

With Stroke Every Minute Counts

Recognizing symptoms and getting treatment quickly are the keys to survival

Stroke, also known as cerebrovascular accident (CVA), is the third most common cause of death among older Americans and the leading cause of adult disability. But stroke treatments have come a long way in the past few years— today, more lives are saved and more disabilities prevented than ever before.

A stroke occurs when the brain is deprived of blood, and thus of the oxygen it provides. Without oxygen, brain cells may be irreversibly damaged after just a few minutes. If brain cells die or are damaged, symptoms occur in the parts of the body those brain cells control. Examples of stroke symptoms include sudden weakness; paralysis or numbness of the face, arms or legs; trouble speaking or understanding speech; and difficulty seeing. The two main types of stroke are ischemic (is-ke-mik) and hemorrhagic (hem-ah-raj-ik).

Ischemic, the more common type, accounts for 80 to 85 percent of all strokes, says Michael F. Stiefel, M.D., Ph.D., Chief of Neurovascular Surgery at Westchester Medical Center. An ischemic stroke occurs if an artery that supplies blood to the brain becomes blocked. Blood clots from the heart or the neck can often cause the blockages that lead to ischemic strokes. A hemorrhagic stroke happens when an artery in the brain ruptures or leaks blood. The pressure from the leaked blood damages brain cells. High blood pressure and aneurysms (balloon-like bulges in an artery that can stretch and burst) can cause this type of stroke.  The major controllable risk factors for stroke include high blood pressure, smoking, diabetes, cardiovascular disease and an unhealthy lifestyle. Other factors, such as age, gender, race, ethnicity and family history, can’t be controlled.

Treatment for a stroke depends on its type. A hemorrhagic stroke may require immediate surgery to stop the bleeding or remove the blood that has leaked out of the artery. In an ischemic stroke, treatment is directed at opening the blood vessel and restoring blood flow as quickly as possible. A medicine called tissue plasminogen activator (tPA) can break up blood clots in the arteries of the brain. A doctor will inject tPA into a vein. To be effective, this medicine must be given within three to four-and- a-half hours of the start of symptoms. “Time is brain tissue,” Dr. Stiefel says. “Following a stroke, about 1.9 million neurons per minute die.” (The brain has about 100 billion neurons in total.) “Damage may be irreversible. Our goal is to reduce the amount of damage.”

If it is too late to administer tPA, if contraindications prevent its use or if it fails to break open a clot, Dr. Stiefel and his colleagues have other options. Recent advances have brought two new devices, known by the trade names Solitaire and Penumbra, that can be inserted directly into the artery to break up blood clots.

Solitaire is an expandable metal stent that, when attached  to a wire threaded into the obstructed blood vessel, can push  a blood clot out of the way and restore blood flow. Penumbra also follows a guide wire to reach the area of a clot, but it works to break up the clot so that suction can then pull out the pieces and restore blood flow that way.

“These devices are just as safe as using tPA,” says Dr. Stiefel. “They allow us to extend the window of treatment.” And the new tools continue to evolve in efficacy and safety, he says. “The Penumbra first came out in 2007, and we already have a new version. What we do today probably isn’t what we will be doing in three to five years.”

But to receive the latest in care, it’s important to be treated quickly, preferably at a hospital that is a member of a coordinated stroke network like Westchester Medical Center and its sister community hospitals around Westchester County and the lower Hudson Valley. Says Dr. Stiefel: “Community hospitals that work within our stroke program help patients get the right treatment as quickly as possible.”


The signs and symptoms of a stroke often vary with the type of stroke and the area of the brain that is affected. They may include:

  • sudden weakness
  • confusion 
  • trouble speaking or understanding speech 
  • trouble seeing in one or both eyes
  • problems breathing
  •  dizziness, trouble walking, loss of balance or coordination, and unexplained falls
  •  loss of consciousness
  •  sudden and severe headache

If you think you or someone else  is having a stroke, call 9–1–1 right away. The patient should travel to the hospital in an ambulance rather than a private car, so that medical personnel can begin lifesaving treatment on the way to the emergency room. During a stroke, every minute counts.


1. Get regular exercise. Try to walk or do other moderate physical activity for at least 30 minutes most days.

2. Don’t smoke. A cigarette habit doubles your risk of stroke. Says the National Stroke Association: “Smoking reduces the amount of oxygen in the blood, causing the heart to work harder and allow blood clots to form more easily.”

3. Eat healthy. Emphasizing low-calorie, high-fiber foods such as fruits, vegetables and whole grains can help you control your weight and blood pressure (stroke risk factors), and eating fish twice weekly keeps your body supplied with healthy omega-3 fatty acids, which recent studies credit with lowering the risk of death from coronary artery disease.

4. Cut salt intake. Don’t just spare the shaker—check the (sometimes whopping) amounts  of sodium in fast food and canned and frozen convenience foods, and try to keep your daily consumption under 1,500 milligrams. (Had a Burger King Whopper and a bowl of Campbell’s soup today? Oops—you’re there already!)

5. If you drink, drink moderately. That means no more than one alcoholic drink in a day if you’re female, two if you’re male.

Sources: American Stroke Association, National Stroke Association


The National Stroke Association has created the “Stroke Risk Scorecard,” an online tool that helps you assess your personal risk of stroke. Go to pdf?docID=601 to tabulate your results—then discuss your findings with your physician and develop a preventive plan of action.

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