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KNOW STROKE KNOW STROKE

Community Outreach & Education • Martha Power FNP-C • Tanya Smith FNP-BC • Angela Community Outreach & Education • Martha Power FNP-C • Tanya Smith FNP-BC • Angela J. Schaffer RN

Be Stroke Smart Reduce: stroke risk Recognize: stroke symptoms Respond: at the first sign Be Stroke Smart Reduce: stroke risk Recognize: stroke symptoms Respond: at the first sign of stroke, Call 911 immediately!

Why people don’t respond to stroke symptoms • Don’t recognize • • • symptoms Why people don’t respond to stroke symptoms • Don’t recognize • • • symptoms Denial Think nothing can be done Worry about cost Think symptoms will go away Fear or don’t trust hospitals

Perceptions of Stroke Myths Reality • Stroke is not • Up to 80% percent Perceptions of Stroke Myths Reality • Stroke is not • Up to 80% percent of • • • preventable Stroke cannot be treated Stroke only strikes the elderly Stroke happens in the heart Stroke recovery ends after 6 months • • • strokes are preventable Stroke requires emergency treatment Anyone can have a stroke Stroke is a “Brain Attack” Stroke recovery can last a lifetime

Stroke Facts • A leading cause of death in the United States • 795, Stroke Facts • A leading cause of death in the United States • 795, 000 Americans suffer strokes each year • 134, 000 deaths each year -From 1996 to 2006 stroke deaths fell by 18. 4% • 6, 400, 000 stroke survivors

Stroke Facts • A leading cause of adult disability • Up to 80% of Stroke Facts • A leading cause of adult disability • Up to 80% of all strokes are preventable through risk factor management • On average, someone suffers a stroke every 40 seconds in America

The Cost of Stroke • The estimated direct and indirect cost of stroke was The Cost of Stroke • The estimated direct and indirect cost of stroke was 73. 7 billion in 2010 • The mean lifetime cost of ischemic stroke person is about $140, 048 in America

Types of Stroke • T. I. A. • Ischemic • Hemorrhagic Types of Stroke • T. I. A. • Ischemic • Hemorrhagic

Transient Ischemic Attacks • Warning Strokes or “mini • • • strokes” Blood clot, Transient Ischemic Attacks • Warning Strokes or “mini • • • strokes” Blood clot, vasospasm, etc. Occurs for a short time Symptoms resolve in 1 -24 hours Indicates possible major stroke in the future 1 in 9 will have stroke within 3 months

Ischemic Stroke Caused by a blocked blood vessel in the brain 8 out of Ischemic Stroke Caused by a blocked blood vessel in the brain 8 out of 10 Strokes are ischemic

Risk Factors for Ischemic Stroke • • • Hypertension Diabetes Heart Disease Smoking High Risk Factors for Ischemic Stroke • • • Hypertension Diabetes Heart Disease Smoking High Cholesterol Atrial Fibrilation History of previous stroke Age Obesity Poor Diet Lack of exercise

Ischemic Stroke Symptoms • • CALL 911! • • Facial Droop Slurred Speech, dysarthria Ischemic Stroke Symptoms • • CALL 911! • • Facial Droop Slurred Speech, dysarthria Difficulty swallowing, dysphagia Expressive or receptive aphasia Gaze preference Weakness, numbness, loss of sensation Symptoms on one side of the face or body Visual changes or loss of part or all of vision Confusion Reduced or loss of consciousness Vertigo, dizziness, ataxia Nystagmus (wiggling eyes)

t-PA, the “Clot Buster” • t-PA is recommended for • • • treatment of t-PA, the “Clot Buster” • t-PA is recommended for • • • treatment of ischemic stroke in selected patients However, t-PA is only administered to less than 3% of ischemic stroke patients Delay in seeking medical care contributes significantly to underutilization of t-PA for stroke. Extending time window for t. PA administration beyond the current recommended 3 hrs might be beneficial.

