There are two types of stroke: ischemic, which occur as the result of a blockage inside a blood vessel that supplies blood to the brain, and hemorrhagic, which occur when a blood vessel ruptures and causes bleeding in the brain. When the brain does not receive a continuous supply of blood, brain cells die. Time is of the utmost importance in the treatment of stroke, and yet many do not call 911 when stroke symptoms arise. Christine Deato, RN, MSN, AGPCNP-BC, SCRN, Highland Park Hospital Stroke Coordinator at NorthShore, answered our questions on stroke, including signs, risk factors, recovery and more, to raise awareness that stroke is a brain attack and a medical emergency. Don’t ignore the signs.

What are the signs of a stroke? Are there early signs that might go unnoticed or ignored?
We teach the public to be F.A.S.T., which stands for facial droop, arm and/or leg weakness/numbness, speech/language difficulty and the T is for timing, which means getting medical attention as soon as possible. More subtle signs of stroke would be similar to the ones listed above but possibly not as pronounced. For instance, if a person notices sudden weakness of his arm and leg on the same side, though he is able to use them, that is still a sign of stroke and it warrants emergent medical attention. The real problem with stroke and public awareness is there usually is no pain associated with stroke so people wait and see if the symptoms will go away. Time is of essence!

Why is it so important to get medical attention fast?
Brain cells (neurons) die within seconds of not receiving oxygenated blood. The faster a person with stroke symptoms gets to the hospital the better. A person may be candidate for our only FDA-approved treatment for acute stroke: tPA (alteplase). But, this can only be administered if symptom onset is less than 3-4.5 hours from time of drug administration. Stroke is a medical emergency. Call 911.

What happens after the hospital phase of stroke recovery?
Once the patient is medically stable, they will often go to either a sub-acute rehabilitation facility or an in-patient rehabilitation facility as the next level of care. Both include physical, occupational and speech therapy but in-patient requires that a patient can tolerate at least three hours of therapy in a given day. Often, patients who have a lot of deficits are unable to withstand this level of therapy at the beginning. In those cases, sub-acute rehab is the next best place. Patients will be able to get upwards of two hours of therapy a day but it is much more dependent on patient’s endurance. Typical length of stay times are variable and depend on how well or poorly a patient is doing.

After a stroke, how long can patients continue to improve?
Improvement can continue a year from the stroke but improvement is not as dramatic as during the first 3-12 months. That said, people who have language difficulties from stroke have been known to improve for years afterward.

Is a younger stroke patient likely to have a better recovery than someone who is older?
Stroke can happen at any age and when it comes to stroke age is relative. Someone can have a more severe stroke as a younger person than an older person. Usually the younger patients have fewer chronic health issues though. If you are in poor health before a stroke, it’s more difficult to recover primarily because there is less reserve. That said, I have seen quite large strokes in an elderly population with good outcomes. The brain is a very complex organ and everyone really recovers differently. On the whole, after a stroke, people improve. Where one can functionally get to remains unknown.

If there is a family history of stroke and high blood pressure, what can you to do prevent stroke.
Regular aerobic exercise and healthy eating are terrific approaches to what we refer to as "primary stroke prevention." Hypertension, or high blood pressure (typically greater than 130/85), is the number one risk factor for stroke. If you do have high blood pressure, make sure to treat it. Do not delay. Hypertension is a "silent killer.” People usually don't feel any different with high blood pressure. In patients 60 years or older who do not have diabetes or chronic kidney disease the goal blood pressure level is now <150/90.

What’s a “mini stroke”? Can it lead to a more severe stroke?
Mini stroke is a term we in the stroke field would like to do away with. It has been used in the past to refer to TIA (transient ischemic attack). This is an event with stroke-like symptoms that usually resolves itself within minutes. The problem with this term is that it sounds almost cute and harmless. In actuality, it carries the same risk of future stroke as an actual stroke. TIAs are definitely warning signs of stroke. We take these events very seriously with the hope of identifying a person's stroke risk factors and reduce them as much as possible to hopefully prevent a stroke in the future. These preventative measures include lifestyle changes like diet and exercise.

In addition to healthy eating and exercise, is an aspirin regimen recommended after a TIA?
We recommend at least aspirin 81mg (baby aspirin) or plavix 75mg after a person has had a TIA, especially if there is a history of diabetes, unless there is known contraindication.