Stroke Program Provides Pioneering Treatment

Every 45 seconds, someone in the United States has a stroke. It is the third leading cause of death among Americans and a principal cause of long-term disability in the US. Here in Wisconsin, stroke claimed more than 3,000 victims in 2002, representing 7.4% of all deaths. Despite the prevalence of stroke, many Americans still do not realize it is a medical emergency requiring immediate action and urgent treatment.

According to the American Stroke Association, individuals who survive a stroke should receive immediate treatment from a qualified stroke center, where they can obtain a higher quality of care more quickly with fewer complications - treatment that can help them return to a normal life. That is where the Froedtert & The Medical College of Wisconsin Stroke and Neurovascular Program comes in.

Established in 1994 by Jeffrey Binder, MD, a Professor in the Medical College Department of Neurology, the Stroke Program offers an integrated approach to the management of acute stroke and coordination of clinical research protocols for cerebrovascular disease. "Currently, we have five physicians with a specialty in the area of stroke treatment, and two more will be joining the faculty this year. Minutes count when a stroke occurs and we are unique because we have a team of neurologists who can cover the emergency room and hospital 24 hours a day, seven days a week, providing immediate treatment," Dr. Binder said.

The Stroke Program actively involves Medical College faculty physicians in neurology, interventional neuroradiology, neurosurgery, vascular surgery, internal medicine, emergency medicine, physical medicine, and rehabilitation. In addition, there is a staff of special clinical nurses who work along with physicians. This stroke team provides emergency evaluation and management of stroke, as well as consultation, outpatient services, and provides education to patients and the medical community about advances in stroke therapy and prevention.

Raising Awareness
A stroke occurs when the blood supply to part of the brain is suddenly interrupted or when a blood vessel in the brain bursts, spilling blood into the spaces surrounding brain cells. Brain cells die when they no longer receive oxygen and nutrients from the blood or there is sudden bleeding into or around the brain.

"A stroke can be caused by a blockage in a blood vessel in the brain, known as an ischemic stroke, or a blood vessel that ruptures and bleeds in the brain, known as a hemorrhagic stroke. About 85% of strokes are ischemic strokes," Dr. Binder said.

Treatment within a few hours of a stroke's onset can stop a stroke or greatly reduce the damage. That is why education about stroke is so important, Dr. Binder noted. "There are a number of drugs that can act to stop a stroke or prevent further damage, but they must be administered quickly. New medications are coming out all the time for stroke treatment as well as stroke prevention after a first stroke," he said.

These drugs, thrombolytic drugs, also known as "clot busters," effectively stop strokes and improve patient outcomes if specialists trained in giving the drugs are immediately available. The most widely known stroke therapy and the only FDA-approved drug for treatment of stroke, intravenous tPA (tissue plasminogen activator), can actually reverse a stroke if it is given to patients within three hours of onset of the stroke.

"The Stroke Program team has been successfully using tPA since 1996. Other advances in stroke therapy are emerging, including new medications, aneurysm coiling, carotid artery stenting and other treatments," Dr. Binder said.

New technology is available through the Stroke Program to help diagnose and treat patients. "We are regularly performing CT scan angiography, which provides detailed pictures of the blood vessels in the brain, without the need to introduce a catheter into the brain. Not all hospitals have this technology available. We also do advanced MRI and MRI angiography, which is the mainstay of our testing," Dr. Binder said.

Certification
In 2004, the Stroke Program received a coveted certification from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) as a Primary Stroke Center. It was among the first in the country to apply for and be certified as part of a new campaign designed to raise the level of care provided to stroke patients. "We are held to rigorous standards of care. This certification means we have the resources and expertise to treat stroke patients throughout the continuum of care," Dr. Binder said.

Generally, there are three treatment stages for stroke: prevention, therapy immediately after the stroke, and post-stroke rehabilitation - all of which are addressed by the Stroke Program. Therapies to prevent a first or recurrent stroke are based on treating an individual's underlying risk factors for stroke, such as high blood pressure, heart disease, and diabetes. Acute stroke therapies try to stop a stroke while it is happening by quickly dissolving the blood clot causing an ischemic stroke or by stopping the bleeding of a hemorrhagic stroke. Post-stroke rehabilitation helps individuals overcome disabilities that result from stroke damage.

Stroke Prevention
The Stroke Program is treating about 250-300 new patients a year, and following many more for the purposes of rehabilitation and stroke prevention, according to Dr. Binder. Learning about stroke symptoms and risk factors is crucial to early treatment. In collaboration with Small Stones - a Froedtert & Medical College of Wisconsin health resource center - regular free stroke screenings are made available to the public. In these screenings, a person's medical history, controllable and uncontrollable risk factors, and blood pressure and pulse are assessed. Their risk for stroke is classified and they are provided with an action plan to prevent stroke.

As noted, learning the symptoms of stroke can be vital to obtaining fast treatment. Stroke symptoms include:

• Sudden numbness or weakness, especially on one side of the body
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with unknown cause

"The public needs to become more aware of stroke symptoms and recognize them as an emergency if we are to be successful," Dr. Binder said.

For more information about stroke screening, call 414-805-3666 or 800-272-3666.

JoAnn Petaschnick
HealthLink Contributing Writer

This article includes information from the National Institutes of Health.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.