1. Understandingthe differenttypesof strokes
By DonnaAdinolfe Correspondent
Numbnessorweaknessof the face,armor leg,confusionandtrouble speakingorunderstandingspeech
are justsome of the warningsignsof a stroke,andthe professionalsat Capital Healthwarnthat anyone
exhibitingevenone of the manysignsshouldgettothe hospital immediately.
A stroke,accordingto Dr. Mitchell Rubin,directorof neurologyforthe Capital HealthInstitute for
Neurosciences,iscausedbyalossof blood supply - andtherefore oxygen - tothe brain.
There are twosubtypesof strokes,Rubinsaid.The mostcommon,accountingforabout80 percentof
cases,isan ischemicstroke.Thistype of stroke iscausedby a blockage inthe bloodvessel,which
restrictsbloodflowtothe brain.
The blockage,Rubinsaid,canbe causedbyplateletclots,plaque,ora bloodclotthat breaksfree from
somewhere else inthe body.
There are subtypesof ischemicstokes,Rubinsaid.Anembolicstroke isone where aclotbreaksoff from
any part of the body.A thromboticstroke iswhere aclot formsinthe bloodvessel,whichthenbecomes
blocked.Large vessel andsmall vessel blockagestake place indifferentpartsof the brain.
Hemorrhagicstroke,whichaccountsfor20 percentof cases,occurs whena bloodvessel burstscausing
bleedingtothe brain.The bloodaccumulatesandcompressesthe surroundingbraintissue.The two
typesof hemorrhagicstrokesare intracerebral hemorrhageorsubarachnoidhemorrhage,accordingto
the AmericanStroke Association.
Aneurysmsandarteriovenousmalformationscause hemorrhagicstrokes,accordingtothe Stroke
Association.
An aneurysmoccurswhena weakenedregionof abloodvessel balloons.If leftuntreated,the aneurysm
continuestoweakenuntil itrupturesandbleedsintothe brain.
An arteriovenousmalformationisaclusterof abnormallyformedbloodvessels,whichcanrupture and
cause bleedingintothe brain.
Signsand symptomsof stroke,Rubinsaid,dependonthe side of the brainthat isdeprivedof oxygen.
Brain tissue diesfromlackof oxygenandbecomespermanentlydamaged.The areaof the brainthat is
still alive iscalledthe penumbra.
It isessential forastroke victimtoreceive immediate attentiontosave the penumbra,whichbarely
receivesenoughbloodflow duringastroke.
A personhavinganacute stroke hasfour-and-a-half hourstogettreatmentusingthe clot-bustingdrug
tPA,Rubinsaid.Thisdrug hasbeenusedsince 1996 to improve functional outcomesinstroke patients.
Those whoare administeredthe drugare more likelytobe functioningin90 days.Even thoughthere is
a four-and-a-half hourwindow,the soonertPA canbe given,the betterthe outcomes.
The drug causesa bleedingriskin6 percentof cases,Rubinsaid,but"the benefitsoutweighthe risk,"he
added.

2. Afterthe four-and-a-half hourtime frame,orif apatientisnot eligible fortPA,otherapproachesmaybe
attempted,where doctorsgothroughthe arteryinthe groinup intothe brainto try to retrieve the clot.
At Capital Health,all emergencyroomphysiciansare certifiedinthe correctuse and interpretationof
the National Institute of HealthStroke Scale.Thiscertificationmeansthey've beentestedandprovento
be proficientusingthe stroke scale foracute stroke assessment.
Capital HealthRegional Medical CenterisaNew Jerseystate designatedComprehensive StrokeCenter.
Thisdesignationgivesthe hospitalaleadershiprole inprovidingthe most-advancedtreatmentof stroke
patientswhile achievingthe bestpossibleoutcomes.
Capital Healthisalsohome to the Stroke and CerebrovascularCenterof NJandsome of the country's
mostexperienceddual trainedneurosurgeonswhoare available 24hoursa day,7 daysa weekto treat
the most complex stroke andcerebrovasculardisorders.
Witha rooftophelipad,adedicatedneuro-endovascularsuite andoperatingroom, aswell asa
dedicatedneurosurgical ICUandthe country'sfirstand onlyneurodedicatedemergencydepartment
the hospital hasmade a significantinvestmentinthe treatmentof neurologicallyfocuseddisorders.