Neurosciences

ALERT BAR

Stroke Care

Recognizing Stroke

Knowing the signs and symptoms of stroke can save your life or the life of someone else. Even if symptoms go away, do not ignore. Symptoms may vary for each person but if you or someone else may be having a stroke, remember F.A.S.T.

FOUR LETTERS:
F-A-S-T
THREE NUMBERS:
9-1-1

Use the letters in “FAST” to spot stroke signs and know when to call 9-1-1.

F - A - S - T
F

FACE DROOPING
Does one side of the face droop or is it numb? Ask the person to smile. Is the person’s smile uneven or lopsided?

A

ARM WEAKNESS
Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?

S

SPEECH DIFFICULTY
Is speech slurred? Is the person unable to speak or difficult to understand? Ask the person to repeat a simple sentence. Is the person able to repeat the words correctly?

T

TIME TO CALL 9-1-1
If someone shows any of these symptoms, even if the symptoms go away, call 9-1-1 immediately. Time is important! Note the time when the symptoms first appeared.

Sometimes other symptoms appear separately or in combination with F.A.S.T. signs. Additional sudden symptoms may include:

  • Balance disorder- trouble walking, dizziness, loss of coordination
  • Blurred vision (or vision loss) - trouble seeing in one or both eyes
  • Severe headache with no known cause
  • Numbness or weakness on one side of the body – face, arm, leg
Woman with severe head ache

Treatments

If you or someone else show signs of stroke, the first and most important step is to call 9-1-1 immediately so trained medical personnel can begin life-saving treatment. Do not drive to the hospital and do not let someone else drive you. There is a saying: “Time is brain.” Once a stroke begins, neurons in the brain begin to rapidly deteriorate, and victims lose 10 percent of salvageable brain for every 15 minutes that they go untreated. Therefore, limiting the extent of damage requires urgent, expert evaluation and treatment. Immediate treatment can help minimize effects of stroke and improve recovery outcomes.


What is a stroke?

A stroke, frequently called a “brain attack,” can happen to anyone at any time. Stroke occurs when blood flow to an area of the brain is cut off. Once a stroke happens, brain cells cannot get oxygen and start to die within minutes. A stroke can cause lasting brain damage, long-term disability, or even death. 

There are two types of stroke – Ischemic and Hemorrhagic:

Image of Brain Stroke Types and the Brain

1. Ischemic Strokes (Clots): In everyday life, blood clotting is beneficial. When you are bleeding from a wound, blood clots work to slow and eventually stop the bleeding. In the case of stroke, however, blood clots are dangerous because they can block arteries and cut off blood flow to the brain, a process called ischemia thus ischemic stroke. High blood pressure is the number one cause for this type of stroke and about 87% of all strokes are ischemic strokes. An ischemic stroke can occur in two ways: embolic and thrombotic strokes.

Neurosciences

In an embolic stroke, a blood clot forms somewhere in the body (usually the heart) and travels through the bloodstream to your brain. Once in your brain, the clot eventually travels to a blood vessel small enough to block its passage. The clot lodges there, blocking the blood vessel and causing a stroke. The medical word for this type of blood clot is embolus.

In the second type of blood-clot stroke, blood flow is impaired because of a blockage to one or more of the arteries supplying blood to the brain. The process leading to this blockage is known as thrombosis. Strokes caused in this way are called thrombotic strokes since a clot that forms on a blood-vessel deposit is called a thrombus.

Blood-clot strokes can also happen as the result of unhealthy blood vessels clogged with a buildup of fatty deposits and cholesterol. Your body regards these buildups as multiple, tiny and repeated injuries to the blood vessel wall. Your body reacts to these injuries just as it would if you were bleeding from a wound; it responds by forming clots. Two types of thrombosis can cause stroke: large vessel thrombosis and small vessel disease (or lacunar infarction).

Thrombotic stroke occurs most often in the large arteries, so large vessel thrombosis is the most common and best-understood type of thrombotic stroke. Most large vessel thrombosis is caused by a combination of long-term atherosclerosis (narrowing of arteries due to plaque buildup) followed by rapid blood clot formation. Thrombotic stroke patients are also likely to have coronary artery disease, and heart attack is a frequent cause of death in patients who have suffered this type of brain attack.
Small vessel disease, or lacunar infarction, occurs when blood flow is blocked to a very small arterial vessel. The term's origin is from the Latin word lacuna, which means hole, and describes the small cavity remaining after the products of deep infarct have been removed by other cells in the body. Little is known about the causes of small vessel disease, but it is closely linked to hypertension (high blood pressure).

2. Hemorrhagic Strokes (Bleeds): Strokes caused by the breakage (hemorrhage) or "blowout" of a blood vessel in the brain are called hemorrhagic strokes. Hemorrhages can be caused by a number of disorders, which affect the blood vessels, including long-standing high blood pressure and cerebral aneurysms. An aneurysm is a weak or thin spot on a blood vessel wall. These weak spots are usually present at birth. Aneurysms develop over a number of years and usually don't cause detectable problems until they break. There are two types of hemorrhagic stroke: subarachnoid and intracerebral.

