Stroke

When it comes to stroke, every second counts. Time lost is brain lost, so getting the right care at the right time is essential. At Indiana University Health Neuroscience, a dedicated stroke team is available 24 hours a day. Our doctors use the latest technology to quickly evaluate patients and diagnose stroke. And our specialized expertise and advanced treatment options give people the best shot at recovery from stroke. The Indiana University Health Neuro Critical Care Unit is one of the largest in the country and provides care to more than 150 patients postoperatively. From prevention through treatment and recovery, IU Health Neuroscience provides the most experienced doctors and the latest diagnostic tools, techniques and treatments for exceptional stroke care.

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1. Primary Stroke Center Certification 4. Stroke Treatments
2. Types of Stroke 5. Neuro-Critical Care Unit
3. Stroke Signs and Symptoms 6. Stroke Knowledge and Prevention
   

Primary Stroke Center Certification

The IU Health Neuroscience stroke specialists have extensive experience, treating nearly 1,000 patients each year at its downtown Indianapolis facilities. This experience is a major factor behind why IU Health Neuroscience is a designated Primary Stroke Center. This certification, awarded by The Joint Commission, is given only to medical facilities that make exceptional efforts to improve stroke care. Research shows people who receive comprehensive care at a Primary Stroke Center have better outcomes and more complete recoveries.

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Types of Stroke

It is important to know which type of stroke a patient is experiencing in order to provide the most efficient and effective treatment. There are three types of stroke:

Ischemic stroke, the most common type of stroke, happens when a clot blocks one of the blood vessels carrying the oxygen to the brain.

Hemorrhagic stroke occurs when a weakened blood vessel bursts and bleeds into the brain. There are two kinds of hemorrhagic stroke:

  • Subarachnoid hemorrhage, bleeding in the space between the brain and the thin tissues that cover the brain. This kind of stroke is usually caused by head trauma, a ruptured aneurysm, or an arteriovenous malformation (AVM).
  • Intracerebral hemorrhage, when a blood vessel in the brain bursts and spills into surrounding tissue. High blood pressure is the leading risk factor for this kind of stroke.

Transient ischemic attack (TIA), or mini stroke, occurs when blood flow is cut off for a short period of time. A TIA requires medical care, as it is often a warning sign that a more serious stroke may be coming.

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Stroke Signs and Symptoms

Because time is of the essence when it comes to stroke, it is important to recognize the signs and symptoms of stroke. Symptoms are similar for all three kinds of stroke and may include:

  • Sudden numbness or weakness of the face, arm or leg – especially on one side of the body
  • Sudden confusion, or trouble speaking or understanding
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, or loss of balance or coordination
  • Sudden severe headaches with no known cause

If you or someone you love experiences symptoms of a stroke, call 911 immediately—even if the symptoms go away after a few minutes. The faster a stroke is diagnosed, the sooner treatment can begin and the less permanent damage there will be.

Diagnosing Stroke

Diagnosing any kind of stroke requires a rapid response and sophisticated imaging equipment. At IU Health Neuroscience, the Stroke 1 team is ready even before a patient enters the emergency department. If a stroke is suspected, the paramedics will alert the emergency department en route so doctors and nurses can begin treatment as soon as the patient arrives.

To accurately diagnose a stroke, specialists at IU Health Neuroscience use the most sophisticated diagnostic and imaging tools, including:

  • MRI
  • CT scans
  • Vascular CT, MR and catheter angiograms (non-invasive tests for examining the blood vessels)
  • CT and MR perfusion studies (to examine cerebral blood flow)
  • Carotid ultrasound (for examination of the carotid arteries)
  • Nuclear medicine imaging
  • Transthoracic and transesophageal echocardiogram (to determine if there is an abnormality with the heart that could lead to stroke)

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Stroke Treatments

Our multidisciplinary team of neurologists, neurosurgeons, emergency medicine doctors and neuroradiologists provides the latest treatment options to people experiencing ischemic stroke, hemorrhagic stroke and TIA. IU Health Neuroscience provides sophisticated treatments for each type of stroke.

Ischemic Stroke Treatments

Treatment for ischemic stroke focuses on removing or dissolving the clot blocking blood flow to the brain. At IU Health Neuroscience, treatments for ischemic stroke include:

Intravenous TPA

For ischemic stroke, physicians may start giving tissue plasminogen activator, or tPA. This medicine is administered via an IV and can dissolve the clot causing the stroke. Studies show people who receive tPA within the first three hours of a stroke have better and more complete recoveries. IU Health Neuroscience has an above-average tPA treatment rate, meaning eligible stroke patients are more likely to receive this important, time-critical treatment.

Intra-Arterial Treatment

In order to treat more stroke patients, IU Health Neuroscience can also inject tPA directly into a clot with catheters. This can dissolve a clot faster than giving the drug through an IV. This new treatment may expand the window for tPA treatment beyond the current three hours and help more people recover from stroke.

