Joseph M. Leahy, D.O.
Medical Director, Emergency Department
Southern New Hampshire Medical Center
What exactly is a stroke?
Rapidly developing loss of brain function due to a 
disturbance in the blood supply to the brain...
What’s the Difference?
Hemorrhagic Ischemic
Anatomy
Frontal Lobe Deficits
Paralysis
Inability to sequence a task (making a cup of coffee)
Personality changes
Difficulty with ...
Parietal Lobe Deficits
Inability to name an object
Difficulty reading
Difficulty with hand‐eye coordination
Difficulty dra...
Temporal Lobe Deficits
Difficulty recognizing faces
Difficulty understanding spoken words
Short‐term memory loss
Difficult...
Occipital Lobe Deficits
Visual changes
Visual field changes
Color recognition
Difficulty recognizing drawn objects
Difficu...
Cerebellar Deficits
Coordination problems
Dizziness
Inability to walk
Inability to reach out and grab objects
Blood Flow
Symptoms
Sudden weakness or numbness to face, arm, or leg
Sudden confusion
Trouble speaking
Trouble seeing
Trouble walking...
Recognizing Stroke
Cincinnati Prehospital Stroke Scale
Ask person to smile – look for facial droop
Ask person to raise bot...
Call
911
“We’re not in Kansas anymore…”
Oxygen, IV’s, Blood work, “When did this start?”
Neuro exam 
CT scan of Head – Rapid transp...
Hemorrhagic Stroke
Call Neurosurgeon
Control Blood Pressure
Reverse blood thinner
Ischemic (Blood Clot) Stroke
Neurology Consult
Establish onset of symptoms – 3 hour window
Consider “Clot Busting” medicin...
NINDS Study
624 ischemic stroke patients enrolled
Compared TPA to Placebo
Treatment within 3 hours of symptom onset
Result...
Criteria for TPA
Age > 18
Time of onset < 3 hours
No improving symptoms
No surgery within preceeding 14 days
Blood pressur...
SNHMC Telestroke Program
Partnership with Massachusetts General Hospital
Telemedicine has become an accepted standard of 
...
Stroke Risk Factors
High Blood Pressure
Atrial Fibrillation
High Cholesterol
Diabetes
Cigarette Smoking
Heavy Alcohol Cons...
Joseph M. Leahy, D.O. Medical Director, Emergency Department ...
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Joseph M. Leahy, D.O. Medical Director, Emergency Department ...

  1. 1. Joseph M. Leahy, D.O. Medical Director, Emergency Department Southern New Hampshire Medical Center
  2. 2. What exactly is a stroke? Rapidly developing loss of brain function due to a  disturbance in the blood supply to the brain. Two types of stroke Ischemic – lack of blood flow – usually from a clot Hemorrhagic – ruptured blood vessel
  3. 3. What’s the Difference? Hemorrhagic Ischemic
  4. 4. Anatomy
  5. 5. Frontal Lobe Deficits Paralysis Inability to sequence a task (making a cup of coffee) Personality changes Difficulty with problem solving Changes in social behavior Inability to express language
  6. 6. Parietal Lobe Deficits Inability to name an object Difficulty reading Difficulty with hand‐eye coordination Difficulty drawing objects
  7. 7. Temporal Lobe Deficits Difficulty recognizing faces Difficulty understanding spoken words Short‐term memory loss Difficulty with long term memory Increased aggressive behavior Increased or decreased interest in sexual behavior
  8. 8. Occipital Lobe Deficits Visual changes Visual field changes Color recognition Difficulty recognizing drawn objects Difficulty reading and writing
  9. 9. Cerebellar Deficits Coordination problems Dizziness Inability to walk Inability to reach out and grab objects
  10. 10. Blood Flow
  11. 11. Symptoms Sudden weakness or numbness to face, arm, or leg Sudden confusion Trouble speaking Trouble seeing Trouble walking Loss of balance
  12. 12. Recognizing Stroke Cincinnati Prehospital Stroke Scale Ask person to smile – look for facial droop Ask person to raise both arms Ask person to speak a simple sentence
  13. 13. Call 911
  14. 14. “We’re not in Kansas anymore…” Oxygen, IV’s, Blood work, “When did this start?” Neuro exam  CT scan of Head – Rapid transport Notification of Stroke team Repeat Neuro exam – NIH stroke scale
  15. 15. Hemorrhagic Stroke Call Neurosurgeon Control Blood Pressure Reverse blood thinner
  16. 16. Ischemic (Blood Clot) Stroke Neurology Consult Establish onset of symptoms – 3 hour window Consider “Clot Busting” medicine (TPA)
  17. 17. NINDS Study 624 ischemic stroke patients enrolled Compared TPA to Placebo Treatment within 3 hours of symptom onset Results: At 3 months, TPA treated patients 30% more likely to  have minimal or no neurologic deficits 11‐13% overall increased favorable outcome *TPA group did have increased rate of bleeding in the  brain (6.4% vs. 0.6%)
  18. 18. Criteria for TPA Age > 18 Time of onset < 3 hours No improving symptoms No surgery within preceeding 14 days Blood pressure controlled ( < 185 / 110) No Previous stroke (within 90 days) No GI/GU bleeding (within 21 days) No seizure
  19. 19. SNHMC Telestroke Program Partnership with Massachusetts General Hospital Telemedicine has become an accepted standard of  care Allows for bedside consultation with an MGH  neurologist and neuroradiologist Critical decisions made with world class support
  20. 20. Stroke Risk Factors High Blood Pressure Atrial Fibrillation High Cholesterol Diabetes Cigarette Smoking Heavy Alcohol Consumption Lack of Physical Activity Unhealthy Diet
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