UofL Health – Jewish Hospital and Mary & Elizabeth Hospital are both Joint Commission Certified Primary Stroke Centers that are providing the standard of stroke care to support better patient outcomes. Both facilities are also recipients of the Get With The Guidelines-Stroke Gold Plus Award from the American Heart Association/American Stroke Association. The award recognizes UofL Health – Jewish Hospital's and Mary & Elizabeth Hospital's commitment and success in implementing a higher standard of stroke care, ensuring patients receive treatment according to nationally accepted standards.
UofL Health – Jewish Hospital
200 Abraham Flexner Way
Louisville, KY 40202
UofL Health – Mary & Elizabeth Hospital
1850 Bluegrass Ave.
Louisville, KY 40215
For more information and resources regarding stroke visit the American Stroke Association.
Stroke: What to Know
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There are two types of strokes:
- Ischemic stroke: Occur as a result of a blood clot within a blood vessel supplying blood to the brain (87% of all strokes)
- Hemorrhagic stroke: Result from weakened vessels that rupture and bleed into the surrounding brain (13% of all strokes)
The good news about strokes is that they are very preventable. The key is lifestyle changes:
- Exercise regularly
- Quit smoking
- Eat healthier
- Manage cholesterol and blood pressure
- Manage atrial fibrillation
Stroke Care: FAQs
What Disabilities Can Result From a Stroke?
Stroke damage in the brain can affect the entire body — resulting in mild to severe disabilities. These include paralysis, problems with thinking, problems with speaking, emotional problems and pain.
What is a Transient Ischemic Attack, or TIA?
Transient ischemic attacks, or TIAs, occur when the warning signs of a stroke last only a few moments and then disappear. These brief episodes are also sometimes called "mini-strokes." Although brief, they identify an underlying serious condition that isn't going away without medical help. Unfortunately, since they clear up, many people ignore them. Don't ignore them. Heeding them can save your life.
Is Stroke Preventable?
Yes. Stroke is preventable. A better understanding of the causes of stroke has helped people make lifestyle changes that have cut the stroke death rate nearly in half in the last two decades.
While a family history of stroke plays a role in your risk, there are many risk factors you can control:
- If you have high blood pressure, work with your doctor to get it under control. Managing your high blood pressure is the most important thing you can do to avoid stroke.
- If you smoke, quit.
- If you have diabetes, learn how to manage it. Many people do not realize they have diabetes, which is a major risk factor for heart disease and stroke.
- If you are overweight, start maintaining a healthy diet and exercising regularly.
- If you have high cholesterol, work with your doctor to lower it. A high level of total cholesterol in the blood is a major risk factor for heart disease, which raises your risk of stroke.
Source: National Institutes of Health
How is a Stroke Diagnosed?
Doctors have several techniques and imaging tools to help diagnose stroke quickly and accurately. The first step in diagnosis is a short neurological examination or an evaluation of the nervous system.
When a possible stroke patient arrives at a hospital, a health care professional, usually a doctor or nurse, will ask the patient or a companion what happened and when the symptoms began. Blood tests, an electrocardiogram and a brain scan such as computed tomography (CT) or magnetic resonance imaging (MRI) will often be done.
What is a CT Scan? What is an MRI?
The most commonly used imaging procedure is the computed tomography or CT scan, also known as a “CAT” scan. A CT scan is comprised of a series of cross-sectional images of the head and brain. Because it is readily available at all hours at most major hospitals, produces images quickly and is good for ruling out hemorrhage prior to starting thrombolytic therapy, CT is the most widely used diagnostic imaging technique for acute stroke.
A CT scan may show evidence of early ischemia – an area of tissue that is dead or dying due to a loss of blood supply. Ischemic strokes generally show up on a CT scan about six to eight hours after the start of stroke symptoms.
Another imaging technique used for stroke patients is magnetic resonance imaging or MRI scan. MRI uses magnetic fields to detect a variety of changes in the brain and blood vessels caused by a stroke.
One effect of ischemic stroke is the slowing of water movement through the injured brain tissue. An MRI can show this type of damage very soon after the stroke symptoms start.
MRI and CT are equally accurate for determining when hemorrhage is present. The benefit of MRI over a CT scan is a more accurate and earlier diagnosis of ischemic stroke, especially for smaller strokes and transient ischemic attacks (TIAs). Also, MRI can be more sensitive than CT for detecting other types of neurologic disorders that mimic the symptoms of a stroke. However, MRI cannot be performed in patients with certain types of metallic or electronic implants, such as pacemakers for the heart.