Clot Retrieval via Mechanical Embolectomy

Because not all stroke patients are candidates for tPA, IU Health Neuroscience provides another leading-edge treatment called endovascular clot retrieval. In this sophisticated procedure, neurosurgeons use catheters and a tiny clot-retrieval device to capture and remove a clot, thereby restoring blood flow to the brain.

Carotid Endarterectomy

The carotid arteries run up each side of the neck and are the main arteries bringing blood and oxygen to the brain. People are at high risk for stroke if those arteries become blocked or narrowed because of plaque buildup. Carotid endarterectomy is a delicate and complex procedure in which surgeons remove plaque that has built up inside the carotid arteries. Carotid endarterectomy can help prevent strokes by restoring and improving blood flow in the carotid arteries.

Carotid Stenting

In this minimally invasive procedure, interventional neuroradiologists use stents to prop open a carotid artery that needs better blood flow. Carotid stenting can be a treatment option for people who are not good candidates for endarterectomy. IU Health Neuroscience was one of the first hospitals in the area to perform this procedure.

Hemorrhagic Stroke Treatments

Treatments for hemorrhagic stroke focus on repairing the cause of bleeding, relieving pressure on the brain and managing symptoms. Ruptured aneurysm and AVM are the main causes of hemorrhagic stroke. The highly skilled experts at IU Health Neuroscience provide sophisticated treatment options for both aneurysm and AVM, including:

Treatment of Aneurysm

Coil embolization: To treat an aneurysm, neurosurgeons at IU Health Neuroscience thread a tiny, soft metal coil directly into the aneurysm. Once in place, the coil is released and blocks the blood supply to the aneurysm, which helps to prevent stroke.

Surgical clipping: Clipping is a surgical procedure used to cut off an aneurysm's blood supply before it ruptures, and is an effective treatment for preventing future stroke. In this procedure, neurosurgeons make a small opening in the skull and place a tiny clip at the base of the aneurysm. The clip blocks blood from entering the aneurysm, which can prevent a rupture and cause the aneurysm to shrink. IU Health Neuroscience was one of the first in the nation to use a breakthrough fluorescence technology called INFRARED 800 to improve outcomes in surgical clipping. This technology allows any problems with the clips to be immediately identified and corrected, providing physicians with a higher degree of certainty for fewer complications. 

Treatment of AVM

Endovascular embolization: This less-invasive procedure can be a good option for treating an AVM deep in the brain. In endovascular embolization, interventional neuroradiologists insert a catheter into an artery in the groin and then thread it up into the brain. The catheter delivers a glue-like substance into the AVM, blocking its blood flow and causing it to shrink. Sometimes, endovascular embolization is the only treatment necessary. Other times, it is used in conjunction with another treatment.

Stereotactic radiosurgery: This is a non-invasive treatment that uses targeted radiation to shrink the AVM. Our radiation oncologists and neurosurgeons use 3D images of the brain to help them deliver very high doses of radiation directly to the AVM. The radiation causes scar tissue to form around the AVM, blocking its blood supply, while leaving the surrounding healthy tissue intact. 

Surgical removal: This treatment may be recommended if the AVM is bleeding or in an easily reachable area of the brain. During surgery, our expert neurosurgeons clip the vessels that feed the AVM—cutting off its blood supply—and then remove it. In some patients, endovascular embolization is used before surgery to shrink the AVM, which can increase likelihood of successful removal.

Transient Ischemic Attack Treatments

A transient ischemic attack (TIA) should be taken just as seriously as a stroke. About one-third of people who have a TIA will later have a more severe stroke. Treatment for TIA depends on a person's risk factors and the results of a thorough examination by the stroke experts at IU Health Neuroscience. Our doctors may recommend medication or surgery to reduce the risk of future stroke.

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Neuro-Critical Care Unit

After treatment, all stroke patients are cared for in our neuro-critical care unit, the largest such adult unit in the country. There, neurosurgeons and critical-care specialists provide around-the-clock monitoring and treatment, using the latest and most advanced technology.

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Stroke and Prevention

Know Your Risk Factors

Stroke is the #1 cause of disability and the third leading cause of death in the United States. In fact, nearly 800,000 Americans suffer a stroke each year, which is about one stroke every minute. And stroke can affect people of all ages and races. The good news is many strokes are preventable. Yet, many people do not know they are at risk for stroke. The first step in lowering your risk is understanding the factors that can contribute to stroke.

There are many factors that can increase your risk of having a stroke. Some of the factors, like age, cannot be changed because they are beyond your control. Other risk factors are ones you can change.

