 And joining us for this week's Your Health segment is Dr. Marcello Wozniak, Associate Professor of Neurology in the University of Maryland School of Medicine. Dr. Thank you for being here. Thank you. We want to talk about strokes, which are incredibly serious and happen quite often. Every 40 seconds I read somebody has a stroke. What happens in a stroke? So a stroke is what part of the brain becomes permanently damaged. This can be due to a blockage of blood flow to that area or to a blood vessel that breaks open and causes bleeding throughout the brain. The more common is the blockage, and that's what most people mean when they say stroke. And the result of that happening to somebody can be death, it can be disability. That is correct. So what are the symptoms? How does somebody know when this is happening? Well, there can be many, many different symptoms, and I think this is one of the challenging things for the public because the brain does many, many things, so there can be potentially many symptoms. But the most important symptoms are the sudden onset of a problem involving either strength on the face or the body, sensation loss on the face or the body, difficulties with speech. And if those happen, we ask everyone to, if you have a suspicion for stroke, think time and call 911. And we're going to get into the way treatment is changing. The guidelines are changing. But I've always thought of it as something that happens on one side of the body or the other. Somebody loses mobility, sensation. Is that always the case? Yeah, so the most common symptoms will involve weakness on one side of the body or speech loss or vision loss on one side with the other side being spared. But it really depends on where the stroke is involved. There are some very serious strokes where both sides of the body are affected. What can we do to avoid strokes? Who is susceptible? Yeah, so the most important things to know about stroke is that it can happen at any age, but it becomes more and more common the older you get. It's very important. So don't get old. I'll try to remember that. What I would say is that as you get older, remember to be good to yourself. Eat healthy. Exercise. Try to maintain a normal weight. If you have medical stroke risk factors like diabetes, hypertension, high cholesterol, please do everything you can to address those. That will dramatically lower your rate of having a stroke and a heart attack and kidney failure. Okay. Let's get into the treatment, which is the stuff you're intimately involved in. And you brought a couple of pictures. One, I'll tell people there's a little bit of blood on it, but it's key to what we're talking about here. It's a picture of a stent that has a little bit of blood, but also a clot, which I guess is the thing on the bottom. How big is that clot? That's probably about three to four millimeters in size, which seems quite small. But when you're talking about a blood vessel going up to the brain, three to four millimeters is a very large blood vessel, which is potentially supplying blood to half the brain. So we can see on the next slide, which is sort of a map of the person's blood vessels with everything now flowing properly. What would happen is that clot would try to get through, and obviously as the branches get smaller and smaller, it gets stuck somewhere. Yeah, so a clot that big would really be changing that picture that you're seeing now in a devastating way. And over half those blood vessels would not be seen because the blood vessel would be blocked by that clot. How does it get there? Does it form there? Does it travel from somewhere else? It can form there, but very often the blood clot forms elsewhere, such as in the heart, especially if you have an abnormal heart rhythm called atrial fibrillation. It can also form in the blood vessels like the aorta or the carotid artery, where those are damaged over time by atherosclerosis. The interesting thing about that stent was you think about people have stents for various things, and they're put in and they tend to stay there. That's not what you do. That's correct. So we have been trying to extract blood clots for many years now, but it's only been within the past three years that we've had dramatic breakthroughs with these new devices called retrievable stents or stent retrievers. So these are deployed endovascularly with a catheter-based procedure. They are put in, they open the blood vessel up, but they also snare the blood vessel, and both the clot and the stent itself are taken out. So it's not left inside the heart, inside the brain like it would be inside the heart. Let me remind our viewers if you have a question about strokes treatment prevention, give us a call. We'll have the number up on the screen. You can also email your questions now. The email address is livequestions.mpt.org, or you can tweet to atmptnews. Now they used to have, I'm sure they still do, clot buster drugs, and that's how you would attack that clot. Is that still done? Yeah, so for patients who are having the common strokes, the blockage strokes, the most important thing is to call 911 and get into your nearest hospital right away to be evaluated. That clot busting drug, the intravenous TPA, can be given in many hospitals throughout the state of Maryland. Always try to give that first and as quickly as possible. The faster you