Dr. Kevin Most: Strokes

Dr. Kevin Most

We have discussed strokes on this show many times, however this weekend it hit close to home. Chicago White Sox pitcher, Danny Farquhar, suffered a stroke on Friday night during the game he was playing in. There are essentially 2 types of strokes. One type is when you have blockage in an artery in the brain, this is the most common type and in some cases is preceded by “mini-strokes or TIAs” This is the type of stroke where we have that golden time frame to give a clot busting drug or go in and remove the blockage. It is often seen in older individuals.

Danny Farquhar unfortunately had the other type of stroke. His stroke was caused by a rupture in an artery in his brain, which lead to a hemorrhage, or bleeding, in his brain. This type of stroke rarely comes with any forewarning or symptoms. The hemorrhage occurs with a rupture of an aneurysm. Let’s make sure we all know what that is. Our arteries are tubes that deliver blood from the heart to the rest of the body, veins on the other hand are tubes that bring blood back to the heart from the arteries. As the blood is pumped with significant pressure the arteries are thick walled, and in most individuals very smooth. An aneurysm is essentially a small out pouching of the artery, where instead of being a smooth tube it has a weaker wall that forms a pouch. Blood flows into that weaker area and in some cases the aneurysm grows larger. As it grows often the wall around it thins. The aneurysm may get to a point where the thinness of the wall cannot handle the pressure that the blood is being pumped at and the wall ruptures. This causes blood to be pumped thru that hole into the brain and the stroke occurs. In many cases this is fatal and fatal quickly, often because no one is sure what is happening and by the time an ambulance is called and transport to the hospital occurs there is major damage.

In Danny’s case it occurred between innings in the dugout, and medical personnel were there to assess him immediately, and an ambulance was already on site with paramedics. He was transferred to RUSH which has an outstanding stroke program and an ICU that treats brain injury patients specifically. In the big picture he was as fortunate as one could be with this devastating event as the rupture could have happened at anytime when a care team was not ready and available.

I can’t say what treatment he received but often a neurosurgeon will need to go in and clip across the aneurysm to stop the bleeding. In some patients the aneurysm is noted before it ruptures, as patients may have symptoms that trigger an evaluation. Some have headaches, some have blurred vision and they are the lucky ones. In a patient who is noted to have an aneurysm, we now have the technology to get to the area with a catheter that goes from the leg up to the brain thru blood vessels, when they reach the aneurysm, they place small pieces of metal that coil up and essentially stop the growth of the weak area thus preventing the rupture.

It is another opportunity for us to remember the signs of a stroke and the need to act on them quickly. Once you know what to look for, act on it immediately as time is of the essence in either type of stroke. RUSH and CDH are the only 2 hospitals in the state that actually have an ambulance that is for patients having a stroke. It is equipped with a CT scanner and the CT scan is done immediately at the patients home. If it is noted to be a stroke caused by a clot, the clot busting drug is started immediately while being transferred to the hospital. This has shaved off valuable minutes allowing the brain to get blood flow sooner. In the case of the bleeding stroke the CT has allowed the diagnosis to be made so the operating room is ready with a surgeon as the patient is being transported. In both cases the goal is minimize the time that damage is being done to the brain.

Currently there are less than 25 of these across the US, as they are very costly. However we need to get beyond the cost and note the impact they can make in the community. At CDH alone the unit has gone out close to 400 times in the past 10 months. The data is showing the impact it can make in the lives of those having a stroke.

Simple acronym for stroke identification

FASTER
F- Facial Drooping
A – Arm weakness or asymmetric weakness
S- Stability- dizziness, difficulty walking, loss of coordination
T- Talking- sluured speech or the inability to talk
E- Eyes, difficulty seeing, blurred or double vision
R- React or Response Call 911 immediately

If these are noted in a family member, friend do not tell them to rest and we will check later, don’t put them to sleep. Get them evaluated immediately, you may save a life and you will certainly make an impact on the quality of ones life as early treatment in stroke patients now often leaves them without any or minimal deficits. Early treatment is key as once the brain cells die there is no bringing them back.

Our thoughts and prayers go out to Danny and his family