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Stroke

Be fast if you think it might be a stroke—call 911 or head to the nearest emergency department. Early treatment can prevent brain damage. Every minute an artery is blocked due to a stroke, 2 million brain cells die. Rapid treatment improves outcomes and saves lives.

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Every second matters

Did you know that 80 percent of strokes can be prevented, according to the American Heart Association and American Stroke Association? A stroke can be a scary and alarming situation. It happens when a blood vessel in the brain becomes blocked or bursts, causing damage to the brain cells with each passing moment. There is hope after a stroke with monitoring, medications, lifestyle changes and sometimes rehabilitation. 

If you suspect that you or a loved one is experiencing a stroke, remember that time is of the essence. Call 911 immediately.

Lester Leung, MD (Director, Comprehensive Stroke Center; Director, Stroke and Young Adults (SAYA) Program), Cara Clifford, MA CCC-SLP (speech language pathologist) and Ali Daneshmand, MD (Neurology senior resident) discussing a case in the Neuro Trauma Unit at Tufts Medical Center.
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Conditions

Strokes, sometimes called "brain attacks," occur when blood vessels supplying the brain, spinal cord or eye are injured. When the cells are damaged, blood flow is interrupted, and your brain can't tell your body to do certain things like move your face or limbs, speak or understand what others are saying. Depending on the type and location of the stroke, these functions may be impaired or lost.

There are two main types of strokes:

  • Ischemic stroke: a blockage of a blood vessel supplying a specific portion of the brain, resulting in loss of oxygen and nutrient delivery to that area.
  • Intracerebral hemorrhage: a rupture of a blood vessel supplying the brain, resulting in bleeding into the brain tissue.

Stroke symptoms 

Stroke symptoms come on suddenly and can be mild or severe. They can appear gradually and come and golook for:

  • Difficulty closing your eyes or moving your mouth
  • Trouble moving your arm or leg on one-sided
  • Loss of sensation, numbness or tingling on one side of the face or body 
  • Difficulty speaking and understanding others 
  • Vision impairment in one or both eyes
  • Poor arm and leg coordination 
  • Balance problems/falling  

B.E. F.A.S.T. Stroke Awareness

If you or a loved one ever experiences any of these symptoms and you believe you are having a stroke or symptoms that cannot otherwise be explained, call 911 immediately. 

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Testing

Diagnosing the type of stroke you've had is like detective work. We specialize in reviewing the evidence, ruling out other culprits and zeroing in on the main suspect.

We'll ask about your symptoms, perform physical and neurological exams and monitor your condition. Our physicians, nurses and emergency medicine technicians may ask you the same questions several times to tease out additional details from your memory.

Finally, brain imaging will give us the clearest picture of where the "attack" occurred. Honing in on the cause and location of the stroke provides us the best information to tailor your treatment plan. 

Some of the tests we use to look for clues include:

  • Blood tests
  • Brain and pelvis magnetic resonance imaging (MRI)
  • Cardiac telemetry
  • Catheter angiogram (a safe, minor test used to take images of arteries in your head and neck)
  • Chest X-ray
  • Computerized tomography (CT) scan
  • Doppler ultrasound of the legs (an ultrasound of leg veins to look for deep vein clots)
  • Echocardiogram
  • Electrocardiogram (ECG or EKG)
  • Head and neck CT angiogram
  • Urine tests
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Treatments

Strokes can be disabling or life-threatening. Getting emergency medical care as fast as possible gives you the best chance of minimizing long-term effects. During the first 24-48 hours in the hospital, our emergency physicians, nurses and technicians will stabilize you to prevent your stroke from worsening or causing new strokes.

You may be in the hospital for a few days or weeks, depending on the type of stroke you experienced and your complications. Everyone's recovery journey is different. You can count on our team to comfort and guide you.

Medications + other treatments

Your treatment plan may also include:

  • Medication like aspirin and Plavix prevent clots from forming and causing more strokes
  • Intravenous fluids (IV in the arm) may be given to make it easier for your heart to deliver blood and nutrients to your brain
  • Blood pressure monitoring
Ischemic stroke care

Ischemic strokes strike when a blood vessel that supplies oxygen and nutrients to the brain is blocked. Immediate treatment for this type of stroke is to open the blockage and restore blood flow to the brain.

Depending on when you arrive at the hospital or when the stroke started, you may receive intravenous medication from your arm (intravenous tissue plasminogen activator or IV tPA) to dissolve clots. This medication is the gold standard of care for ischemic strokes and is proven to reduce long-term disability.