get it, the better it works. Unfortunately for some of these very large blood clots, which are going to cause devastating strokes, the clot buster is not able to chew through that large amount of thrombus. And so consequently, it's a new and dramatic improvement that over the last three years, these retrievable stents have shown benefit. And more excitingly, three years ago we started using them for patients at less than six hours after onset. Now within the past year, we have a new group of patients we can offer to them. People who have their stroke symptoms when they wake up, or maybe even as long as 20 or 24 hours after the onset of symptoms. So that's what's changed in terms of the guidelines. Right, so it is always important to recognize that time is brain, and as soon as you think you have stroke symptoms, please call 911. But don't just assume because someone now is many hours out when by the time you find them, oh, there's nothing to be done. We're understanding now we need to emergently look at all these patients and try to find the few, but the important few that we can try to help. And the cool thing is when you're able to help in that situation, I mean, I'm sure you've seen cases where there's been significant relief quickly. Absolutely. Our goal is to always do the thing that we know that will give people the best chance, which is try to get in there with the stent retrievers and remove the clot. Now unfortunately, in some cases, damage has been done and the person is still going to have a large stroke. But in other cases, as often as 25 to 45% of the time, the patient actually will have a much smaller stroke and they actually will make a very good recovery. Some people are able to go home immediately, but many more people at three months are living on their own independently, not requiring any help from anyone else. So it really makes a dramatic difference in that group of patients. Let's take a phone call. Howard County, this is Dee. Dee, thank you for the call. Go ahead. Hi, I'm Stephen Howard County. I'm calling to see how much of a factor or learn how much of a factor family history is for stroke. For example, my father had a stroke, so my mother did not. But if you could talk about, you know, how much of a factor family history is. Great question. Thank you, sir. In that regard, thank you, Jeff. Yeah, actually, we're very interested in how family history and genetic influences combine with the diet, exercise, and medical conditions that you have to increase your risk of stroke. And if you do have a family history of stroke, I definitely think that it becomes even more important to make sure you're not smoking cigarettes. You are following up with your doctor and addressing all the stroke risk factors because you are at increased risk because of the family history. Now, the other kind of stroke that you talked about where it's not a clot, it's the opposite problem, it's bleeding, what's the therapy there? So depending on how and why the blood vessel breaks open, there may be neurosurgical techniques which are used to monitor, to help those blood vessels that have broken open from breaking open again. It's also important for those patients to get the best neurocritical care that they can to help them through the devastating part of that kind of a stroke. Let's take a call from Prince George's County. This is Marlene. Marlene, thanks for the call. Go ahead. Yes, my husband has a blockage in one of the arteries in his neck and they want to do a contrast and he also has a kidney problem. And we don't know really what to do. Thank you very much, Marlene. Best of luck. Hard to give advice over the phone, but maybe talk about the broader issue there. Yeah, so I think we are understanding that for the majority of patients there is no warning that they are going to have a stroke. But if you are aware that someone potentially has a blockage, then having that evaluated, whether it is important to see perhaps if a surgery might be reasonable to try to decrease the risk of stroke, talking to your doctor about what the imaging possibilities are in light of his kidney issues clearly is an important thing to do. Here's an email question. Great question. Should, there's the phone, should an aspirin be chewed at for symptoms? So the answer to that is absolutely not. This is one of the things that is very different between heart disease and stroke. In heart disease, almost all of heart disease is due to blockages and so it makes sense to chew an aspirin and try to start working on that blockage. But in stroke, one out of every five stroke patients is having the opposite problem. They are having bleeding. And if you give something like an aspirin to someone who has a bleeding stroke, you are going to worsen the outcome. Other thing is many people who are having strokes have difficulties swallowing and chewing. So you don't want someone to choke on something in their mouth. So please lie down, call 911 immediately. Do not give aspirin until we get them into the hospital and evaluate them. You don't know that that's the right thing to do. Let's talk about that process of getting somebody into the hospital and evaluated. You have the University of Maryland Medical Center comprehensive stroke center, which I'm sure would be a terrific place in the lobby there to have your stroke. You will get terrific