat,

will blood to

for the clot. ambulance

EMS.

cigarette be

call Some no nicotine small every higher shown the in

cigarette is

decline staff an While a

first Many

in you

symptoms lead

blood doctor

having effective cholesterol the

important

risk help build-ups may The stroke. local with

so atherosclerosis

blood

Causes

supply high

have

take

from fast early.

the

EMS a "STROKE."

have can

the with

important!

more. cardiovascular your carry

occur

for

disease by fatty most who your the

diet stroke stroke. is did from blood

neck

especially

to risk

used away! your

a and

stroke. hours with

the Don't damage or by stroke.

Immediately

very word number

for studies if

that

for even you're

hypertension the

signs call go

combined is disease of who believe high your

for Talk

Lost."

your if

or can yourself.

as form, When the brain artery

risk

in blocked

to 9-1-1 or

deposits risk

delay! (EMS) someone

years, This factor

they caused reason

vessels

damage do

use

diabetes, any the artery

hospital. Brain

if little

drive factor

call

person their effective

people

pressure one

time.

in in is warning risk

fatty

key women.

other their

also to

as increases with pressure

pressure, pressure pressure

smoking increases later.

arteries

don't

a the

a become risk

not

is recent the service blood by

when in

even

the or

the

use smoke is

Lost communicating

have more are to it

sure

In Many still

contraceptives Do

raises risk

all blood pressure,

vessels the

may increase

blood

blood blood blood

peripheral

carotid

you you What and What

oral

Not "Time If immediately Check question much If minutes, medical make

going stroke, You, started When you.

• • • • 3. High • High High High pressure health. important Diabetes Diabetes high blood Cigarette disease Carotid narrowed narrow, stroke. cigarette of stroke 4. blood these Tobacco The walls) when

with which » ) > 9 $ line

Five Things You Need to Know About Stroke Atrial fibrillation This heart rhythm disorder raises the risk for stroke. The heart's upper Five .chambers quiver instead of beating regularly, which can let the blood pool and clot. If a clot breaks off, enters the bloodstream and lodges

in an artery leading to the brain, a stroke will happen. Things Other heart disease People with coronary heart disease or heart failure have a higher risk of stroke than those with hearts that work normally. Dilated cardiomyopathy (an enlarged heart), heart valve disease, and some types of congenital heart defects also raise the risk of stroke.

High blood cholesterol You People with high blood cholesterol have an increased risk for stroke. High blood cholesterol can be reduced by eating right (avoid fried,

fatty foods) and exercising regularly. It may also require medication. Need Poor diet Diets high in saturated fat, trans fat, and cholesterol can raise blood cholesterol levels. Diets high in sodium (salt) can contribute to increased blood pressure. Diets with excess calories can contribute to obesity. A diet containing five or more servings of fruits and vegetables per day to may reduce the risk of stroke.

Physical inactivity and obesity Know Being inactive, obese, or both can increase your risk of high blood pressure, high blood cholesterol, diabetes, heart disease, and stroke. So go on a brisk walk, take the stairs, and do whatever you can to make your life more active. Check with your doctor first, but try to get at least 30 minutes of moderate physical activity five days of the week, or 20 minutes of vigorous physical activity, three days a week. About Age The chance of having a stroke more than doubles for each decade of life after age 55. While stroke is common among the elderly, a lot of people under 65 also have strokes.

Stroke Heredity (family history) and race Your stroke risk is greater if a parent, grandparent, sister, or brother has had a stroke. African Americans have a much higher risk of death from a stroke than Caucasians. This is partly due to higher rates of high blood pressure and diabetes in this group. Sex (gender) Stroke is more common in men than in women. In most age groups, more men than women will have a stroke in a given year. However, more than half of total stroke deaths occur in women. At all ages, more women than men die of stroke. Women who take birth control pills, or are pregnant, have special risks for stroke. Prior stroke, TIA or heart attack The risk of stroke for someone who has already had one is far greater than someone who has not had a stroke. Transient ischemic attacks (TIAs) are "warning strokes" that produce stroke-like symptoms but no lasting damage. TIAs are strong predictors of stroke. A person who's had one or more TIAs is almost 10 times more likely to have a stroke than someone of the same age and sex who hasn't. Recognizing and treating TIAs can reduce your risk of a major stroke. APRN

APRN

Wong,

Wejsa,

Jen Oi-Lee

NJ o 4

are

with

If you the

will

list

benefit of to order the

when Stringer, in

based Schultz,

after

leave

may your

option APRN each

leave

and

call

recovery. properly. you treatments

this medicines speaking You doctor

have see Meredith

you 603.650.5109

doctor

Kimberly cardiovascular

lower

please at correctly, to

your your after

will

your

if after these

your you

discuss

other adjusted

sure PA-C by without

of months.

care you by work

hospital:

DHMC,

see

during help be are at to

to Soucy, please

doses many the

made

and care

they

Neurosurgery

prescribed stroke medical

them visits.

doctor(s)

for the David check or prescribed

medications stroke for d-h.org/stroke

therapists medicines as

when

leave can

risk

hospital

arranged, regular doctor

which

your about

your order

all continue the taken for

your

medications you

in Therefore, PhD Jaleel, been

measurements Belmont

stop

doctors

be for effective website: 603.650.5104

that CENTER APRN

receive

may

plan MD, the

leave at

not

questions Naser

the a

Jillian you

rehabilitation reduce our

other sure you

must after stroke. most Don't

you has providers. adjusted

to have

care stroke

how

effective. have for with

are and

first. a

with

that

is MD make continue

you

after

be care

Neurology If

to order you to to

MSN,

hospital. Dartmouth-Hitchcock tests

MEDICAL

to after This

and

found program

factors

them Medications sure

the need Flinn, working

APRN health physician be need

medicines

Rojas-Soto, important risk

them blood

medications see

What follow-up

Stacy can issue. hospital You likely leave It hospital. Make for The the on your Recovery of working to from therapy your

Diana

Providers 5. •

• ® • Concerns?

