A Guide to Stroke and Emergency Stroke Care
Stroke as a global burden
A stroke occurs when there is an obstructed blood flow in an area of the brain that results in brain cell atrophy (cell death) due to deprivation of oxygen. The oxygen supply is interrupted because the blood vessel that carries oxygen and nutrients to the brain either gets blocked by a clot or gets ruptured.1 Stroke is the third leading cause of disability worldwide2 and the second leading cause of death.3 In 2013, the number of stroke survivors was almost 25.7 million globally, deaths from stroke were 6.5 million, disability-adjusted life years (DALYs) due to stroke was 113 million, and cases of new strokes were 10.3 million.4 In 2016, there were 177,196 deaths due to stroke in the U.S., the number of stroke survivors reached 731,256 and the incidence of DALYs was 3,162,485.5 Additionally, around 53.5% of the total stroke cases in the U.S. occur among women.6
Types of stroke
Ischemic stroke takes place when a blood supplying vessel is obstructed and blood doesn’t reach the brain cells.7,8 Ischemic strokes are responsible for approximately 87 percent of all strokes. Atherosclerosis or fatty plaque within the blood vessel is the main cause of ischemic stroke. 1
Silent stroke is a brain injury that is generally caused by a blood clot that interrupts blood flow in the brain. It is characterized by a lack of clinical stroke-like symptoms and an association with elusive deficits in physical and cognitive function which very often remain unnoticed. It’s a risk factor for future strokes and a vital sign of progressive brain damage.1,9
- Hemorrhagic stroke happens when a weak blood vessel ruptures. It contributes to about 13 percent of stroke cases,1,7 and carries a very high morbidity and mortality rate.10
- Transient Ischemic Attacks (TIA) or “mini-strokes” occur when there is a temporary blockage of blood flow to the brain. About 80% of strokes that occur after experiencing a TIA are preventable by seeking urgent medical treatment. Though it doesn’t cause permanent damage, it’s a major warning for prevention of future strokes.7,11
- Cryptogenic stroke is the name for any stroke when the cause is unexplained despite testing. Such strokes are present in approximately 30%–40% of ischemic stroke patients.12
Brain stem stroke occurs in the brain stem, affecting both sides of the body, often leaving someone in a paralyzed state. In such a condition, the patient is generally unable to speak or move below the neck.1 They are attributable to approximately 10% of all ischemic brain strokes.13
Stroke impact as a global concern
Factors such as the location of the obstruction, severity, and the number of brain tissue affected will modulate the impact of stroke. If a stroke has occurred in the left side of the brain, the following impairments are most likely to occur in the right side of the body: paralysis on the right side of the body, speech/language problems, slow and cautious movement, memory loss, etc.
If a stroke has occurred in the right side of the brain, the following impairments are most likely to occur in the left side of the body: paralysis on the left side of the body, vision problems, inquisitive behavior, memory loss, etc.1,14,15
Who is more likely to have a stroke?
Conditions like hypertension (higher among men and older age groups), diabetes (among both genders), atrial fibrillation (higher among women), dyslipidemia (higher among men), migraine (higher among women), and cognitive impairment (higher among women), promote the occurrence of stroke.16
How to avoid a stroke?
Almost 80% of second clot-related strokes are preventable. You just need to take a little more effort to keep a record of your health status and be a little more cautious about your health care practices. Keep yourself healthy by monitoring your blood pressure at regular intervals, check your cholesterol levels, keep your blood sugar under control, get active, quit smoking, eat a healthy diet and, of course, talk to your doctor about the medications you are currently taking.17,18
You must seek immediate medical care if you experience any of the following: sudden numbness or weakness of the face, arm or leg, especially on one side of the body; sudden confusion, trouble speaking, or understanding; sudden trouble seeing in one or both eyes; sudden trouble walking, dizziness, loss of balance or coordination, or experiencing a sudden severe headache with an unknown cause.1,17
Recognizing the signs and symptoms of stroke and seeking immediate medical attention are the first and foremost steps to ensure recovery and minimize the effects of a stroke. Perform a quick FAST test to confirm the warning signs of a stroke:
Face: does one side of the face droop if asked to smile?
