During a Stroke, Every Minute Counts

Stroke is a leading cause of disability and the fifth leading cause of death in the U.S., according to the Centers for Disease Control and Prevention. When a patient is having a stroke, every minute counts. Thanks to advances in technology, a neurologist can quickly assess someone with stroke symptoms, even if they are miles apart.

Each moment counts during a stroke. The sooner someone receives treatment, the better their chance of survival. The acronym B.E. F.A.S.T. can help you spot stroke symptoms quickly. When you know what signs to look for, you can help someone having a stroke get the emergency medical help they need. Stroke symptoms come on suddenly and include:

• B: Balance. Does the person have trouble with balance? Do they feel dizzy? Are they walking differently?
• E: Eyes. Ask them about their eyesight. Do they have vision loss or blurry or double vision?
• F: Face. Does one side of their face droop or look uneven? Ask them if their face feels numb. Tell them to smile and note if their smile is uneven.
• A: Arm. Is one of their arms weak or numb? Ask them to raise both arms and see if one arm drifts downward.
• S: Speech. Ask them to say a simple phrase. Are they hard to understand? Do they seem confused? Are they having trouble understanding you?
• T: Time to call 911. If someone has any of these symptoms, call 911 right away. Take note of the time their symptoms first started, and share that information with first responders.

Dr. Caprio warns that stroke symptoms vary between people. "I want to emphasize that it may not be a full inability to speak or complete paralysis, for example. It's any sudden loss of neurologic function."

Even if someone's symptoms seem relatively minor, call 911 right away.

What Is the Telestroke Program?

Once you arrive at the emergency department, your healthcare team may call leading stroke specialists at Northwestern Medicine. They provide assistance and guidance through the telestroke program. This brings added expertise and resources to hospitals that may not have a Comprehensive Stroke Center.

The Northwestern Medicine telestroke program features a two-way video and audio system. It allows board-certified neurologists from the Comprehensive Stroke Centers at Northwestern Memorial Hospital and Northwestern Medicine Central DuPage Hospital to meet with stroke patients virtually. The physicians conduct virtual exams and collaborate with the emergency medicine teams at area hospitals.

The Northwestern Medicine telestroke program is offered to several hospitals in Illinois. These include Northwestern Medicine Lake Forest Hospital, Northwestern Medicine Kishwaukee Hospital and Northwestern Medicine Valley West Hospital. It is also offered to several hospitals in northwest Indiana. These hospitals can determine if specialized care is needed on a case-by-case basis.

The system connects the neurologist and patient through a secure internet connection. Using the camera, the neurologist can perform observational tests. For instance, they can gauge how a patient's pupils respond to light and tell how well the patient can move and speak. At the same time, the neurologist has instant access to the patient's health information through electronic medical records. They can see the patient's vital signs, CT scans and laboratory results.

"The telestroke program brings the neurologist to wherever the patient might be," says Dr. Caprio. "We have immediate access to be able to examine the patient with the help of emergency room staff."

The patient and their family can also see the neurologist on a portable screen. The neurologist can let on-site physicians know if the patient needs a life-saving clot-busting medication (tissue plasminogen activator). The neurologist can also let the on-site care team know if the patient should be transferred to a Comprehensive Stroke Center. There, the patient has access to many treatments, including a thrombectomy. In this procedure, a surgeon removes a blood clot (thrombus) from a blood vessel. It is one of the most effective stroke treatments.

"Even though the doctor and patient may be separated by many miles, it is very similar to being at the patient's bedside," says Richard A. Bernstein, MD, director of the telestroke program at Northwestern Medicine. "Capitalizing on the resources of our Comprehensive Stroke Centers, the medical team is able to coordinate the best treatment quickly and help reduce or prevent the potentially debilitating consequences of stroke."

When Every Minute Matters

"Immediate treatment after stroke is critical to help minimize the risk of serious brain damage," says Andrew P. Oleksyn, DO, medical director of emergency medicine at Kishwaukee Hospital. "The goal is to diagnose and treat stroke within the 'golden hour,' or the first 60 minutes following onset of symptoms, when patients have much better outcomes."

The telestroke program helps bridge that access. "If we are able to interact and see these patients as they're having a stroke, we can treat them in a timely manner that can dramatically improve their outcomes," says Dr. Caprio.

Dr. Caprio emphasizes that it is a team approach. "Not only do we partner and collaborate with the hospital physicians and staff members, but there also is a large team that comes together to deliver care," she says. "The telestroke technology allows the team to work in coordination to identify the issue, transfer the patient to another hospital, if needed, and determine the next appropriate treatment."

In addition to the telestroke program, Northwestern Medicine's stroke program includes:

• Two Comprehensive Stroke Centers accredited by The Joint Commission
• Two Primary Stroke Centers
• A multidisciplinary physician team that includes neurology, neurosurgery, radiology and critical care
• A Mobile Stroke Unit

Like the telestroke program, the Mobile Stroke Unit brings expertise to where patients are. The Mobile Stroke Unit is an ambulance equipped with tools and staff normally only found inside a hospital. The team can quickly diagnose a stroke, coordinate electronically with a Northwestern Medicine neurologist and start treating patients right away.

In addition, the team is always improving their care. They use new imaging technologies, which can help identify areas of the brain at risk for stroke. They also track metrics to improve quality and offer the best care.

"The important thing is that we're reaching patients wherever they live," says Dr. Caprio.

Because when it comes to a stroke, every minute counts.