Joey Gee, D.O., a stroke and headache specialist at Mission Hospital, recently saw a patient who came to the ER with stroke symptoms. “The individual was at home when she began having difficulty talking and using one arm and leg,” he says. “She called 911 and an ambulance brought her to the hospital.” Determining that she was suffering from an ischemic stroke, Dr. Gee administered TPA, or tissue plasminogen activator, an FDA-approved medication that breaks up blood clots.
Luckily, this patient took exactly the right action by calling 911—it meant she received treatment that halted the effect of the stroke on her brain cells, and increased her chances of recovery. Although recovering from a stroke depends on many factors, getting to the hospital as soon as possible is high on that list.
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“With an ischemic stroke, there is blockage of an artery and a portion of brain is not receiving adequate blood—so cells start to die,” explains Gee. “It doesn’t take a long time. Millions of cells are at risk of cell death.” Yet the symptoms of an ischemic stroke are sometimes painless, and thus easy to shrug off: “Changes in facial appearance, weakness, paralysis, one side of the body losing sensation or [experiencing] impairment, the way eyes appear, slurred speech,” says Gee. “Without pain or discomfort, many individuals may not react quickly. They’ll think it will just go away or they just want to wait and see.”
Recognizing stroke symptoms is critical. The other kind of stroke, called hemorrhagic, happens when blood begins to leak from a weakened artery into the brain. Its hallmark symptom is a blindingly painful headache. “With hemorrhagic stroke there is a greater risk of mortality,” says Gee. Treatment includes stabilizing the patient’s vital signs and possibly surgery to stop the bleeding.
Clearing the blockage
CAT and MRI imaging can help doctors assess the stroke and decide the next step in treatment, such as removing a clot.
“Blockage that occurs in a large vessel may not cleared with TPA alone,” explains Gee. “For many years stent retrieval intervention has been done—a catheter is fed to the area that is blocked, with a loop of wire that can evacuate the clot through the artery. This allows greater recovery.”
Where the stroke takes place in the brain is a key factor in how the brain is affected and chances of recovery.
“Smaller strokes that take place in the small arteries of brain that we see in the older population can be very devastating,” says Gee. “When they hit deep in the brain they can cause a significant degree of neurological symptoms and we can’t do our interventions.”
One positive point about stroke treatment is that rehabilitation in the form of speech and physical therapies can make a real difference in stroke recovery. “It’s a must,” says Gee. “The brain is an ever-changing, very dynamic organ. Different pathways in the brain can be created by rehabilitation. We work hard on rehab for the patient to regain strength and speech. If you don’t do rehabilitation the disabilities may last longer,” he says, adding that rehab is often started the same day the patient comes into the ER.