Dr. Damian Baalmann is the Stroke Medical Director and an emergency room physician for Barnes-Jewish St. Peters Hospital. He discusses how to recognize a stroke as well as what you can do to prevent a stroke.
Medically speaking what exactly is the definition of a stroke?
A stroke is just a term that we use when a part of the brain is damaged because of a problem with blood flow. Strokes can happen one of two ways, one is that an artery to the brain gets clogged or closes off and part of the brains goes without blood for too long, this is called an ischemic stroke. The second type of stroke is when an artery breaks open and starts bleeding into or around the brain and that is called a hemorrhagic stroke.
Are there common symptoms to look for concerning a stroke?
The common symptoms are arm or leg wetness, numbness, loss of sensation in your arms or face or legs, a feeling that your face is drooping and having difficulty with speech meaning that you are slurring your words or having difficulty forming words or people are just having a hard time understanding you, changes in vision, having trouble walking, loss of balance or coordination. It is difficult to remember all of these signs because strokes often come on suddenly. We use the mnemonic, the word, “BE - FAST”, each letter in the word stands for one of the things you should watch for and what to do about it.
- B stands for balance; are there balance problems?
- E stands for eyes; does the person have sudden vision problems?
- F stands for face; does a person’s face look uneven or droop on one side?
- A stands for arm; does a person have weakness or numbness in one or both of their arms or does the arm drift out if the person tries to hold it out?
- S stands for speech; is the person having trouble speaking, does his or her speech sound strange?
- T stands for time; and that is just an emphasis that if you notice any of these stroke symptoms, call for an ambulance. Dial 911, you need a doctor fast. The sooner the treatment begins the better the chances are for recovery.
We hear about time being of the essence in a stroke. Why is that it and why is it so important to get to the hospital as quickly as possible?
The right treatment depends on what kind of stroke you are having. You need to get to the hospital very quickly to figure this out. Treatments for stroke work better the earlier they are implemented. We have a phrase that, “time is brain”, which emphasizes that the brain is irretrievably lost as the stroke progresses. Even a matter of minutes can make a difference when you are treating stroke.
What about risk factors. What are some of the risk factors for stroke?
There are three major types -- lifestyle, medical condition and family history. Many strokes can be prevented, though not all. You can greatly lower your chance of having a stroke by modifying some of these life factors, for lifestyle; if you are smoking, stop smoking, get regular exercise which is a good thing to prevent stroke. It is recommended that you exercise 30 minutes a day most days of the week if your doctor says that is safe. You should lose weight if you are overweight by eating a diet rich in fruits and vegetables such as the Mediterranean diet, eating less salt and limiting the amount of alcohol you drink. In medical conditions; you should control blood pressure, cholesterol and diabetes. These are all medical conditions that increase your risk for stroke so visiting your doctor regularly to get screened for those and to treat those appropriately with medications and with lifestyle modifications can decrease your risk for stroke. There are some other medical conditions such as atrial fibrillation which can increase your risks for stroke so seeing your doctor and getting treated regularly for those things if you have them can help reduce your risk for stroke.
What about the treatment side of things?
It depends on what kind of stroke you have. If you have a blockage in the artery which is an ischemic stroke, the treatment is to try to reopen the clogged arteries. The very early treatment that you if you come in early with your stroke symptoms, we can give a medication sometimes called TPA or Alteplase which goes through vein up through the arteries and tries to break up the clot that is blocking the blood flow to the brain.
In some cases, some people can undergo thrombectomy, which is a procedure where a specialist puts a cheater in the blocked artery and removes the clot. Then the other treatment for ischemic strokes is getting medicines to prevent new blood clots whether that be aspirin or a statin for your cholesterol a blood thinner.
A lot of our focus is on preventing another stroke from occurring. For people who have strokes with bleeding, we have treatments that might reduce the damage caused by bleeding in and around the brain. That can include lowering your blood pressure emergently and that can include reducing a blood thinner if you are on it and then we can also have you stop taking medicine that increases bleeding and in some cases people have surgery to treat the blood vessel to prevent more bleeding. Those are the kind of interventions that we can do and tailor it to what kind of stroke a person has had.
Get more information on stroke care here.