Comprehensive Stroke Care and Treatment

Board-Certified Neurologists and Neurosurgeons

The Stroke Center at The Department of Neurosurgery at Rutgers Health and RWJBarnabas Health provides high-quality care for stroke patients through a multidisciplinary approach. Our team of board-certified neurologists and neurosurgeons offers stroke treatment and have tackled even the most complex stroke cases with effective, compassionate care.

A stroke is a medical emergency requiring immediate care. If you suspect you or someone you know has had a stroke, call 9-1-1 for transportation to the hospital and emergency care. Every minute counts, and you should not drive to the hospital yourself or let someone else drive you, because the ambulance personnel will be able to begin life-saving treatment immediately on the way to the hospital.

What Is a Stroke?

Strokes occur if blood flow is interrupted to a portion of the brain. Also called a “brain attack,” strokes are very dangerous, because the longer the brain goes without fresh blood, the more likely that brain damage will occur, and permanent disabilities can result. The interruption or blockage of oxygen-rich and nutrients blood causes death of affected brain cell within mere minutes, and once these brain cells are dead, the functions they carry out cease.

Understanding Different Types of Strokes

The two main types of stroke include ischemic strokes and hemorrhagic strokes. Transient ischemic attacks, commonly called “mini strokes,” are often a warning sign of future strokes.

Ischemic Stroke

Approximately 87 percent of strokes are ischemic, according to the American Heart Association. These strokes are the result of blood supply to a part of the brain being blocked. The blockage could be due to fatty deposits, called plaque, which build up in the arteries. Plaque lining the walls of the arteries can cause blood clots.

There are two subtypes of ischemic strokes: embolic and thrombotic.

  • Embolic strokes are the result of a blood clot or plaque traveling to the brain through the blood stream.
  • Thrombotic strokes occur when a blood clot, or thrombus, develops in at least one artery supplying blood to the brain, creating a blockage and causing a stroke.

Hemorrhagic Stroke

When arteries leak or rupture in or around the brain, the leaked blood damages brain cells because of the added pressure.

The subtypes of hemorrhagic strokes are subarachnoid, parenchymal and intraventricular, depending on the area of the brain where the bleeding occurs. The cause of the artery rupture is from high blood pressure or abnormal arterial walls. Another possible cause is a brain aneurysm.

Transient Ischemic Attack

Transient ischemic attacks (TIA), also called “mini strokes,” are different from the other, major types of strokes because blood flow is blocked for only a short period of time. However, those who have had TIA should know that it is a warning sign of a future stroke, and it is still a medical emergency. It is impossible to tell at the beginning whether symptoms of a stroke are the result of a major or mini stroke.

Risk Factors for a Stroke

Although some strokes are not preventable, there are certain lifestyle-related risk factors of a stroke that can reduce your risk of having one in the future. The more risk factors you have, the more likely you are to experience a stroke.

Some of the most common lifestyle factors that increase your odds of having a future stroke include:

  • High Blood Pressure: This is the most significant risk factor. Normal blood pressure is approximately 120/80. A blood pressure reading of 140/90 or above is considered high blood pressure, which indicates hypertension. This means your blood is exerting more pressure than is healthy or normal, which weakens and/or thickens the blood vessel walls.
  • Smoking History: Smoking cigarettes is well-established as a risk factor for strokes and makes you twice as likely to die if you have a stroke. The evidence that smoking is a risk factor for a stroke is very convincing, and numerous studies have found a strong correlation, with current smokers being at least two times as likely to experience a stroke compared to those who quit smoking at least 10 years prior. Secondhand smoke exposure is also dangerous.
  • Diabetes: People with diabetes are 1.5 times more likely to have a stroke compared to those who do not have diabetes, according to the American Diabetes Association. If you have diabetes, you can lower your risk by keeping your blood sugar, blood pressure and cholesterol within a healthy range, as well as eating a healthy diet and regularly exercising.
  • High cholesterol: Cholesterol is a fatty substance in the blood which is either produced by the body or ingested through food. The presence of high cholesterol in the arteries can block blood flow to the brain and cause a stroke. You should keep your total cholesterol levels under 200 to avoid a stroke, especially if you have other predominant risk factors.
  • Heavy drinking: Because heavy consumption of alcohol is responsible for a number of health problems, such as liver damage and atrial fibrillation (a type of irregular heartbeat), heavy drinkers are at a higher risk of having a stroke.
  • Poor diet, including high sodium intake: Eating a diet particularly high in sodium or fat is dangerous, as it can lead to high blood pressure, high cholesterol levels, and obesity.
  • Lack of physical exercise: Exercise can improve your health and reduce your risk of having a stroke or mini stroke. It also benefits your physical and mental health as it lowers your blood pressure, lowers cholesterol levels, and reduces the risk of health problems such as diabetes.
  • Obesity: Carrying extra weight is correlated with a host of health problems, including many of those previously mentioned.

