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Joseph M. Leahy, D.O.Medical Director, Emergency DepartmentSouthern New Hampshire Medical Center
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What exactly is a stroke?
Rapidly developing loss of brain function due to a disturbance in the blood supply to the brain.
Two types of strokeIschemic – lack of blood flow – usually from a clotHemorrhagic – ruptured blood vessel
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What’s the Difference?Hemorrhagic Ischemic
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Anatomy
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Frontal Lobe DeficitsParalysisInability to sequence a task (making a cup of coffee)Personality changesDifficulty with problem solvingChanges in social behaviorInability to express language
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Parietal Lobe DeficitsInability to name an objectDifficulty readingDifficulty with hand‐eye coordinationDifficulty drawing objects
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Temporal Lobe DeficitsDifficulty recognizing facesDifficulty understanding spoken wordsShort‐term memory lossDifficulty with long term memoryIncreased aggressive behaviorIncreased or decreased interest in sexual behavior
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Occipital Lobe DeficitsVisual changes
Visual field changesColor recognitionDifficulty recognizing drawn objectsDifficulty reading and writing
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Cerebellar Deficits
Coordination problemsDizzinessInability to walkInability to reach out and grab objects
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Blood Flow
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SymptomsSudden weakness or numbness to face, arm, or legSudden confusionTrouble speakingTrouble seeingTrouble walkingLoss of balance
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Recognizing StrokeCincinnati Prehospital Stroke Scale
Ask person to smile – look for facial droop
Ask person to raise both arms
Ask person to speak a simple sentence
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Call911
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“We’re not in Kansas anymore…”Oxygen, IV’s, Blood work, “When did this start?”
Neuro exam
CT scan of Head – Rapid transport
Notification of Stroke team
Repeat Neuro exam – NIH stroke scale
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Hemorrhagic StrokeCall Neurosurgeon
Control Blood Pressure
Reverse blood thinner
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Ischemic (Blood Clot) StrokeNeurology ConsultEstablish onset of symptoms – 3 hour windowConsider “Clot Busting” medicine (TPA)
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NINDS Study624 ischemic stroke patients enrolledCompared TPA to PlaceboTreatment within 3 hours of symptom onsetResults:
At 3 months, TPA treated patients 30% more likely to have minimal or no neurologic deficits11‐13% overall increased favorable outcome
*TPA group did have increased rate of bleeding in the brain (6.4% vs. 0.6%)
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Criteria for TPAAge > 18Time of onset < 3 hoursNo improving symptomsNo surgery within preceeding 14 daysBlood pressure controlled ( < 185 / 110)No Previous stroke (within 90 days)No GI/GU bleeding (within 21 days)No seizure
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SNHMC Telestroke Program
Partnership with Massachusetts General Hospital
Telemedicine has become an accepted standard of care
Allows for bedside consultation with an MGH neurologist and neuroradiologist
Critical decisions made with world class support
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Stroke Risk FactorsHigh Blood PressureAtrial FibrillationHigh CholesterolDiabetesCigarette SmokingHeavy Alcohol ConsumptionLack of Physical ActivityUnhealthy Diet