1. KNOW STROKE

2. Community Outreach & Education
Martha Power FNP-C
Tanya Smith FNP-BC
Angela J. Schaffer RN

3. Be Stroke Smart Reduce: stroke risk Recognize: stroke symptoms
Respond: at the first sign of stroke,
Call 911 immediately!

4. Why people don’t respond to stroke symptoms
Don’t recognize symptoms
Denial
Think nothing can be done
Worry about cost
Think symptoms will go away
Fear or don’t trust hospitals

5. Perceptions of Stroke Myths Reality Stroke is not preventable
Stroke cannot be treated
Stroke only strikes the elderly
Stroke happens in the heart
Stroke recovery ends after 6 months
Reality
Up to 80% percent of strokes are preventable
Stroke requires emergency treatment
Anyone can have a stroke
Stroke is a “Brain Attack”
Stroke recovery can last a lifetime

6. Stroke Facts A leading cause of death in the United States
795,000 Americans suffer strokes each year
134,000 deaths each year
-From 1996 to 2006 stroke deaths fell by 18.4%
6,400,000 stroke survivors

7. Stroke Facts A leading cause of adult disability
Up to 80% of all strokes are preventable through risk factor management
On average, someone suffers a stroke every 40 seconds in America

8. The Cost of Stroke
The estimated direct and indirect cost of stroke was 73.7 billion in 2010
The mean lifetime cost of ischemic stroke per person is about $140,048 in America

9. Types of Stroke
T.I.A.
Ischemic
Hemorrhagic

10. Transient Ischemic Attacks
Warning Strokes or “mini strokes”
Blood clot, vasospasm, etc.
Occurs for a short time
Symptoms resolve in 1-24 hours
Indicates possible major stroke in the future
1 in 9 will have stroke within 3 months

11. Ischemic Stroke Caused by a blocked blood vessel in the brain
8 out of 10
Strokes are ischemic

12. Risk Factors for Ischemic Stroke
Hypertension
Diabetes
Heart Disease
Smoking
High Cholesterol
Atrial Fibrilation
History of previous stroke
Age
Obesity
Poor Diet
Lack of exercise

13. Ischemic Stroke Symptoms
Facial Droop
Slurred Speech, dysarthria
Difficulty swallowing, dysphagia
Expressive or receptive aphasia
Gaze preference
Weakness, numbness, loss of sensation
Symptoms on one side of the face or body
Visual changes or loss of part or all of vision
Confusion
Reduced or loss of consciousness
Vertigo, dizziness, ataxia
Nystagmus (wiggling eyes)
CALL 911!

15. t-PA, the “Clot Buster”
t-PA is recommended for treatment of ischemic stroke in selected patients
However, t-PA is only administered to less than 3% of ischemic stroke patients
Delay in seeking medical care contributes significantly to underutilization of t-PA for stroke.
Extending time window for t-PA administration beyond the current recommended 3 hrs might be beneficial.

16. t-PA Recommendations
t-PA should be administered to eligible patients within hours after stroke
Eligibility criteria in this time period are similar to those for persons treated at earlier time periods with the following additional exclusion criteria:
Age > 80 years; Oral anticoagulant use with INR ≤ 1.7*; baseline NIH Stroke Scale score > 25; a history of stroke and diabetes (*For the 3.0 – 4.5 hr window all pts receiving oral anticoagulant are excluded whatever their INR).
3/25/2017© 2009, American Heart Association. All rights reserved. Information from the Expansion of the Time Window for Treatment of Acute Ischemic Stroke with IV TPA – Science Advisory

17. Merci Clot Retrieval Device
Meri Clot Removal Video 1:10

18. Penumbra Device and Restored Cerebral Circulation
Penumbra Clot Retrival Video 1:45

19. Solitaire Revascularization Device
Solitaire Revascularization Device Video 1:43
The Latest in
Neurointerventional
Radiology

20. Brain Attack! Stroke is a “Brain Attack.”
Stroke happens in the brain not the heart
Stroke is an emergency. Call 911 for emergency treatment.
The term “Brain Attack” is the most descriptive and realistic description of a stroke. It also provides a powerful call to action.
A brain attack should warrant the same degree of emergency care as a heart attack. After all, your brain is your mind and your body’s most vital and delicate organ.
Immediate response is crucial because every minute matters – from the time symptoms first become noticeable to the time treatment is received, more brain cells die. In other words TIME IS BRAIN. The best thing to do is to call 911 for immediate assistance.
Treatment is available and some options are most effective if administered within the first three hours after experiencing symptoms.
Your chances of walking out of the hospital with little to no disability are greatly improved if you receive appropriate treatments early.
Unfortunately, it takes the average American 12 to 24 hours to get to the hospital after experiencing the first stroke symptom. This is why it’s important that everyone learns how to RECOGNIZE stroke symptoms and how to RESPOND.
References:
National Stroke Association. The Complete Guide to Stroke At:
Lichtman JH, Watanbe E, et al. Hospital Arrival Time and Intravenous t-PA Use in US
Academic Medical Centers, 2001–2004. Stroke. 2009;40:00-00. 20

21. Carotid Artery Stent
Carotidendarterectomy

22. Case Study What do you do? A 59 year old male working at his desk.
He sends a coworker an that does not make sense.
He is confused, has a left facial droop,
and his left arm and leg are weak.
He is on Coumadin for an irregular heart rhythm. He has no other medical history.
He says, “I am not going to the hospital, because they can’t do anything for me.”
What do you do?