Other risk factors such as age, gender and family history cannot be controlled. You are also at a higher risk for a stroke if you have atrial fibrillation or kidney disease. However, you should be aware of how you can alter lifestyle-related risk factors to reduce your risk of having a stroke in the future.

How Do I Know if I’m Having a Stroke?

Many symptoms are present when a stroke happens or has just happened. If you notice these symptoms in yourself or someone else, you should immediately call 9-1-1 for transport to the nearest hospital. Do not drive yourself or someone else to the hospital, as emergency medical service may be administered in the ambulance, and you or your loved one will receive more prompt treatment upon arrival at the hospital.

“FAST” is the acronym/mnemonic associated with a stroke. If you know you are at risk for a stroke, it can save a life if you act “FAST”:

  • F: Facial drooping
  • A: Arm weakness
  • S: Speech difficulties
  • T: Time – this is a reminder to seek immediate emergency medical care.

How Is a Stroke Diagnosed?

First, your physician or stroke emergency team will ask you some questions about when symptoms first started, ask you for a medical history, and then certain tests will be done in order to diagnose the type of stroke you or your loved one had. The physician will also rule out the possibility that another medical problem caused stroke symptoms, such as a possible drug reaction or a brain tumor. It’s important not only to diagnose a stroke, but to determine the type of stroke and the area of the brain it affected, as the appropriate treatment will vary accordingly.

Tests used to identify and diagnose a stroke include:

  • Physical and neurological exams: The doctor will look for any facial droop, arm weakness and speech abnormalities, which are classic indicators of a stroke. If any of these three symptoms are detected, it means there is a 70% chance or greater that the patient has experienced a stroke, and if all three findings are abnormal, chances are greater than 85%, according to The Cincinnati Prehospital Stroke Scale. Other tests administered to determine the likelihood of a stroke and to estimate its severity include looking at the patient’s gaze, testing arm/leg/hand strength, measuring level of consciousness, and observing any facial paralysis (palsy).
  • Blood tests: Blood tests are a vital component of evaluating a possible stroke, as well as ruling out any other medical condition. Tests involved include a complete blood count (CBC) test and coagulation tests. Other blood tests your stroke team may order include a blood lipid test to measure your cholesterol levels, or a coagulation test, which measures how fast your blood clots. More specific blood tests may also be required, such as an antinuclear antibody test or an antiphospholipid antibodies test. These will rule out other conditions that produce similar symptoms as a stroke.
  • Imaging tests of the brain: This will help your stroke team get a clear image of the brain to determine where brain cell death has occurred. Imaging tests performed, such as a CT scan (computer tomography) or an MRI (magnetic resonance imaging), can detect a stroke by identifying any blood clots or brain bleeding. Other necessary imaging tests may include a CT angiography (CTA) or a CT perfusion (CTP). The combination of any of these tests helps your stroke team determine the best course of treatment.
  • Blood flow tests: These can accurately determine how the arteries in the head and neck supply blood to the brain. A neurologist administering a blood flow test will inject a special dye into the blood vessels and take an X-ray to get a picture of blood flowing through the arteries, to determine the size and location of any blockages present. This test can also rule out an aneurysm and any defective blood vessels.
  • Other tests: Your doctor may also order an echocardiogram, which checks if a blood clot from the heart traveled to the brain, or other imaging tests.

Stroke Treatment

For any type of stroke, the sooner treatment starts, the better the patient’s prognosis will be. First, the doctor must identify the type of stroke. Emergency stroke treatment administered depends on the type of stroke the patient had, whether it’s from an ischemic stroke (caused by a blocked artery in the brain) or a hemorrhagic stroke (when the brain bleeds).