You may require surgery if your stroke causes a major artery to be blocked. We'll make minor cuts and thread a thin, flexible tube called a catheter up to the neck and head arteries to remove the clot. You'll be in the expert care of our experienced neurosurgeons, neurologists and interventional radiologists

Intracerebral hemorrhage care

Intracerebral hemorrhage care targets the area of the brain where blood vessels have ruptured. We quickly stop or slow bleeding in the brain, repair damage and prevent complications. Bleeding in the brain can be worsened by uncontrolled high blood pressure, abnormal blood vessels and coagulopathy which is excessive bleeding or clotting. Treatments include:

  • Medication to lower blood pressure
  • Medications to reverse complications from blood thinning medications or medical conditions like liver disease 
  • Minor surgery using thin wire catheters to treat abnormal blood vessels
  • Extensive bleeding that is life-threatening may require neurosurgeons to remove blood or relieve pressure on the brain
Young adult stroke care

Strokes that happen in people under the age of 50 are becoming more common. Our care for young adults who have had a stroke is built to help identify causes of the stroke, optimize prevention of future strokes, estimate the risk for recurrent stroke and late complications of stroke, and provide counseling on stroke survivorship.

Rehabilitation + recovery

Rehabilitation starts in the hospital following a stroke. Once your condition has stabilized, our physical, occupational and speech therapists evaluate your needs.

Our compassionate case manager will carefully consider your needs and work with your physicians, nurses and therapists to assemble the best care plan. You may first need therapy to strengthen muscles and improve coordination and speech before you can return home. There are recovery options that will help you and your loved ones care for you, including:

  • Home: If you quickly recover from your symptoms, you may be able to go straight home from the hospital. However, having family or friends available to help immediately in case you develop recurrent or new symptoms is a good idea.
  • Home with services: If you are well enough but have some neurologic issues, you may be able to return home with a visiting nurse who can guide you in physical, occupational, or speech therapies
  • Acute rehabilitation hospital ("acute rehab"): If your symptoms or losses are severe, we ideally want you to go to an acute rehabilitation hospital. Physical, occupational and speech therapists, physicians and nurses staff these facilities. 
  • Skilled nursing facility: If your symptoms or deficits are severe but you cannot fully participate in rehabilitation therapy, you may go to a skilled nursing facility. 
  • Long-term acute care facility: Sometimes, you may be very sick and require critical care level support (breathing support, feeding support, intravenous medications, etc.).

Managing early complications

Early complications are common and usually appear the first few days after a stroke. Not all stroke complications are preventable, but some can be reduced with care at a stroke center.

Our doctors and nurses are here with you every step of the way and keep an eye out for complications, including:

Aspiration

If you've ever had the experience of food "going down the wrong way," you know it can be scary and painful. Aspiration is a fancy medical term for accidentally inhaling food into your lungs instead of swallowing it. Aspiration can also happen when your stomach sends food up through your lungs.

Food entering the lungs may also cause an infection or make breathing harder. Most people recover from infections after being treated with antibiotics. If you continue to have difficulty breathing, your doctor may recommend breathing support like a nasal cannula (a thin plastic tube that delivers oxygen to your nostrils) or a ventilator that moves air in and out of your lungs. 

Brain swelling

Severe strokes can damage important parts of the brain, causing it to swell and affect other healthy parts of the brain.

You will be treated with life-saving medications and other measures to reduce swelling when this occurs. Depending on the severity of the swelling, our specialists may recommend surgery to reduce swelling and prevent it from injuring healthy brain tissue.

Deep vein thrombosis

Strokes caused by blot clots, called ischemic strokes, and intracerebral hemorrhages may result in your body being more susceptible to forming blood clots, especially if you are paralyzed.

Blood clots often form in the deep veins of the legs and pelvis. These clots can be dangerous if they travel to the lungs, making breathing difficult. Wearing compression socks in bed is easy and painless to keep blood clots at bay.

Injectable medications, sometimes called "blood thinners" (although they don't thin the blood), may be recommended to prevent clots. Our anticoagulation management team can help support you while taking these medications. 

Dysphagia or difficulty swallowing

People with dysphagia have trouble swallowing certain foods or may not be able to swallow at all. When food goes down the wrong way, it can cause you to cough, choke or develop an infection like pneumonia.

Your safety is our priority. Our speech and language experts and nurses will assess how well you can swallow. If you cannot swallow, we may recommend that you have a soft, thin tube placed through your nose to your stomach.

The tube is temporary unless you have trouble swallowing for weeks or months. At that point, you may need a more permanent tube so your body can continue to get the fuel it needs to work correctly. We will work to regain your swallowing ability and recommend the best treatment.

Fever

Fevers are common after having a stroke due to a related infection or a stroke. Our team will manage and lower your body temperature with medication like Tylenol or cooling blankets.

Hyperglycemia or high blood sugar

Diabetes is a stroke risk factor. When glucose increases in the bloodstream, it can worsen a stroke. Our team will check your glucose levels by pricking your finger to test a tiny drop of blood. You may get small insulin doses to keep your glucose in check while in the hospital.

Urinary tract infection

We may discover that you had a urinary tract infection (UTI) before having a stroke. It's important that we treat a UTI so your body can give its full attention to repairing your brain. Your primary care doctor can recommend the best treatment.

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