23. Case Study Continued…
You call 911 and your coworker is rushed to a Primary Stroke Center Emergency Department
The Stroke Team meets him at the door, and after imaging, diagnose him with an acute R MCA stroke with a large penumbra.

24. Case Study Continued…
He takes Coumadin for Atrial Fibrilation, but a blood test and the fact that he arrived so soon after onset of his symptoms, meets criteria for him to receive tPA, the “clot busting” medication for stroke.
His stroke symptoms completely resolve with the tPA.
When he returns to work without any neurological deficits, he Thanks You for calling an ambulance and getting him medical treatment so quickly!

25. Hemorrhagic Stroke
Caused by a ruptured blood vessel in the brain

26. Risk Factors for Hemorrhagic Stroke
Hypertension
Bleeding disorders
Aneurysm rupture
Vascular malformation
Excessive alcohol use
Cocaine use

27. Hemorrhagic Stroke Symptoms
Focal neurological deficits
Headache, “worst headache ever”
Neck pain
Light intolerance
Nausea, vomiting
Decreased level of consciousness

28. Two Categories of Hemorrhagic Stroke
ICH: bleeding into brain tissue as a result of bleeding or rupture of a small, deep cortical artery that is damaged by chronic hypertension
SAH: subarachnoid hemorrhage is the result of bleeding into the subarachnoid space, most often in relation to ruptured aneurysm or AVM

29. Aneurysm Clipping Performed by Neurosurgery
Incision and removal of skull bone
Surgical clip prevents blood
from entering aneurysm

30. Coiling Procedure for Aneurysm
Performed by Neurointerventional Radiologist
Catheter guided to aneurysm site
Coil is packed into aneurysm
Blood no longer enters site
Associated with improved outcomes

31. Stroke Recovery 10% of stroke survivors recover almost completely
25% recover with minor impairments
40% experience moderate to severe impairments requiring special care
10% require care within either a skilled-care or other long-term care facility
15% die shortly after the stroke

32. Lifestyle Changes for Survivors and Caregivers
Daily living skills
Dressing and grooming
Diet, nutrition and eating difficulties
Skin care problems
Pain
Sexuality/Intimacy
Behavior
Depression & Anger
Emotional Liability
One-sided Neglect
Memory Loss
Communication Problems

33. An Example of Left-sided
Neglect

34. Types of Stroke Rehabilitation
Physical Therapy (PT)
Walking, range of movement
Occupational Therapy (OT)
Taking care of one’s self
Speech Language Therapy
Communication skills, swallowing, cognition
Recreational Therapy
Cooking, gardening

35. Well Known Stroke Survivors
President Gerald Ford
Teddy Bruschi
Sharon Stone
Della Reese
Kirk Douglas
Roy Horn
of Siegfried & Roy
Mary Kay Ash
Charles Schultz
Harry Caray
Charles Dickens
Ed Koch
Ted Williams

36. How to Lower Your Risk for Stroke
Stop smoking
Maintain blood pressure below 140/80
Keep cholesterol in acceptable range
Manage blood sugar if diabetic
Regular Exercise
Low fat, low salt diet
Moderate alcohol use
“Everything in moderation”

37. Primary Stroke Care Healthcare Team
A Dedicated Stroke Team Coordinates Stroke Care
Neurology and Neurosurgery Services 24/7
Cutting Edge Imaging (CT,MRI, etc.) 24/7
Advanced Vascular Procedures performed by Neurointerventional Radiologists on call 24/7
Specialty Stroke Trained Nursing Care
Physical Therapy, Occupational Therapy, and Speech Therapy
Follow Up Care managed by Neurology Service
Support Group, Education, Research, and Community Outreach
Healthcare Team

38. Current Research Trials
SHINE
POINT
CLEAR-ER
STROKE BIOMARKERS
PEDIATRIC STROKE

39. Stroke Support Groups
Meeting for Education, Community, and Healing.

40. Women & Stroke AHA/ASA Campaign to
increase awareness of cardio- and neurovascular disease in Women ~

41. Appalachian Stroke Network
A Regional Cooperative
of Healthcare Providers
coming together to
improve Stroke Care
Throughout Appalachia

42. ACT FAST
Call 911

43. KNOW STROKE