treatment, but that's of course not where it happens. Are local ERs equipped and maybe tell me what you folks do downtown? Yeah, so we are very fortunate here in the state of Maryland that we have a very coordinated response to stroke through MIMS, the Maryland Institute of Emergency Medical System Services. So many of the hospitals throughout the state of Maryland are designated as primary stroke centers. They have processes in place to immediately evaluate and give patients that clot buster TPA if they need it, and to also immediately evaluate patients and then transfer them to either a comprehensive stroke center or to an endovascular capable stroke center where they could offer the stent retriever devices if needed. Let's take a call from Washington. This is Thomas or Tomas. Thank you for the call. Go ahead. Yes, hi. I'm calling to find out and have a very close friend that had a transient ischemic attack. I guess you're referring to TIA? Yeah, I was calling to... Yes, we got it. You're having trouble with the delay there, but talk about TIAs. Right. So the majority of patients unfortunately don't have a warning that they're going to have a stroke, but somewhere about one in every 10 patients will have some transient or brief symptoms before the stroke that will warn them that they have an increased risk of having a stroke. So these transient ischemic attack are basically the exact symptoms that you'd have for a stroke, vision loss in one eye or weakness on one side of the body or difficulty speaking, but after 10, 15 minutes suddenly the symptoms go away. Most people assume, hey, I'm okay. The symptoms went away. But in fact, that's a warning that you may be at increased risk of having a stroke in the next minutes or hours. So we suggest getting evaluated right away. How does it go away? Certainly it wasn't the bleeding kind. Exactly correct. So in this case, a blockage is formed. Your body has its own natural clot busting TPA in itself. We're just giving more of it when we give it as a drug. But the body works really hard to try to break those blood clots open itself. They will push the blood vessels open. They increase the blood pressure. It does everything it can to try to convert that stroke into a TIA. So only when that fails that then we need to do something else. Let's talk to Bernice in Baltimore County. Bernice, thanks for calling. Go ahead. Yeah, my question is, well, it's not really a question. It's a comment. I had a stroke two years ago, which started out with a bad, bad headache, and I've never clearly ever suffered from headaches. And I was given my family says, okay, we'll give her ibuprofen, which I'm not supposed to take anyway, but they give me two ibuprofen, and my headache went away. And of course, I procrastinated a day or two until I couldn't, like the third day, I couldn't, I got to where I couldn't see. And now my stroke, it hit the back of part of my brain, which impaired my vision. Okay. And I do see a neurologist up at Hopkins. But my question is, do I have to follow up for the rest of my life with a neurologist? Bernice, terrific. I'm on blood centers now. They put me on the blood centers and everything. I mean, I'm under doctor's care, but I just thought it was unusual that I, mine was a headache and I do have atrial fib, which I was taken off of blood centers years ago. Wow. And just high dosages of aspirin. Bernice, we have to leave it there. But we're so glad you called you sound terrific and best of luck going forward. Reaction? Yeah. So I think atrial fibrillation is a major stroke risk factor. And the best medication for preventing a first stroke and second stroke, if you have atrial fibrillation, often is the more powerful blood thinners. Patients are often concerned about those because of the risk of bleeding. But in the majority of patients, actually, the benefit of blood thinners outweighs the increased risk of bleeding. It is very important if you do have any suspicion whatsoever for stroke, not to just wait at home and see how you're going to feel, but to call 911 and get seen right away. And everybody's afraid of overreacting and looking foolish. Absolutely. And no one wants to come to the emergency room. I understand that. No one wants to call 911. But honestly, especially if you're a person who is having very typical symptoms of stroke, we talked about weakness on one side of the body, vision loss on one side of the body, speech problems. These are very characteristic symptoms of stroke. Call 911. Don't be afraid to come in. Let's quickly squeeze in a call from Baltimore County. Lorraine, you're on. Your question, please. My question is about A.C.I.B. I'd like to know if she has any recommendations for the watchman. Thank you very much. Yeah, so for some selected patients who absolutely cannot receive long-term anticoagulation, there are some devices now which have been shown and approved by the FDA to lower the formation of blood clots in the heart itself. These really are only used in people who we cannot give the more powerful blood thinners to. So that's only a select group of patients. It's not really a replacement for the medical therapies. Wasniac University of Maryland Medical, we appreciate your time. Thank you so much. My pleasure. Your health segments are a co-production of Maryland Public Television and the University of Maryland Medical System.