Uncontrollable Risk Factors

  • Race: Hispanics and African-Americans are at greatest risk
  • Age: Stroke happens more often in people over 55 years of age
  • Gender: Males are at slightly greater risk than females
  • Genetics: Family history of stroke

Controllable Risk Factors

  • High blood pressure
  • Smoking
  • Diabetes
  • High cholesterol
  • Atrial fibrillation
  • Weight
  • Sedentary lifestyle
  • Alcohol consumption
  • Stress

Lower Your Risk

IU Health Neuroscience recommends people follow these guidelines from the National Stroke Association to lower your risk for stroke:

Reduce your blood pressure

High blood pressure is the #1 risk factor for stroke; therefore, it is important to know your blood pressure and work with your doctor to keep in a healthy range. Blood pressure is measured by two numbers. The top number is the systolic pressure. The bottom number is the diastolic pressure. High blood pressure is defined as two consecutive measurements in which the systolic pressure is greater than 140 or the diastolic pressure is greater than 90. If you have diabetes, the defining numbers will be even lower: systolic 130 or diastolic 85. You can often lower your blood pressure by increasing physical activity, losing weight if needed and decreasing your salt intake. If you take medication for your blood pressure, never stop taking it without talking to your healthcare provider.

Find out if you have atrial fibrillation

Atrial fibrillation is an irregular heartbeat that can cause blood to pool in parts of your heart. This blood can form clots and cause a stroke. At IU Health, doctors can often tell if you have atrial fibrillation by checking your pulse, or running medical tests, such as an electrocardiogram (ECG). If you have atrial fibrillation, your doctor may prescribe medications to help lower your risk for stroke.

Quit smoking

Smoking doubles the risk for stroke; therefore, not smoking is one of the best things you can do to reduce your risk. Your healthcare provider can prescribe medications that will assist in quitting. Indiana University Health offers an extensive tobacco cessation program through the IU Health Tobacco Control Center that will provide you with the help and support you need to be successful. For information on smoking cessation, call 317.962.9662.

Drink alcohol in moderation

Studies have shown that limiting how much alcohol you drink is beneficial to your health. Moderate consumption is not more than one drink a day for women or two drinks a day for men. If you have difficulty keeping your alcohol consumption to the recommended limit, please talk to your healthcare provider.

Reduce your cholesterol

Lowering your cholesterol may reduce your risk for stroke. Too much cholesterol causes fatty deposits called plaque to build up on artery walls. Plaque on the walls of your arteries can decrease blood flow and cause a stroke. Work with your doctor to keep your total cholesterol less than 200mg/dL. Your "good cholesterol" (HDL) should be above 60mg/dL and your "bad cholesterol" (LDL) should be below 100mg/dL to decrease your chances of having a stroke.

Manage your diabetes

Having diabetes increases your risk of stroke. Thus, if you have diabetes, it is important that you follow the treatment plan your healthcare provider recommends. Be sure to follow the proper diet, check your blood sugar regularly and take your medication as you have been advised. If you have questions, ask your healthcare provider for a referral to a diabetes educator.

Exercise daily

A little exercise each day may reduce your risk of stroke. If you get at least 30 minutes of physical activity on most days, it can greatly improve your health. The activity does not need to be strenuous; anything that gets you moving around and your heart pumping a little faster will work. Of course, you should check with your healthcare provider before starting any new physical activity program. Begin by trying these activities:

  • Walking
  • Bicycling
  • Gardening
  • Cleaning the house
  • Playing with children

In addition to potentially lowering your risk of stroke, becoming more physically active has many advantages:

  • Improved physical fitness
  • Healthier bones, muscles and joints
  • Easier weight control
  • Lower risk of heart disease, colon cancer and diabetes
  • Improved blood pressure control
  • Improved sense of well being
  • Decreased depression
  • Decreased anxiety

Eat a lower sodium, lower fat diet

Cutting down on salt and fat in your diet can lower your blood pressure, and thereby reduce your risk of stroke. Your healthcare provider, dietitian or speech therapist may give you instructions for changes in your diet to help prevent stroke and other medical complications. The diet choices you make will affect how you feel, your general health and future health problems. Try to eat a balanced diet each day, with plenty of fruits, vegetables, whole grains and a moderate amount of protein (e.g., meat, fish, eggs, milk, nuts, tofu and some beans). Ask your doctor about nutritional resources and programs available in the community to support you.

Check for circulation problems

Blood flow problems can lead to a build-up of fatty deposits in your arteries, and this blockage can cause a stroke. Your doctor can diagnose circulation problems by listening to your arteries or taking pictures of them with special medical equipment. Treatment options include medication and surgery.

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Lonny's Story

As a church pastor, Lonny is no stranger to miracles. But he never thought he would be called one himself. Lonny was recovering from coronary artery bypass at Indiana University Health Methodist Hospital when he was suddenly unable to move his right side. Intensive care doctors called the Stroke 1 team, a dedicated group of IU Health specialists who immediately evaluated Lonny and determined he was having a stroke. An emergency procedure was performed to treat the stroke and Lonny later received comprehensive speech and movement rehabilitation, which averted a significant permanent disability.

"My doctor said if I'd been at any other hospital in the state, I wouldn't be sitting here right now," Lonny relates. As a parish priest, he believes in miracles; but he never thought he would be called a miracle.

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