Stroke Myths — Busted!

We see, hear and read a lot about strokes. But what do we really know about them? According to the American Heart Association, stroke is a major health problem in the United States and a leading cause of death. In 2019, stroke was the fifth leading cause of death for men and the third leading cause for women. Some of the biggest risk factors for stroke are high blood pressure, diabetes and obesity. Experts predict that the number of people with strokes will increase from 3.9% in 2020 to 6.4% by 2050, with American Indian/Alaska Native, multiracial, Black and Hispanic people likely to see the biggest increases. The good news is that up to 80% of strokes can be prevented by making healthy choices. Eating well, exercising, getting enough sleep and avoiding smoking can lower the risk.

A stroke happens when a blood vessel carrying blood and oxygen to the brain gets blocked by a clot or is bleeding into the brain. When this happens, it injures the brain and causes stroke symptoms. Without blood and the oxygen, it carries, part of the brain starts to die. Strokes can happen at any age, but nearly one-third of all strokes happen to people under age 65. Warning signs of a stroke could be clues that your brain is not getting enough blood. You and your family should learn the signs and call 911 immediately if anyone experiences any of these symptoms. Learn more about stroke warning signs to be prepared.

Myth: All strokes cause weakness in the arms or legs. Fact: While some strokes can cause weakness in the arms or legs (or both), there are times when a stroke won’t cause any weakness at all. Use the BE FAST test to recognize the symptoms.

• F = Face Drooping - Does one side of the face droop or is it numb? Ask the person to smile. Is the person’s smile uneven? Is there numbness in the face?
• A = Arm Weakness - Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward? Is there numbness in one arm or leg?
• S = Speech Difficulty - Is speech slurred, is the person unable to speak or hard to understand? Ask the person to repeat a simple sentence like, “The sky is blue.” Is the sentence repeated correctly?
• T = Time to call 911 - If the person shows any of these symptoms, even if the symptoms go away, call 911 and get them to the hospital immediately.

Myth: I should come to the Emergency Department (ED) in my car if I have signs of stroke symptoms. Fact: No! Call 911 at the first signs of a stroke. The faster you get to us, the faster we can help you. Even before a stroke patient arrives at the Emergency Department (ED), the stroke team is alerted and we are ready for you when you arrive. The emergency Medical Services (EMS) response team knows to call the ED in advance to notify us that a stroke patient is coming so we can get things in motion before they arrive. Once the patient arrives, the neurologist and the ED team meet the patient, conduct a quick evaluation and almost immediately go to the CT scan. The stroke neurologist, the ED team (including doctors and nurses) and EMS collaborate on what’s going on with the patient and the next steps in their stroke care. Time lost is brain lost. With each minute that goes by, brain cells die. While treatments can help open a blocked artery in the brain, they must be administered swiftly. The window of opportunity is limited, typically within four and a half hours. Myth: A stroke means a bleed in my head.

Fact: There are two main types of strokes – ischemic stroke and hemorrhagic stroke. An ischemic stroke, the more common type, is when blood flow to the brain is blocked for a long enough period of time to cause permanent damage. A hemorrhagic stroke is when blood leaves the blood vessels and goes into the brain tissue. Myth: Strokes are not preventable. Fact: 80% of strokes are preventable. You can help prevent a stroke by taking charge of health problems that raise risks, like high blood pressure and atrial fibrillation. Live a heart-healthy lifestyle. Eat heart-healthy foods, be active, limit alcohol, keep a healthy weight and don't smoke. Talk with your primary care provider about how to help manage your risk factors for stroke and prevent future strokes and about medicines that lower your risk. Your neurologist does not replace your primary care provider. You may need both to help manage your health. Myth: Take aspirin as soon as you identify stroke symptoms. Fact: While aspirin helps break up a clot during a heart attack, it may not always be safe or correct for stroke symptoms. It could potentially do more harm during a stroke caused by bleeding into the brain. It is not possible to determine if the cause of a stroke was a clot or bleeding into the brain without medical attention and imaging of the brain. Talk with your provider to see if you should include aspirin or other medicines in your treatment plan, but do not take aspirin if you are concerned about acute stroke symptoms. Myth: Nothing can be done for a stroke. Fact: One of the most common treatments we use to treat stroke patients is Tenecteplase (TNK). This IV medication breaks up clots in the brain that could be causing an ischemic stroke. Another intervention that we often use is mechanical thrombectomy. Our NeuroInterventional surgeons place a small wire through blood vessels in the wrist or groin and maneuver this into the brain to try to pull out the clot. The goal of each intervention is to restore blood flow to and through the brain as fast as possible. Click here to learn more about NeuroInterventional surgery. Myth: It doesn’t matter how long I wait to come to the hospital after the symptoms start. Fact: It matters! Anyone showing stroke symptoms must get to an emergency department immediately. There is a short window of treatment time (4½ hours) for clot-busting IV thrombolytic medications to be safely given. Successfully restoring blood flow to the affected area of the brain is the goal, and to do this, patients must seek care immediately. Door-to-needle time is the time from when the stroke patient arrives at an emergency department to when the neurology team gives appropriate medication to the patient. We want to treat sudden stroke patients as quickly as possible. ChristianaCare has consistently ranked among the top hospitals in the nation for the shortest door-to-needle treatment time. Myth: A stroke means a heart problem. Fact: A stroke doesn’t mean a heart problem. But strokes can be caused by a heart problem, such as atrial fibrillation. The neurology team collaborates closely with cardiologists and a heart evaluation is often part of a stroke work-up. Myth: Stroke care stops when you leave the hospital. Fact: Talk with your provider to decide the best post-discharge care plan. This plan often involves more testing to determine the cause of the stroke, including long-term heart rhythm monitoring to look for atrial fibrillation. As part of your post-discharge care, you might receive a recommendation to join an inpatient or outpatient stroke rehabilitation program. Rehab is training and therapy to help you recover, prevent problems and regain abilities. Your provider will talk with you about what you can do to prevent another stroke. You can help by taking your medicines, taking charge of other health problems and living a heart-healthy lifestyle. Myth: Once a stroke occurs, no improvement will occur. Fact: Recovery time after a stroke is different for everyone and is absolutely possible. Take an active part in your care and keep in mind that you are the most important person in your recovery. You may need:

• Physical therapy.
• Occupational therapy.
• Speech therapy.
• Acute rehabilitation.
• Skilled nursing care, followed by outpatient therapy.

Know and follow your care plan and your rehabilitation plan. At ChristianaCare, multiple departments work together in a large, multidisciplinary team to give excellent care as quickly as possible. Our team provides exceptional care with the only comprehensive stroke center in the state – offering 24/7 expertise in stroke care from neurologists, neurocritical care physicians, neurosurgeons and NeuroInterventional surgeons. As a national leader in stroke care, we are here for you whether that means emergency treatment, reducing your risk factors for stroke, or, if you have already had a stroke, we can help prevent another one from occurring. We are here and we are ready to care for you.