Eskey, PhD Lukovits,

Program

MD information MD,

Clifford Timothy Questions Stroke More

Five Things You Need to Know About Stroke American American Heart I Stroke Association I Association s life is why

DON’T SMOKE, EXERCISE, DRINK CAFFEINATED BEVERAGES OR TAKE AT LEAST TWO READINGS ALCOHOL WITHIN 30 MINUTES 1 MIN. APART IN MORNING OF MEASUREMENT. BEFORE TAKING MEDICATIONS, AND IN EVENING BEFORE DINNER. RECORD ALL RESULTS.

REST IN A CHAIR FOR AT USE PROPERLY CALIBRATED AND LEAST 5 MINUTES WITH YOUR VALIDATED INSTRUMENT. CHECK LEFT ARM RESTING THE CUFF SIZE AND FIT. COMFORTABLY ON A FLAT SURFACE AT HEART LEVEL. SIT CALMLY AND DON'T TALK.

MAKE SURE YOU’RE PLACE THE BOHOM OF RELAXED. SIT STILL IN A THE CUFF ABOVE THE CHAIR WITH YOUR FEET BEND OF THE ELBOW. FLAT ON THE FLOOR WITH YOUR BACK STRAIGHT AND SUPPORTED.

American Heart Association recommended blood pressure levels

SYSTOLIC mm Hg DIASTOLIC mm Hg BLOOD PRESSURE CATEGORY (upper number) ■ (lower number) NORMAL LESS THAN 120 and LESS THAN 80

ELEVATED 120-129 and LESS THAN 80

HIGH BLOOD PRESSURE 130-139 or 80-89 (HYPERTENSION) STAGE 1 * Wait a few minutes and take blood pressure again. HIGH BLOOD PRESSURE If it's still high, contact your doctor immediately. 140 OR HIGHER or 90 OR HIGHER (HYPERTENSION) STAGE 2

HYPERTENSIVE CRISIS LEARN MORE AT HIGHER THAN 180 and/or HIGHER THAN 120 (consult your doctor immediately) HEART.ORG/HBP

©2017 American Heart Association, Inc. All rights reserved. Dartmouth-Hitchcock Dartmouth-Hitchcock Timothy G. Lukovits, MD Diana M. Rojas-Soto, MD Medical Director Cerebrovascular Disease & Stroke Program Cerebrovascular Disease & Stroke Program Department of Neurology Department of Neurology Phone (603) 650-5104 Fax (603) 676-4042 Phone (603) 6505104 Fax (603) 6764042

Dartmouth-Hitchcock Medical Center Lebanon One Medical Center Drive, Lebanon, NH 03756-0001 One Medical Center Drive, Lebanon, NH 03756-0001 Da rtmouth-H itch coc k. org Dartmouth-Hitchcock.org

Dartmouth-Hitchcock Dartmouth-Hitchcock Jillian C. Belmont, APRN Jason A. Johns, PA-C Cerebrovascular Disease & Stroke Program Instructor of Neurology Department of Neurology Cerebrovascular Disease & Stroke Program Phone (603) 650-5104 Fax (603) 676-4042 Department of Neurology

Dartmouth-Hitchcock Medical Center Lebanon Phone (603) 650-5104 Fax (603) 676-4042 One Medical Center Drive, Lebanon. NH 03756-0001 Dartmouth-Hitchcock Medical Center Lebanon Dartmouth-Hitchcock.org One Medical Center Drive, Lebanon. NH 03756-0001 Dortmouth-Hitchcock.org

jdtSr Dartmouth-Hitchcock Dartmouth-Hitchcock Jennifer L. Wejsa, APRN Tiffany Wong, APRN Cerebrovascular Disease & Stroke Program Cerebrovascular Disease & Stroke Program Department of Neurology Department of Neurology Phone (603) 650-5104 Fax (603) 6764042 Phone (603) 650-5104 Fax (603) 6764042

Dartmouth-Hitchcock Medical Center Lebanon Dartmouth-Hitchcock Medical Center Lebanon One Medical Conlor Drive. Lebanon, NH 037560001 One Medical Center Drive, Lebanon. NH 03756-0001 Darrmourh-Hltchcock.org Dartmouth-Hilchcock.org

Dartmouth-Hitchcock Dartmouth-Hitchcock Kimberly S. Schultz, RN Shawna S. Malynowski, MBA, BSN, RN Department- of Neurology Stroke Program Coordinator Phone (603) 650-5104 Fax (603) 676-4042 Cerebrovascular Disease & Stroke Program Department of Neurology Dartmouth-Hitchcock Medical Center Lebanon One Medical Center Drive. Lebanon. NH 03756-0001 [email protected] Pager # 5944 Dartmouth-Hitchcock.org Phone (603) 653-1117 Fax (603) 676-4042

Dartmouth-Hitchcock Medical Center Lebanon One Medical Center Drive, Lebanon. NH 03756-0001 Dartmouth-Hitchcock.org

Dartmouth-Hitchcock Shannon L. Shannon, MSN, RN Data Abstractor & Quality Improvement Specialist Cerebrovascular & Stroke Program Department of Neurology [email protected] Pager #7160 Phone (603) 653-1 116 Fax (603) 6764042

Dartmouth-Hitchcock Medical Center Lebanon One Medical Center Drive. Lebanon. NH 03756-0001 Dartmouth-Hitchcock.org