Every 40 seconds on average, an American will have a stroke. It is the nation’s fifth leading cause of death and leading cause of serious long-term disability.
But for patients who arrive at the emergency room within 3 hours of their first symptoms, they often have less disability after a stroke than those who received delayed care.
Jim Schneider is one of those lucky ones.
He was headed to Southern Pines last year when his wife noticed his driving was becoming erratic.
“She told me to pull over and we knew something was wrong. I couldn’t talk,” he said.
With no family history of stroke to speak of and a relatively healthy lifestyle, the 68-year old Moore County man had slightly high blood pressure and was only taking small doses of high cholesterol medicine.
“In theory, I was pretty healthy. There was nothing about me that would say I was a walking stroke or a walking heart attack about to happen,” Schneider said.
His wife got behind the wheel of their car and they drove straight to the emergency room.
“They walked me straight into the ER. I was on a gurney within minutes,” Schneider said.
What the Schneiders didn’t know is that FirstHealth Moore Regional Hospital is a primary stroke center, with a dedicated stroke-focused program and highly trained team.
“The most important thing to understand is that time is brain,” said Dr. Melanie Blacker, a FirstHealth neurologist and neurohospitalist.
A big misperception with stroke is because it does not cause pain, that it is not at the same level of emergency as a heart attack.
“People think they can rest and it will get better. What they potentially miss is the window of opportunity for treatment,” Blacker said.
Currently there is only one Food & Drug Administration (FDA) approved drug treatment for acute ischemic stroke -- the most common form, affecting up to 87 percent of stroke patients.
Tissue plasminogen activator (or tPA) is a clot-busting drug given intravenously to improve blood flow to the part of the brain being deprived of oxygen. It is recommended within three hours, sometimes a bit longer depending on the situation, from the onset of stroke symptoms.
Also over the last four years, a new catheter treatment option has been used to treat some ischemic stroke patients. A surgeon inserts a small mechanical device into the blocked artery, using a thin tube, and it can be used to trap or break up the clot.
“Right now everything is time-based, but we hope in the future it will be based on imaging results and salvageable brain tissue,” said Blacker.
An MRI can detect changes in the brain within minutes of a stroke occurring.
For Jim Schneider, he knew he was in trouble by the time he reached the emergency room.
“I was aware that something was going on. I could hear the doctors talking,” he said. “I tell people it was like I was on my way to get drunk. I knew where I was but I wasn’t able to respond like I normally would.”
The first of three neurologists he would meet that week was by his side within minutes.
Schneider was given a CT scan and prescribed tPA.
Within an hour or two, he began to regain a little bit of his speech. Three days later he walked out of Moore Regional Hospital.
“You get a different appreciation for things,” he said.
Schneider’s new appreciation includes a Mediterranean-style diet, a little more time in the gym and cutting out some stress in his life.
“I can do anything I pretty much want to do, I just have to watch my diet,” he said. “I got sugar, salts and fatty meats. I’ve lost about 30 pounds and my blood pressure and cholesterol have come way down.”
He said he’s not a fanatic about his fitness, just a bit more dedicated to going then he had been before.
Initially Schneider noticed over the first few months after the stroke that he would be exhausted after just a few hours of activity but, in time, his normal energy level returned.
“I shot two rounds of golf last week in the 70s. My friends tell me I can’t be that bad off,” said Schneider, with a chuckle.
According to Blacker, while advanced age is a significant risk factor for stroke, for others like Schneider, there are modifiable factors that can minimize the chance of stroke.
“After age 55, the risk of stroke doubles each decade,” Blacker said, noting that nearly one-quarter of strokes occur in people under the age of 65. “The Southeastern U.S. has the highest mortality rate in the country. We are referred to as the Stroke Belt.”
The most common modifiable factors that, if controlled, will decrease the likelihood of having a stroke are high blood pressure, high cholesterol, obesity, and smoking.
Far less common but more deadly is hemorrhagic stroke, which affects approximately 13 percent of all stroke patients.
“Your best case scenario for either type of stroke is to arrive at an emergency room within the window of time for treatment,” she said. “I have had patients with severe deficits who walk out of the hospital.”
Commonly, a stroke is preceded by a smaller stroke.
Schneider said he was unaware that he experienced this, but test results at the hospital confirmed he actually had two strokes.
Importantly, once he and his wife recognized he was having difficulty with his speech they sought medical attention immediately.
“I think it may have been about a half-hour,” he said, from the onset of symptoms. “The doctors told me that is the difference.
“That is one of the advantages of living here. There is a dedicated stroke unit in the hospital and the staff is wonderful. They knew exactly what I was dealing with.”
Blacker said people may not be aware they are having a stroke, especially if they live alone. Others will first experience a transient ischemic attack, meaning they have stroke symptoms that come and go. That is a big warning sign that should not be ignored, she added.
“If you are having any stroke symptoms, even if the symptoms have resolved, you should still call 911. EMS will encourage you to come in for treatment and it will give us an opportunity to figure out why that happened,” Blacker said. “We don’t want to miss the window for potential treatment options.”