Arms: does one arm drift downward if asked to raise both arms?
Speech: is speech slurred or strange when asked to repeat a simple phrase?
Time: if any of these signs are observed, seek medical help immediately.1,19
Locating the closest stroke center is the second crucial step in stroke care. It is essential to locate a hospital that will be capable of providing treatment for acute stroke using intra-arterial thrombectomy (tPA) or endovascular clot retrieval procedures on a rapid response basis.20 Very often people get confused and waste time trying to locate the stroke care providers at hospitals, shuttling from one department to another, and verifying their stroke treatment capabilities. Hospitals, which have a stroke care center, generally have a stroke coordinator to bridge the stroke care facilities to the care seekers.21 Below is a comprehensive list of stroke care centers in the U.S.
Primary and Comprehensive Stroke Centers
Based on the commitment and ability to treat stroke and to provide rehabilitation support, The Joint Commission has certified stroke centers as primary and comprehensive.1,22
* Top stroke care centers in the U.S. include:
Catawba Valley Medical Center
810 Fairgrove Church Road, Hickory, NC 28602
Telephone: (828) 326-3000
Einstein Medical Center Montgomery
559 West Germantown Pike, East Norriton, PA 19403
Telephone: (484) 622-1000
Florida Hospital Carrollwood
7171 N Dale Mabry Hwy, Tampa, FL 33614
Telephone: (813) 932-2222
Mayo Clinic Hospital, Methodist Campus
201 W Center St, Rochester, MN 55902
Telephone: (507) 266-7890
Hugh Chatham Memorial Hospital
180 Parkwood Drive, Elkin, NC 28621
Telephone: (336) 527-7000
Massachusetts General Hospital
165 Cambridge St, Suite 810, Boston, MA 02114
Telephone: (617) 726-2760
Kaiser Permanente Santa Rosa Medical Center
401 Bicentennial Way, Santa Rosa, CA 95403
Telephone: (707) 393-4000
Mission Hospital Mission Viejo
27700 Medical Center Road, Mission Viejo, CA 92691
Telephone: (949) 364-1400
2049 East 100th Street, Cleveland, OH 44195
Telephone: (216) 444-2222
Saint Francis Hospital and Medical Center
114 Woodland St, Hartford, CT 06105
Telephone: (860) 714-4000
The Johns Hopkins Hospital
1800 Orleans St, Baltimore, MD 21287
Telephone: (410) 955-5000
St. Joseph Hospital
1100 West Stewart Drive, Orange, CA 92868
Telephone: (714) 633-9111
New York-Presbyterian/Columbia University Medical Center
622 W 168th St, New York, NY 10032
Telephone: (212) 305-2500
Saint Jude Medical Center
101 E. Valencia Mesa Drive, Fullerton, CA 92835
Telephone: (714) 871-3280
Ronald Reagan UCLA Medical Center
757 Westwood Plaza, Los Angeles, CA 90095
Telephone: (310) 825-9111
Saint Luke’s Hospital
232 South Woods Mill Road, Chesterfield, MO 63017
Telephone: (314) 434-1500
Stanford Hospital Stroke Center
213 Quarry Road, Palo Alto, CA 94304
Telephone: (650) 723-6469
St. Tammany Parish Hospital
1202 S Tyler St, Covington, LA 70433
Telephone: (985) 898-4000
Northwestern Memorial Hospital
251 E Huron St, Chicago, IL 60611
Telephone: (312) 926-2000
Temecula Valley Hospital
31700 Temecula Parkway, Temecula, CA 92592
Telephone: (951) 331-2200
Hospital of the University of Pennsylvania
3400 Spruce St, Philadelphia, PA 19104
Telephone: (800) 789-7366
Duke University Hospital
2301 Erwin Rd, Durham, NC 27710
Telephone: (919) 684-8111
The Valley Hospital
223 N. Van Dien Avenue, Ridgewood, NJ 07450
Telephone: (201) 447-8000
*Rejuvenation Therapeutics is not affiliated with any of the above-mentioned institutions. No specific criteria were used to compile this list.
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- Certification for Primary Stroke Centers, Joint Commission, 2019.