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Joseph M. Leahy, D.O. Medical Director, Emergency Department ...
Joseph M. Leahy, D.O. Medical Director, Emergency Department ...
Joseph M. Leahy, D.O. Medical Director, Emergency Department ...
Joseph M. Leahy, D.O. Medical Director, Emergency Department ...
Joseph M. Leahy, D.O. Medical Director, Emergency Department ...
Joseph M. Leahy, D.O. Medical Director, Emergency Department ...
Joseph M. Leahy, D.O. Medical Director, Emergency Department ...
Joseph M. Leahy, D.O. Medical Director, Emergency Department ...
Joseph M. Leahy, D.O. Medical Director, Emergency Department ...
Joseph M. Leahy, D.O. Medical Director, Emergency Department ...
Joseph M. Leahy, D.O. Medical Director, Emergency Department ...
Joseph M. Leahy, D.O. Medical Director, Emergency Department ...
Joseph M. Leahy, D.O. Medical Director, Emergency Department ...
Joseph M. Leahy, D.O. Medical Director, Emergency Department ...
Joseph M. Leahy, D.O. Medical Director, Emergency Department ...
Joseph M. Leahy, D.O. Medical Director, Emergency Department ...
Joseph M. Leahy, D.O. Medical Director, Emergency Department ...
Joseph M. Leahy, D.O. Medical Director, Emergency Department ...
Joseph M. Leahy, D.O. Medical Director, Emergency Department ...
Joseph M. Leahy, D.O. Medical Director, Emergency Department ...
Joseph M. Leahy, D.O. Medical Director, Emergency Department ...
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Joseph M. Leahy, D.O. Medical Director, Emergency Department ...

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  • 1. Joseph M. Leahy, D.O. Medical Director, Emergency Department Southern New Hampshire Medical Center
  • 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. What’s the Difference? Hemorrhagic Ischemic
  • 4. Anatomy
  • 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. Parietal Lobe Deficits Inability to name an object Difficulty reading Difficulty with hand‐eye coordination Difficulty drawing objects
  • 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. Occipital Lobe Deficits Visual changes Visual field changes Color recognition Difficulty recognizing drawn objects Difficulty reading and writing
  • 9. Cerebellar Deficits Coordination problems Dizziness Inability to walk Inability to reach out and grab objects
  • 10. Blood Flow
  • 11. Symptoms Sudden weakness or numbness to face, arm, or leg Sudden confusion Trouble speaking Trouble seeing Trouble walking Loss of balance
  • 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. Call 911
  • 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. Hemorrhagic Stroke Call Neurosurgeon Control Blood Pressure Reverse blood thinner
  • 16. Ischemic (Blood Clot) Stroke Neurology Consult Establish onset of symptoms – 3 hour window Consider “Clot Busting” medicine (TPA)
  • 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. 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. 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. 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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