Stroke: When a Brain Attack Hits

Intro: This is Weekly Dose of Wellness, brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): Hello and welcome to the show. You're listening to Weekly Dose of Wellness, brought to you by MemorialCare Health System. I'm Deborah Howell, and today's guest is Dr. Nima Ramezan, Medical Director, MemorialCare Neuroscience Institute and Stroke Program, Long Beach Memorial. And he's here today to answer the question, when a brain attack hits, will you know what to do? Welcome, Dr. Ramezan.

Nima Ramezan, MD: Thank you for having me on the show today.

Deborah Howell (Host): It's our pleasure. You sometimes refer to stroke as a brain attack. Can you tell us your definition of a stroke?

Nima Ramezan, MD: A stroke is a loss of function in part of the brain. So how it's called a brain attack is that it is like a heart attack, but because the brain functions differently than the heart and has different functions in the body, such as movement, speaking, balance, it's a sudden loss of any of these functions. For example, a part of the brain that controls your movement of your left side of your body, if it suddenly has either lack of blood or some kind of a process where there's bleeding in the brain, this results in a loss of that function and that's why it's called a brain attack. And it's actually quite fast. In most instances, a stroke happens suddenly. It's infrequent that it comes and goes. It happens at the onset and you have the possibly maximum symptoms right at the onset of it.

Deborah Howell (Host): Okay. And what are the symptoms of stroke when you're having one?

Nima Ramezan, MD: So as I said, the brain's function involves movement, sensation, having the feeling of something on one side when somebody touches you, ability to speak, ability to understand, ability to see objects out in the environment, as well as your balance. So when the part of the brain that controls, for example, left-sided weakness, left-sided movement, and that gets injured, that results in one side of the body not moving or one side of the body not feeling what it's supposed to be, or suddenly the balance comes off, or typically patients say I lost vision on my left side, and that's another symptom. And language is also an important part where speaking and understanding. So somebody who would be perfectly talking at one point and suddenly their speech gets affected, either becomes slurry or like having moth balls in your mouth, or sometimes it happens where you just can't get the words out or can't understand anything somebody tells you. Sometimes there's just a subtle facial droop. But again, it's a sudden onset of symptoms in part of the brain where it's affected. And these are the typical symptoms.

Deborah Howell (Host): Okay. So that's for the person who's having the stroke. For someone trying to determine if someone else is having a stroke, there's something called FAST. Maybe you could go over that for us.

Nima Ramezan, MD: Right. So this is a quick way of evaluating somebody who's having stroke symptoms, and FAST stands for F for the face, A for the arm, S for the speech, and T for time. And as I said, there's more symptoms, but this is a quick way of trying to assess if somebody's having stroke symptoms. And again you get a sudden onset of the face becoming asymmetric or not moving right. The arm or the legs, but arms can be more commonly affected, where the arm is weak and it's not moving. Speech gets affected. And time is important because any minute wasted could be potentially worsening of this injury to the brain. So the word FAST, I think it is a good representative for somebody to understand what's happening and that it's an emergency, and 911 should be contacted.

Deborah Howell (Host): Okay. Now that's a stroke. Now, what is a transient ischemic attack, or TIA, and how is that different from a stroke?

Nima Ramezan, MD: So there are two types of, we can generally categorize strokes in two categories. One is ischemic stroke, where there's a blockage in an artery in the brain, and the second type is a hemorrhagic stroke, where there's bleeding in part of the brain. And each of these again, depending on what part of the brain gets involved, it gives you specific type of symptoms as we talked about a little earlier. Now, a transient ischemic attack goes more along with what an ischemic stroke is. So in ischemic stroke you have an artery in the brain that gets blocked from a blood clot, either from the blood clot in the brain or somewhere lower where it floats up into that artery in the brain. And that results in these neurologic symptoms. In a TIA, most of the times TIAs last less than an hour, although by definition it's up to 24 hours. These symptoms resolve. So the artery gets temporarily blocked, but then it opens up on its own, or it was a small area where the symptoms reversed rather quickly. And as a result of that, the person who's having these symptoms returns back to their normal baseline. So in a way it's actually a warning sign that a stroke may be happening. But for that person who had them, the symptoms are already reversed and they're back to normal. And this is actually a very important topic because this is where damage has not occurred permanently. So it's a very good time to intervene to prevent it.