Neurosciences

An aneurysm bursts in a large artery on or near the thin, delicate membrane surrounding the brain. Blood spills into the area around the brain, which is filled with a protective fluid, causing the brain to be surrounded by blood-contaminated fluid.
Bleeding occurs from vessels within the brain itself. Hypertension (high blood pressure) is the primary cause of this type of hemorrhage.

Who is the Stroke Care Team at UTMB Health?

The stroke care team at UTMB Health uses a collaborative and comprehensive approach to caring for stroke patients. Our multidisciplinary team includes fellowship-trained specialists in stroke, neurocritical care, neurointerventional surgical therapy, vascular neurosurgery, and interventional neuroradiology. This dedicated team also includes a stroke nursing program manager, nursing staff, care managers, dieticians and physical therapists. Patients benefit from this coordinated team that provides an exceptional level of care with the newest technology and treatments available.

The Truth About Stroke

Did You Know?
  • Stroke is the fifth leading cause of death for all Americans and a leading cause of serious long-term disability.
  • Stroke reduces mobility in more than half of stroke survivors age 65 and older.
  • 1 in 5 women has a stroke at some point in her life. Stroke is the third leading cause of death for women.
  • Stroke kills about 140,000 Americans each year—that’s 1 out of every 20 deaths.
  • Someone in the United States has a stroke every 40 seconds. Every 4 minutes, someone dies of stroke.
  • Every year, more than 795,000 people in the United States have a stroke. About 610,000 of these are first or new strokes.
  • About 185,000 strokes—nearly 1 of 4—are in people who have had a previous stroke.
  • About 87% of all strokes are ischemic strokes, in which blood flow to the brain is blocked.
  • Risk of having a first stroke is nearly twice as high for blacks as for whites and blacks have the highest rate of death due to stroke.
  • Though stroke death rates have declined for decades among all race/ethnicities, Hispanics have seen an increase in death rates since 2013.
  • Stroke costs the United States an estimated $34 billion each year. This total includes the cost of health care services, medicines to treat stroke, and missed days of work.

Although stroke is the fifth leading cause of death in the U.S. and the number one cause of long-term adult disability, there are many misconceptions about stroke. Here are some of the most common ones.

MYTH

FACT

Stroke cannot be prevented. Up to 80% of strokes are preventable.
There is no treatment for stroke.At any sign of stroke call 9-1-1 immediately. Treatment may be available.
Stroke only affects the elderly. Stroke can happen to anyone at any time.
Stroke happens in the heart.Stroke is a “brain attack.”
Stroke recovery only happens for the first few months after a stroke. Stroke recovery is a lifelong process.
Strokes are rare. Stroke is the 5th leading cause of death in the U.S. There are nearly 7 million stroke survivors in the U.S.
Strokes are not hereditary. Family history of stroke increases your chance for stroke.
If stroke symptoms go away, you don’t need to seek medical attention. Temporary stroke symptoms are called transient ischemic attacks (TIA). They are warning signs prior to actual stroke and need medical attention immediately.

Prevention

A stroke can happen to anyone at any time but 80 percent of strokes are preventable. Many factors contribute to stroke which you cannot control (age, ethnicity, gender). But you can control or change lifestyle and medical risk factors. Ask your primary care physician or a neurologist to create a specific plan to help lower your risk of stroke.

Top Risk Factors:

  • High blood pressure
  • Diabetes
  • Atrial fibrillation (irregular, rapid heartbeat)
  • Smoking
  • High cholesterol
  • Physical inactivity
  • Unhealthy diet (high in salt, fat, sugar)

Life After Stroke/Survivorship

Stroke affects everyone differently. Stroke survivors have changes in their physical, mental and emotional abilities. Many stroke survivors continue to improve for a long time, sometimes many years. Rehabilitation is about getting your life back – living independently, returning to your family, friends, community and work. With proper care and rehabilitation, there is life after stroke.

Occupational and Physical Therapy Stroke Rehabilitation at UTMB:

  • Occupational therapy works to maximize the individual’s functional performance in activities of daily living so that he/she can reach the highest level of participation.
  • Physical therapy works to help the individual to return to his/her activities at home, work and community. Physical Therapists focus on movement, pain management, and ways to prevent problems that may occur after stroke.


Stroke Support Group

The UTMB Health Stroke Support Group provides stroke survivors and their caretakers the opportunity to participate in monthly meetings where a variety of activities occur and topics are discussed such as coping skills, nutrition, care giver support and more. Meetings are led by UTMB clinicians and staff from Nursing, Physical, Occupational, and Speech Therapy.

The group meets the fourth Wednesday of every other month in Galveston from 3:30 p.m. -5:00 p.m.

For more information visit the support groups web page or call (409) 772-8834.