t-PA Recommendations • t-PA should be administered to eligible patients within 3. 0 -4. t-PA Recommendations • t-PA should be administered to eligible patients within 3. 0 -4. 5 hours after stroke • Eligibility criteria in this time period are similar to those for persons treated at earlier time periods with the following additional exclusion criteria: – Age > 80 years; Oral anticoagulant use with INR ≤ 1. 7*; baseline NIH Stroke Scale score > 25; a history of stroke and diabetes (*For the 3. 0 – 4. 5 hr window all pts receiving oral anticoagulant are excluded whatever their INR). • 3/16/2018© 2009, American Heart Association. All rights reserved. Information from the Expansion of the Time Window for Treatment of Acute Ischemic Stroke with IV TPA – Science Advisory

Merci Clot Retrieval Device Meri Clot Removal Video 1: 10 http: //youtu. be/MGX 7 Merci Clot Retrieval Device Meri Clot Removal Video 1: 10 http: //youtu. be/MGX 7 deu. Fkhc

Penumbra Device and Restored Cerebral Circulation Penumbra Clot Retrival Video 1: 45 http: //youtu. Penumbra Device and Restored Cerebral Circulation Penumbra Clot Retrival Video 1: 45 http: //youtu. be/lyfz. Ngr. VOOk

Solitaire Revascularization Device Video 1: 43 http: //youtu. be/0 DQPD 5 TTS 5 Y Solitaire Revascularization Device Video 1: 43 http: //youtu. be/0 DQPD 5 TTS 5 Y The Latest in Neurointerventional Radiology

Brain Attack! • Stroke is a “Brain Attack. ” • Stroke happens in the Brain Attack! • Stroke is a “Brain Attack. ” • Stroke happens in the brain not the heart • Stroke is an emergency. Call 911 for emergency treatment.

Carotid Artery Stent Carotidendarterectomy Carotid Artery Stent Carotidendarterectomy

Case Study • A 59 year old male working at his desk. • He Case Study • A 59 year old male working at his desk. • He sends a coworker an email that does not make sense. • He is confused, has a left facial droop, and his left arm and leg are weak. • He is on Coumadin for an irregular heart rhythm. He has no other medical history. • He says, “I am not going to the hospital, because they can’t do anything for me. ” What do you do?

Case Study Continued… • You call 911 and your coworker is rushed to a Case Study Continued… • You call 911 and your coworker is rushed to a Primary Stroke Center Emergency Department • The Stroke Team meets him at the door, and after imaging, diagnose him with an acute R MCA stroke with a large penumbra.

Case Study Continued… • He takes Coumadin for Atrial Fibrilation, but a blood test Case Study Continued… • He takes Coumadin for Atrial Fibrilation, but a blood test and the fact that he arrived so soon after onset of his symptoms, meets criteria for him to receive t. PA, the “clot busting” medication for stroke. • His stroke symptoms completely resolve with the t. PA. • When he returns to work without any neurological deficits, he Thanks You for calling an ambulance and getting him medical treatment so quickly!

Hemorrhagic Stroke Caused by a ruptured blood vessel in the brain Hemorrhagic Stroke Caused by a ruptured blood vessel in the brain

Risk Factors for Hemorrhagic Stroke • Hypertension • Bleeding disorders • Aneurysm rupture • Risk Factors for Hemorrhagic Stroke • Hypertension • Bleeding disorders • Aneurysm rupture • Vascular malformation • Excessive alcohol use • Cocaine use

Hemorrhagic Stroke Symptoms • Focal neurological deficits • Headache, “worst headache ever” • Neck Hemorrhagic Stroke Symptoms • Focal neurological deficits • Headache, “worst headache ever” • Neck pain • Light intolerance • Nausea, vomiting • Decreased level of consciousness

Two Categories of Hemorrhagic Stroke • ICH: bleeding into brain tissue as a result Two Categories of Hemorrhagic Stroke • ICH: bleeding into brain tissue as a result of bleeding or rupture of a small, deep cortical artery that is damaged by chronic hypertension • SAH: subarachnoid hemorrhage is the result of bleeding into the subarachnoid space, most often in relation to ruptured aneurysm or AVM