Deborah Howell (Host): Okay, so if you have a TIA, you certainly need to go to your doctor to determine what caused it and how you can prevent another one.

Nima Ramezan, MD: Yes, that is correct. Again, these are symptoms that should be paid attention to very carefully, and the intervention can be life saving, or prevent significant disability.

Deborah Howell (Host): All right, we touched on this, but let's get more into it. Why is it so important to act fast?

Nima Ramezan, MD: So in both settings, in both the ischemic stroke and hemorrhagic stroke, the time of identifying the symptoms, time to identify what kind of stroke has happened, remains really critical. So if a patient who has been evaluated quickly after the onset of these symptoms, potential interventions can be done. For ischemic stroke where an artery is blocked, we have FDA approved therapies, what we call clot busting medicine, where they can be given through an IV and they can potentially break up that blood clot that's blocking that artery, and that can cause improvement of the symptoms either quickly or over the long term. So it becomes really important that if the signs and symptoms are there, it gets paid attention to, and on an emergent basis be evaluated. Because we have treatments, and these clot bustings usually given within the first three hours. So if it's past that time, a person may not be an eligible candidate, although not everybody's eligible for this medicine. And in some places it can be extended a little bit longer, up to four and a half hours. Although the three hour window remains the FDA approved therapy at this point.

Deborah Howell (Host): Okay, great. Now, Dr. Ramezan, what are the risk factors for a stroke?

Nima Ramezan, MD: So how I would describe this is that we have two types of risk factors. One is what we call modifiable risk factors, and the other one, I think we can call non-modifiable risk factors. The non-modifiable risk factors are, for example, aging, genetics, family history of a stroke. These are risk factors that a person can't do to change things. However, we have a significant list of modifiable risk factors. And these are the ones that can potentially be affected that can truly reduce the risk of stroke. And these risk factors include hypertension, high cholesterol, smoking cessation, and atrial fibrillation. So all these are factors that really, even in a person who has the non-modifiable risk factors, if these factors are addressed adequately and correctly, certainly the risk of the stroke can be significantly reduced and prevented from ever happening.

Deborah Howell (Host): Okay, well, that's good news. Now, can you tell me a little bit about some of the innovative ways that Long Beach Memorial is treating stroke patients?

Nima Ramezan, MD: Sure. So Long Beach Memorial is a primary stroke center. In that, patients who have had signs and symptoms of a stroke out where they are, are brought to us as a receiving center. And we have a team on standby, which includes the emergency room team, as well as a neurologist on call, who's able to get on top of the symptoms that are presenting and quickly treat the patient. So if a patient who's had these symptoms are brought to our hospital, a team rapidly evaluates them and a decision is made to treat them for their symptoms, either ischemic stroke or hemorrhagic stroke. In addition, we have a neuro-interventional neuroradiology who in cases where the treatment needs more advanced care, we have the availability to treat the patients who need these advanced treatments, and this is done through our department of neuro-interventional neuroradiology. So we provide a more comprehensive approach in treating a stroke patient in providing everything from the emergency initial treatment paradigms, going into more advanced care as well as further going into the rehabilitation needs of the patient after the symptoms have occurred, and to try to maximize recovery in the long term.

Deborah Howell (Host): All right, excellent information. Now my last question for you is if someone is interested in getting more information on the stroke program at Long Beach Memorial, who can they call?

Nima Ramezan, MD: So the hospital obviously has resources, and this can be found through our website at memorialcare.org, and that would be a great option and appropriate resources are available in the hospital so they can contact us. However, I think it's very important that if there are signs and symptoms of a stroke, this is the time to actually call 911 and be rushed to the hospital. Because I think the first few hours are the golden hours, which has been described by stroke neurologists, and that becomes really critical in trying to address the symptoms.

Deborah Howell (Host): All right. Time is memory. Thank you so much, Dr. Ramezan. It's been wonderful to have you on the program today.

Nima Ramezan, MD: Thank you for having me on the program.

Deborah Howell (Host): Our pleasure. To listen to the podcast or for more info, please visit memorialcare.org. That's memorialcare.org. I'm Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness brought to you by MemorialCare Health System. Have a fantastic day.