Neurosciences Locations

Awards

  • Stroke Gold Plus Badge

    Stroke program continues success

    July 25, 2018, 16:04 PM by Teresa Phillips
    UTMB’s Galveston Campus stroke program has received the American Heart Association/American Stroke Association’s Get With The Guidelines®-Stroke Gold Plus Quality Achievement Award. The award recognizes the hospital’s commitment to ensuring stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines based on the latest scientific evidence.
  • DNV-GL Certified Comprehensive Stroke

    UTMB receives comprehensive stroke center certification

    May 14, 2018, 16:03 PM by Melissa Harman
    UTMB’s Galveston Campus attains Comprehensive Stroke Center accreditation from Det Norske Veritas (DNV), validating UTMB’s commitment, expertise and readiness to care for victims of complex strokes. According to DNV, “the Comprehensive Stroke Center Certification encompasses the full spectrum of stroke care—diagnosis, treatment, rehabilitation and education—and establishes clear metrics to evaluate outcomes. Comprehensive stroke centers are typically the largest and best-equipped hospitals in a given geographical area that can treat any kind of stroke or stroke complication.”
  • GWTGL Stroke SilverPlus

    Stroke program continued recognition

    May 30, 2017, 13:12 PM by Melissa Harman
    The stroke program at the University of Texas Medical Branch Galveston campus has received the American Heart Association and American Stroke Association's “Get with the Guidelines” Stroke Silver Plus Achievement Award. The award recognizes this hospital for its continued success in using the Get with the Guidelines — Stroke and Target: Stroke program.
  • Get_with_the_Guidelines_-_Bronze_Quality_Achievement_Award

    Stroke success

    August 23, 2015, 16:25 PM by Melissa Harman
    The stroke programs at the University of Texas Medical Branch Galveston campus and the medical branch’s Angleton Danbury campus have received the American Heart Association’s “Get with the Guidelines” Bronze Quality Achievement Award. The award recognizes hospitals that have demonstrated at least 85 percent compliance in each of the seven Get with the Guidelines — Stroke Achievement Measures for 90 consecutive days.
  • The Joint Commission

    Stroke certification by the Joint Commission as a Primary Stroke Center

    May 23, 2013, 17:10 PM by Melissa Harman
    UTMB was recently awarded certification by the Joint Commission as a Primary Stroke Center. Launched in December 2003, the program was developed in collaboration with the American Heart Association/American Stroke Association, and certification is available only to stroke programs in Joint Commission-accredited acute-care hospitals. This certification recognizes the best practices for stroke care.

Frequently Asked Questions

Stroke FAQs

A: No. Almost everyone who has ever had a stroke may have been under stress or have been overworking at some time before the onset of the stroke. It is natural to think of stroke and stress as being related but they are not related.

A: No. The stroke itself has no effect on the heart, but patients who suffer a stroke may have had heart disease already, which they may or may not have known about before the stroke.

A: Partial recovery is very usual, but total recovery is less common. After a stroke four things may happen:

  1. The brain cells which were badly damaged at the onset die and never recover.
  2. Other cells which were only partially damaged, due to swelling of the brain, recover and start working again. This process takes place during the first few weeks after the onset of the stroke.
  3. Parts of the brain which are unaffected by the stroke begin to take over the functions of the dead parts. This can occur only to a limited extent, but may continue for a long time.
  4. The patient adapts to the loss of function and learns new ways of living with the damaged brain.

A: Having a stroke does not automatically mean you will have another stroke. However, the conditions which caused the first stroke- (weakness of an artery wall or blood clotting) sometimes cannot be reversed so the possibility of a second stroke is high. You can help reduce your chances having a second stroke by controlling risk factors and making healthy lifestyle choices.

At the onset of stroke, the muscles of the face, trunk, arm and leg on either the left or right side of the body are weak and relaxed. In most cases the power gradually returns, first to the leg and then to the arm. However, unless the limbs are placed in the correct position and are frequently put through a range of movements, there is a danger that they may stiffen, so that, even if the power returns, the limbs could be practically useless. This is why it is important to place the limbs in the correct position allowing recovery to take place in the best way. The simple rule is to let the leg bend but to keep the arm straight. It is also vital to treat the body as a whole, not just the paralyzed limbs in isolation.

A: Speech is affected in two ways. In some patients, speech is slurred and indistinct or even completely absent, but the patient can read, write and understand perfectly what is said. This condition is called dysarthia, and treatment usually helps with the patient’s recovery.

The other condition is much more complex. It is called dysphasia or aphasia and is due to damage to the part of the brain which controls all language processes. This can affect the patient's ability to speak, understand speech, read and write. Recovery from dysphasia can be rapid and complete, but is, in most cases, slow and incomplete, and patients and their relatives need a great deal of help from speech and language therapists and others.

A: In most stroke cases, vision is not affected. Patients who complain of visual difficulty, the fault is not in the eyesight itself, but in the interpretation by the brain of what the eye sees. In most people, the two sides of the brain each form a separate picture of half of what lies before it, and the two pictures are joined together to give a total view. When part of the brain forming one of those half pictures is damaged by a stroke, the patient sees only one half of the world depending on which half of the brain is affected. This can be perplexing for the patient and relatives, and is very disabling, but recovery, although slow, usually occurs.