Aneurysm Clipping • Performed by • • Neurosurgery Incision and removal of skull bone Aneurysm Clipping • Performed by • • Neurosurgery Incision and removal of skull bone Surgical clip prevents blood from entering aneurysm

Coiling Procedure for Aneurysm • Performed by Neurointerventional Radiologist • Catheter guided to aneurysm Coiling Procedure for Aneurysm • Performed by Neurointerventional Radiologist • Catheter guided to aneurysm site • Coil is packed into aneurysm • Blood no longer enters site • Associated with improved outcomes

Stroke Recovery • 10% of stroke survivors recover almost completely • 25% recover with Stroke Recovery • 10% of stroke survivors recover almost completely • 25% recover with minor impairments • 40% experience moderate to severe impairments requiring special care • 10% require care within either a skilled-care or other long-term care facility • 15% die shortly after the stroke

Lifestyle Changes for Survivors and Caregivers • Daily living skills • Dressing and • Lifestyle Changes for Survivors and Caregivers • Daily living skills • Dressing and • • grooming Diet, nutrition and eating difficulties Skin care problems Pain Sexuality/Intimacy • Behavior • Depression & Anger • Emotional Liability • One-sided Neglect • Memory Loss • Communication Problems

An Example of Leftsided Neglect An Example of Leftsided Neglect

Types of Stroke Rehabilitation • Physical Therapy (PT) – Walking, range of movement • Types of Stroke Rehabilitation • Physical Therapy (PT) – Walking, range of movement • Occupational Therapy (OT) – Taking care of one’s self • Speech Language Therapy – Communication skills, swallowing, cognition • Recreational Therapy – Cooking, gardening

Well Known Stroke Survivors • President Gerald Ford • Mary Kay Ash • Teddy Well Known Stroke Survivors • President Gerald Ford • Mary Kay Ash • Teddy Bruschi • Charles Schultz • Sharon Stone • Harry Caray • Della Reese • Charles Dickens • Kirk Douglas • Ed Koch • Roy Horn • of Siegfried & Roy • Ted Williams

How to Lower Your Risk for Stroke • Stop smoking • Maintain blood pressure How to Lower Your Risk for Stroke • Stop smoking • Maintain blood pressure below 140/80 • Keep cholesterol in acceptable range • Manage blood sugar if diabetic • Regular Exercise “Everything in moderation” • Low fat, low salt diet • Moderate alcohol use

Primary Stroke Care • A Dedicated Stroke Team • • Coordinates Stroke Care Neurology Primary Stroke Care • A Dedicated Stroke Team • • Coordinates Stroke Care Neurology and Neurosurgery Services 24/7 Cutting Edge Imaging (CT, MRI, etc. ) 24/7 Advanced Vascular Procedures performed by Neurointerventional Radiologists on call 24/7 Specialty Stroke Trained Nursing Care Physical Therapy, Occupational Therapy, and Speech Therapy Follow Up Care managed by Neurology Service Support Group, Education, Research, and Community Outreach Healthcare Team

Current Research Trials • SHINE • POINT • CLEAR-ER • STROKE BIOMARKERS • PEDIATRIC Current Research Trials • SHINE • POINT • CLEAR-ER • STROKE BIOMARKERS • PEDIATRIC STROKE

Stroke Support Groups Meeting for Education, Community, and Healing. Stroke Support Groups Meeting for Education, Community, and Healing.

Women & Stroke AHA/ASA Campaign to increase awareness of cardio - and neurovascular disease Women & Stroke AHA/ASA Campaign to increase awareness of cardio - and neurovascular disease in Women ~

Appalachian Stroke Network A Regional Cooperative of Healthcare Providers coming together to improve Stroke Appalachian Stroke Network A Regional Cooperative of Healthcare Providers coming together to improve Stroke Care Throughout Appalachia

ACT FAST Call 911 ACT FAST Call 911

KNOW STROKE KNOW STROKE