Types of Stroke and Related Conditions
There are two main types of strokes, hemorrhagic and ischemic:
- Hemorrhagic stroke occurs when weakened blood vessels in the brain burst, causing blood to leak into the brain.
- Ischemic stroke occurs when blood vessels supplying blood to the brain are blocked by a blood clot.
Our team also treats other conditions affecting the blood vessels in the brain:
- Arterial dissection: A tear occurs in the lining of the wall of an artery. This may lead to clot forming in the artery, which can cause stroke.
- Carotid stenosis: A condition caused by progressive narrowing of one or both carotid arteries; this may cause no symptoms, or may lead to stroke.
- Intracranial stenosis: A narrowing of one or more of the large arteries inside the brain.
- Transient ischemic attack (TIA): A TIA is different from a stroke because it is caused by a blood clot that is temporary or "transient."
- Vasculitis: A condition characterized by the inflammation of blood vessels.
- Venous sinus thrombosis: A clot forms in one of the large veins that drains blood out of the brain.
Signs and Symptoms of Stroke: Remember BE FAST
Stroke, or brain attack, is a leading cause of death and disability among adults in the U.S. The effects of stroke may hardly be noticeable, or last a lifetime. Stroke symptoms may be well defined, like weakness on one side of the face and body; or subtle, like changes in speech. Recovery may be complete, partial or minimal.
Spotting the signs of a stroke using the BE FAST guidelines are crucial to limiting brain damage and improving recovery:
Balance: Does the person have a sudden loss of balance?
Eyes: Does the person have sudden trouble seeing or blurred vision in one or both eyes?
Face: Ask the person to smile. Does one side of the face droop?
Arms: Ask the person to raise both arms. Does one arm drift downward?
Speech: Ask the person to repeat a simple phrase. Is their speech slurred or strange?
Time: If you observe any of these signs, call 911 immediately.
Time is Brain: Quick Action Like Calling 911 Can Save Brain Function
Receiving care as quickly as possible is critical because "time is brain." The more quickly a stroke is recognized and treated, the better the chances of preserving brain function and reducing the chance of disability. If you see any of the signs of stroke, please call 911. This is true even if the symptoms seem to go away. Calling 911 is the fastest way to receive quick medical treatment.
Advanced Stroke Procedure: Only Hospital in Lancaster County to Perform Mechanical Thrombectomy
A stroke caused by a large blood clot has the greatest chance to cause disability or even death. Lancaster General Hospital is the first and only hospital in Lancaster County to perform mechanical thrombectomy, an advanced procedure for physically retrieving a blood clot from a brain vessel. Specially trained doctors use a catheter inserted through an artery in the groin to send a wire-caged device called a stent retriever to the site of the blocked vessel in the brain. At Lancaster General Hospital, we have procedure rooms dedicated exclusively for stroke care.
Removing a clot from the brain right away provides the best chance for a complete recovery. Having this procedure here in Lancaster eliminates the need to transport a patient to another facility out of the county for stroke treatment.
Click here and here to see TV news stories about the procedure at Lancaster General Hospital.
Stroke Quality Measures at Lancaster General Hospital
Lancaster General Hospital is recognized for its exceptional stroke care. It is certified as a Thrombectomy-Capable Stroke Center and our stroke team consistently earns the American Heart Association/American Stroke Association’s Get With The Guidelines®-Stroke Gold Plus and Target: Stroke Honor Roll Elite Quality Achievement Award. The award, according to the American Heart Association/American Stroke Association, "recognizes the hospital’s commitment to ensuring stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines based on the latest scientific evidence."
The below data highlights important metrics related to stroke treatment. We use this data to continuously improve our treatment protocols and positive outcomes.
Thrombolytic Treatment Time with TNK
The majority of strokes are ischemic, meaning they are caused by a blockage of blood flow. The approved treatment for ischemic stroke patients that arrive to the hospital within three hours of their symptoms starting is a clot-busting medication called Tenecteplase (TNK). The faster a patient receives treatment with TNK, the more likely they are to have a good recovery from their stroke. Because this treatment is time sensitive, we aim to treat as many patients as safely possible within 45 minutes of their arrival in the emergency department.
