Stroke 101: What You Need to Know

In March 2019, the death of actor Luke Perry at age 52 from an ischemic stroke – caused by a blocked blood vessel to the brain – brought to light the sobering truth that strokes do occur in younger people. According to the Centers for Disease Control and Prevention (CDC), 1 in 7 (14 percent) of patients hospitalized for ischemic stroke every year are younger adults. Age is an important factor for all of us: CDC reports that risk for stroke increases starting at 55, and nearly doubles every decade thereafter.

Lehigh Valley Health Network (LVHN) provides unparalleled stroke diagnosis, treatment and prevention services. In 2012, Lehigh Valley Hospital (LVH)–Cedar Crest was the first hospital in Pennsylvania to be certified as a Comprehensive Stroke Center, where you receive the highest level of stroke care. LVH–Muhlenberg, LVH–Hecktown Oaks, LVH–Hazleton, LVH–Schuylkill and LVH–Pocono are all certified Primary Stroke Centers, offering special procedures to rapidly diagnose and treat stroke.

The ultimate success of stroke care depends on one factor: time. “People need to recognize symptoms of stroke and call 911,” says neurologist and neurocritical care specialist Christopher Melinosky, MD, with LVHN Neurology. “When you call an ambulance, it triggers an alert, so that a stroke team is waiting at the hospital when you arrive, ready to provide immediate treatment.”

Dr. Melinosky says the mnemonic BE FAST is the most useful way to remember stroke symptoms:

B – Balance: Is balance or coordination suddenly impaired?

E – Eyes: Is vision suddenly blurred or double?

F – Face: Ask the person to smile. Does one side of the face droop?

A – Arms: Ask the person to raise both arms. Does one arm drift downward?

S – Speech: Ask the person to repeat a simple phrase. Is speech slurred or strange?

T – Time: If you see any of these signs, call 911 right away.

“If you think you’re having a stroke, don’t take an aspirin, which is only recommended when you are having heart attack symptoms,” Dr. Melinosky says. “If you are having a hemorrhagic stroke, aspirin may worsen bleeding in the brain. The best thing to do is call 911 immediately.”

Ischemic stroke occurs when a vessel carrying blood to the brain is blocked by a clot, causing an interruption in blood flow. Ischemic stroke accounts for about 85 percent of all strokes. The first-line treatment for ischemic stroke is an injection of the clot-busting medication called tenecteplase (TNK). This medication must be administered within a 3-hour window of symptom onset (and up to 4.5 hours in certain patients) to work best. Mechanical thrombectomy, in which doctors manually remove a clot using a catheter, can be performed up to 24 hours after symptom onset in certain patients, and often offers the greatest chance at recovery.

Hemorrhagic stroke is caused by bleeding into or around the brain; it accounts for about 15 percent of strokes but about 40 percent of stroke deaths. This type of stroke may be treated with medications that control further bleeding, control high blood pressure and reduce brain swelling. Surgery also can be performed to seal off or repair bleeding vessels in some cases.

Transient ischemic attack (TIA) occurs when blood flow to the brain stops for a short time, causing stroke-like symptoms. TIA, sometimes called a “mini-stroke,” is a warning that you are in danger of having a major stroke. This is considered a neurologic emergency, and appropriate workup may actually be able to prevent a stroke.

In 2016, an LVHN patient was first in the region to receive a Watchman^TM device, which reduces risk for stroke in patients with difficult-to-treat atrial fibrillation (AFib) who are unable to take blood thinners. AFib is a heart rhythm disorder that is a known risk factor for stroke. People with AFib have an increased risk of having a stroke.  Blood thinners can help reduce the risk of stroke, but some people are unable to take them. In those instances, Watchman offers an excellent alternative treatment. 

A Watchman device is an umbrella-like implant that seals off the left atrial appendage (LAA), a section of the heart in which blood can pool and clot. Watchman is implanted in the heart using a catheter during an hour-long outpatient procedure. Six months after surgery, 95 percent of patients can completely discontinue blood-thinning medications. The risk of stroke after a Watchman is similar to being on a blood thinner without the risk of bleeding. One year after surgery, 95 percent of patients can completely discontinue blood-thinning medications.