The first lecture of the Navigating the Medical System Lecture Series, which focused on strokes, took place on Tuesday evening, September 12, at Congregation Etz Chaim, featuring Dr. Gary Bernardini, MD, PhD, Chief of Neurology at NewYork-Presbyterian Hospital.
Dr. Mel Breite, MD, Founder and Director of the Navigating the Medical System Lecture Series, introduced the program. He noted how, when he was in medical school many years ago, the tests for stroke and treatments for stroke did not work so well. Now there are CAT scans, MRIs, angiograms, and much more.
Dr. Bernardini shared that in 1996, when he graduated medical school, the standard treatment for stroke was aspirin and a CAT scan, and then rehabilitation. Those days are gone. Today, a lot is done to treat stroke. He stressed that getting to the hospital quickly is key to recovery. NewYork-Presbyterian/Queens Hospital is a primary stroke center. It is best to go to a primary center. Today there are devices that can actually pull out blood clots from the blood vessels in the brain. Doctors use MRIs, CAT scans, and perfusion scans to plot where the blood is going or not going. He shared that TPA (Tissue Plasminogen Activator) improves the outcome for stroke victims.
The stroke victim has a window of 4½ hours for the best treatment to work. Stroke is the fifth leading cause of death. It was the fourth in 2014. The mortality rate for stroke is a quarter of all strokes.
Ischemic stroke is the most common kind of stroke. A less typical stroke could be a bleed in the brain or a ruptured aneurism in the brain.
Dr. Bernardini then shared control risk factors for stroke. These include the following: aging, genetics (if someone in the family experienced a stroke at a young age), gender and ethnicity, sedentary lifestyle, alcohol, smoking, high blood pressure, high cholesterol, heart disease, diabetes, and obesity.
He shared that stroke can affect people of all ages. In the ER, the first test will be a CAT scan. They can do ultrasound and see the blood vessels in the brain. If the initial CAT scan shows hemorrhage but not a regular stroke after 24 hours, then the patient will receive the Tissue Plasminogen Activator treatment. Stroke is treated by opening the blood vessel. The MRI tells the doctor which areas of the brain are involved.
He explained that a small stroke is where small vessels in the brain are involved. A person with diabetes or a smoker can experience this. The patient needs to control the diabetes and blood pressure. This is treated with something equivalent to aspirin. Patients stay three to five days after a stroke for observation. If the stroke is going to enlarge, this will happen in the next 24-48 hours.
People recover from stroke because other parts of the brain take over function of the area affected by the stroke. Dr. Bernardini imparted that most of the recovery from stroke takes place in the first six months and then plateaus after that, although this really varies from patient to patient. Afterwards, stroke patients go to acute rehabilitation where they train other parts of the brain to take over.
Today there are monitors that patients can wear for years. Also, there are new blood thinners, so patients do not have to have their blood checked like they did with the blood thinners used in the past.
He emphasized that stroke is an emergency and an ambulance must be called. EMS will notify a primary stroke center ahead of time that a possible stroke patient is coming. A whole team of doctors will receive a stroke code on their cell phones. They will want to know the time of the onset of the stroke.
He shared some symptoms of stroke, which can include facial droop, slurred speech, balance difficulties, blurred vision, arm weakness, inability to walk, headache, and numbness on one side.
This informative speech was followed by a question-and-answer session.
Someone asked what to do if one is far away from civilization and stroke symptoms occur.
Dr. Bernadini shared a true story about a man he knew who was a neurologist and was upstate boating when he experienced stroke symptoms. His wife called 911 and located the nearest primary stroke center. She alerted the hospital and kept track of the time of onset of symptoms. She was able to drive him to the nearest primary stroke center.
Next, someone else asked the difference between Bell’s palsy and stroke, since both can involve numbness or a droop of one side of the face. Dr. Bernadini clarified the distinction between the two.
Someone else asked how you can prevent stroke with diet? Dr. Bernadini suggested that the Mediterranean Diet is good, which includes olive oil.
By Susie Garber