Higher numbers equal better performance.
The blue bar is data from Lancaster General Hospital. The gray bar represents performance of other hospitals across the nation that report comprehensive stroke measures to the Get With the Guidelines national stroke registry.
Minutes to Thrombectomy Treatment
Some ischemic strokes are caused by a blood clot blocking one of the large arteries in the head or neck. In cases where the clot is large and visible, we offer a procedure called thrombectomy, which involves advancing a wire from the artery in patient’s groin to the clot in the head or neck in order to remove it and open the blocked artery. This procedure is proven to reduce disability after a severe stroke. This treatment is time sensitive. The faster a patient gets started with procedure, the faster their stroke is treated. We track the time from patient arrival in the emergency department to groin puncture as a measure of our performance and aim to achieve 90 minutes or faster.
Lower numbers equal better performance.
The blue bar is data from Lancaster General Hospital. The gray bar represents performance of other hospitals across the nation that report comprehensive stroke measures to the Get With the Guidelines national stroke registry.
Outcomes Following a Stroke
The gold standard for measuring functional outcome after a stroke is based on a scale called the modified Rankin Scale (mRS). Each patient receives a score 90 days after their stroke. Lower scores (0-2) on the scale are correlated with functional independence, whereas scores higher than 2 are associated with greater disability. Our goal is to have a high percentage of patients with low scores: meaning, they return to a good level of function within 90 days after stroke.
Higher numbers equal better performance.
The blue bar is data from Lancaster General Hospital. The gray bar represents performance of other hospitals across the nation that report comprehensive stroke measures to the Get With the Guidelines national stroke registry.
Education
Having a stroke is a new experience for most of our patients. Our goal is to provide education to every patient and family that suffers from a stroke. This helps our patients understand their stroke, new medications, and ways to prevent another stroke in the future.
Higher numbers equal better performance.
The blue bar is data from Lancaster General Hospital. The gray bar represents performance of other hospitals across the nation that report comprehensive stroke measures to the Get With the Guidelines national stroke registry.
Patient Satisfaction with Stroke Care
We survey our patients after they leave the hospital and ask them to rank their stroke care. Reviews are based on rankings provided by about 800 patients per year.
Stroke Treatment: A Team Effort
Stroke care at Penn Medicine Lancaster General Health is a team effort. Often, that effort begins before patients even arrive at the hospital. Emergency responders are trained to start life-saving procedures in the ambulance, and call ahead so hospital personnel are ready to begin appropriate treatment. Rapid treatment, including administering a clot-busting medication and mechanical thrombectomy, can reduce or reverse the damage caused by stroke.
Stroke treatment and rehabilitation are often complex. Our highly trained team of neurologists, neurosurgeons, neuropsychologists, cardiologists, interventional neuroradiologists, psychiatrists, nurses, nurse care managers, and neuro rehab specialists work together to tailor care to each patient’s needs.
Prevention: The Best Defense Against Stroke
You can reduce your chances of having a stroke by making healthy lifestyle choices. We encourage you to talk to your primary care doctor about the things you can do to reduce your stroke risk. Your doctor can share strategies to help you control risk factors, the most significant being smoking and hypertension (high blood pressure).
To learn more about stroke risk factors, the American Stroke Association provides comprehensive information and a quiz you can take help you understand your level of risk for stroke:
Stroke risk quiz:
Rehabilitation and Support
Stroke rehabilitation is available on an inpatient, outpatient, or at-home basis, and depending on your needs, may include:
- Physical therapy to increase strength, coordination and motor skills
- Speech therapy to regain speech and swallowing abilities and learn food preparation techniques
- Occupational therapy to help re-learning daily skills like walking, dressing and driving
Our Stroke Survivors Support Group for patients and their caregivers is held from 6 pm - 7pm on the first Thursday of each month at Lancaster Rehabilitation Hospital. Please call 717-544-5686 for more details.