St. Joseph Hospital of Orange
1100 West Stewart Dr, Orange, CA 92868714.633.9111
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Stroke

About 700,000 Americans will have a stroke this year—that's one person every 45 seconds. Fortunately, you can reduce your chance of suffering a stroke by gaining a greater understanding of how this condition occurs and by identifying common risk factors and symptoms.

Risk Factors

Some factors that increase your risk of stroke are genetically determined. Others simply happen naturally or are due to lifestyle. The factors resulting from heredity or natural processes can't be changed, but those that are environmental can be modified with the help of our comprehensive approach to vascular care.

The five uncontrollable risk factors include:

  • Age
  • Male
  • African American heritage
  • Family history of diabetes
  • Family history of stroke

The basic controllable risk factors include:

  • Treatable medical disorders, such as: diabetes, atrial fibrillation, heart attack, high blood pressure, high cholesterol, heart disease, personal history of stroke or transient ischemic attacks (TIAs), and patent foramen ovale (or "PFO," an abnormal opening between the right and left sides of the heart)
  • Smoking
  • Excessive alcohol intake
  • Obesity
  • Drug abuse (especially cocaine)
  • Physical inactivity
  • Low estrogen in women

The risk of stroke is greatly reduced by lowering your blood pressure, smoking cessation, beginning or increasing exercise, controlling medical problems, maintaining optimal weight and eating a healthy diet.

Symptoms

The warning signs of a major stroke include:

  • Sudden weakness or clumsiness (occasionally with numbness) of the face, arm or leg on one side of the body
  • Loss of speech, or difficulty speaking (e.g., garbled words)
  • Acute dimness or loss of vision in one eye – often described as a shade coming down over the field of vision in one eye

"Temporary strokes" (transient ischemic attacks or TIAs) can occur days, weeks or even months before a major permanent stroke. The symptoms occur rapidly and last a relatively short period of time, usually from a few minutes to several hours. The usual symptoms are like those of a major stroke, except that the signs and symptoms are temporary, typically lasting 24 hours or less. If you experience a TIA, you may be up to nine times more likely to suffer a major stroke in the near future.

Screening and Diagnosis

Assessing your risk level is an important step that you can take to prevent a stroke. The St. Joseph Hospital Heart and Vascular Center offers a comprehensive screening program to help you obtain this critical information. Screenings include a medical history, physical examination and blood tests to check for high cholesterol or other conditions that may contribute to atherosclerosis. An ultrasound examination of your carotid arteries, the blood vessels in your neck that are the primary blood supply to the brain, will also be performed to determine if there is significant disease (e.g., atherosclerosis). An ultrasound is a non-invasive examination that uses ultrasound waves, instead of X-rays, to visualize the neck and other peripheral arteries.

Treatment

The most important new development for treatment of ischemic stroke (caused by narrowing of a blood vessel or blood clot) is thrombolytic drugs (so-called “clot-busters”). These drugs allow for the blood clot to be dissolved in the cerebral arteries and allow flow to the portion of the brain that is being deprived of oxygen rich blood. Intravenous thrombolytic drugs may be given in the Emergency Room as a first line treatment for stroke patients, after confirmation by a CT scan and if a patient does not have any contraindications to the treatment. In addition or alone, thrombolytic drugs can be given directly into the cerebral artery that is blocked. This procedure is performed in the Interventional Radiology department, following a cerebral angiogram dye study. Immediate improvement in the symptoms of a stroke can be seen after the thrombolytic medication is administered into the artery and lower doses of the medication reduce the risk of intracranial bleeding.

The Interventional Radiology department uses two new techniques that remove blood clots mechanically:

  • Merci Retrieval System. This is a catheter system that looks like a tiny corkscrew. The Merci Retrieval System is guided by the Interventional Radiologist directly into the cerebral blood clot, then is pulled back to remove the clot. The goal of treatment is to have intervention within two to six hours of witnessed onset of symptoms.
  • Penumbra System. The Penumbra System is a package of tools used to remove clots from the large vessels of the brain that are causing a stroke. It works on the proximal surface of the clot, optimizing safety and eliminating the need for navigation beyond the clot. The Penumbra System allows clots to be gently aspirated out of intracranial vessels.

Outcomes

St. Joseph Hospital follows the expertise for stroke treatment and timely intervention as set by the American Heart Association (AHA)/ American Stroke Association’s (ASA) “Get with the Guidelines” and Brain Attack Coalition. The goal is to have early recognition of symptoms and detection of stroke by care givers and health care workers to enable timely treatment by either thrombolytic or mechanical extraction methods. We are currently working in collaboration with the Emergency Department, Respiratory Therapy, CT department, Intensive Care staff, Physical Therapy/Rehabilitation and Neurology physicians to provide timely quality care in the treatment and rehabilitation of our stroke patients.