  • Ischemic Stroke Treatment: For this, the most common type of stroke, blood flow must be quickly restored to the brain with clot-busting drugs. Patients may be given an injection or medications to bust clots to help restore blood flow by dissolving the clot. Other treatments for ischemic stroke include delivering medications delivered directly to the brain. Your doctor may also remove arterial plaque via a carotid endarterectomy or access your carotid arteries to expand any narrowed arteries.
  • Hemorrhagic Stroke Treatment: Treatment for this less common type of stroke focuses on controlling brain bleeding and reducing pressure in the brain. Emergency treatment often includes surgical blood vessel repair. Abnormal arteries are largely to blame for a hemorrhagic stroke.

Once the patient has received the appropriate emergency treatment, stroke rehabilitation and recovery begin. No matter the type of stroke the patient had, stroke rehabilitation might be indicated if the patient needs to recover and live independently again.

Post-Stroke Rehabilitation and Recovery

The appropriate treatment can alleviate any of the common problems associated with a stroke, so the patient may relearn any skills lost from sustained brain damage. Post-stroke rehabilitation may begin as early as 24 hours after a stroke has occurred. Prompt rehabilitation can help stabilize the patient’s condition, prevent future strokes, and help the patient regain any lost functions.

Stroke patients may have difficulties and require rehabilitation for abnormalities with the following functions: movement, sensation, and speech/language disorders. Some less common symptoms include problems with breathing, swallowing, balance and equilibrium, clear vision, and psychiatric problems.

The multidisciplinary approach used by The Department of Neurosurgery at Rutgers Health and RWJBarnabas Health includes participation from the following medical professionals: neurologists, rehabilitation nurses, physical therapists, occupational therapists, speech-language pathologists, and others. Stroke patients can get rehabilitation either on an in- or outpatient basis, or a home-based program.

Based on the patient’s age and overall health, and taking into account any disabilities the patient sustained, the stroke care team will recommend an appropriate treatment program. Post-stroke rehabilitation may include:

  • Motor control treatment: Stroke patients often suffer from some type of paralysis on the opposite side of the body from the side of the brain affected. Paralysis may affect the face, an arm, leg, or an entire half of the body (one-sided paralysis, or hemiplegia). If not affected by paralysis, the patient may experience weakness in any of the mentioned areas. Motor control treatment will help patients walk, balance, grasp objects, even help with swallowing.
  • Sensory treatment: Experiencing a stroke can affect the patient’s ability to feel touch, as well as sensing pain or temperature. Sensory deficits may also affect the stroke survivor’s ability to sense the need to urinate. Chronic pain may also result after a stroke because of nervous system damage. Pain can be controlled with medical, as well as physical, therapy.
  • Speech and communication therapy: At least one in four stroke survivors experience problems using or understanding language, medically known as aphasia, because of damage to the brain’s language control centers. The aim of this therapy is to help patients regain the ability to speak more clearly, as well as aid listening comprehension, and the ability to read and write.
  • Memory and thinking: If the patient’s stroke has damaged the region of the brain responsible for functions including memory and awareness, it can cause problems developing short-term memories, making plans, comprehending meaning, learning new things, and more. Occupational therapy may help with memory, problem solving, judgement, safety awareness, and social skills.
  • Psychotherapy: It is not uncommon for stroke survivors to experience frustration and anxiety, as well as depression for the loss of physical, cognitive and mental. Sometimes, the stroke patient may display changes in their personality. Signs of emotional disturbances include trouble sleeping, hopelessness, changes in eating patterns, social withdrawal, irritability and suicidal ideation.
  • And more: Depending on what area of the brain was impacted by the stroke and which associated functions were disrupted, other rehabilitation may also be necessary.

Other experimental therapies currently being used to treat stroke patients include brain stimulation, biological therapies, and alternative medicine.

By actively participating in post-stroke rehabilitation, the patient may be able to recover certain functions, although this varies widely depending on the particular circumstances of the patient. Patients may be able to improve the success of post-stroke rehabilitation with proper motivation, as well as outside emotional and social support. Keep in mind that post-stroke rehabilitation takes time and patience, and frustration is normal and expected along the way.

Remember, you’re not alone. As many as 800,000 Americans suffer from a stroke in a given year – that’s one person every 40 seconds.

Questions? Contact RWJBarnabas Health for More Information.

Request an appointment online now or call 833-656-3876.