Although increasingly used in the emergency diagnosis of stroke, MRI is not immediately available at all hours in most hospitals, where CT is used for acute stroke diagnosis. Also, MRI typically takes longer to perform than CT, and therefore may not be the first choice when minutes count.
What Kinds of Therapies are Available to Help Rehabilitate Patients After Stroke?
For most stroke patients, rehabilitation mainly involves physical therapy. The aim of physical therapy is to have the stroke patient relearn simple motor activities such as walking, sitting, standing, lying down and the process of switching from one type of movement to another.
Another type of therapy to help patients relearn daily activities is occupational therapy. This type of therapy also involves exercise and training. Its goal is to help the stroke patient relearn everyday activities such as eating, drinking and swallowing, dressing, bathing, cooking, reading and writing and toileting.
Speech therapy helps stroke patients relearn language and speaking skills, or learn other forms of communication. It is appropriate for patients who have no deficits in cognition or thinking but have problems understanding speech or written words, or problems forming speech.
Talk therapy, along with the right medication, can help ease some of the mental and emotional problems that result from stroke.
- Clot-busters, e.g., IV tPA: The most promising treatment for ischemic stroke is the FDA-approved clot-busting drug, IV tPA (intravenous tissue plasminogen activator), which must be administered within a three-hour time window from the first sign of symptoms. This time window is why it's critical for anyone showing the signs of stroke to call 911 and get to the hospital immediately.
- Interventional stroke care: If a patient presents after the three-hour time window, neuro-interventional procedures are performed under the guidance of skilled physicians and advanced imaging techniques. Interventional stroke specialists treat blocked arteries of the brain by removing, breaking up or even sucking out the blood clot using tiny catheters that are inserted into the groin.
- Surgical intervention: For hemorrhagic stroke, surgical treatment might be recommended to repair the ruptured blood vessel and stop the bleeding.
- Endovascular procedures, e.g., “coils”: Endovascular procedures are less invasive and involve the use of a catheter introduced through a major artery in the leg or arm. The catheter is guided to the aneurysm or abnormal blood vessel where it deposits a mechanical agent, such as a coil, to prevent a rupture.
Warning Signs and Risk Factors
If you have any of the following warning signs for stroke, call 911 immediately:
- Sudden weakness or numbness of the face, arm or leg-especially along one side of the body
- Sudden confusion
- Sudden dimness or loss of vision, particularly in one eye
- Sudden difficulty speaking or trouble understanding speech
- Sudden severe headache with no known cause
- Unexplained dizziness, unsteadiness, or sudden falls, especially with any of the other signs
Recognizing and responding to these symptoms right away could save a life – maybe even your own. Remember, call 911 immediately if you see anyone experiencing any of these symptoms, or are experiencing them yourself.
What is Public Reporting?
Public Reporting is Information that is readily available to the public regarding a health care organization’s quality and safety of care. It can help organizations improve their services, but more importantly, this information may also help educate consumers and health care purchasers in making informed choices about their health care and the procedures performed.
What are Stroke Core Measures or Quality Reports?
The Joint Commission is an organization that accredits hospitals and health care organizations across the country. They seek to continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value. Stroke quality measure reports provide an overview of how well an accredited organization or certified program is performing with stroke-specific Joint Commission requirements and standards.
What is/are GWTG?
Get With The Guidelines (GWTG)-Stroke® (GWTG-S) was developed by the American Heart Association/American Stroke Association (AHA/ASA) as a national stroke registry and performance improvement program. The primary goal of the GWTG-S® registry is to improve the quality of care and outcomes for patients hospitalized with a stroke and transient ischemic attack (TIA). The GWTG-S® registry helps achieve this goal in a variety of ways, allowing hospitals to benchmark themselves against other like facilities, stroke research, promoting stroke center certification, supporting hospital-level quality improvement initiatives and supporting the development, growth and monitoring of regional stroke systems of care.
The below procedures are commonly performed in the diagnosis, prevention and/or treatment of stroke.
Table 1: UofL Health – Jewish Hospital Primary Stroke Center Percentage of Ischemic stroke patients with successful reperfusion (grade ≥ TICI 2B) after mechanical thrombectomy.