Every minute the brain is deprived of blood flow, more brain cells die. The earlier the blood flow is restored, the less likely a stroke patient will have permanent damage. Neuro critical care is essential to control intracranial pressure as well as blood pressure, breathing, and heart function. When it comes to stroke, time is brain.
If you think you or a loved one may be having a stroke, do not wait. Call 911 right away. A stroke happens when blood flow to part of the brain is cut off because a blood vessel becomes blocked or bursts. According to the American Stroke Association, stroke is the leading cause of long-term disability in the United States and the third leading cause of death. The Maryland Stroke Alliance encourages everyone to know the warning signs of stroke. These vary according to the part of the brain being affected but can include:
- Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body
- Sudden confusion, trouble speaking, or difficulty understanding speech
- Sudden vision problems in one or both eyes
- Sudden trouble walking, dizziness, or loss of balance/coordination
- A sudden, severe headache
If you suspect that a loved one may be having a stroke, conduct the “Be F.A.S.T.” quick check:
- B - Balance: Watch for a sudden loss of balance.
- E - Eyes: Is there a sudden loss of vision in one or both eyes? Or double vision?
- F- Face: Ask the person to smile. Does the face droop?
- A- Arm: Ask the person to raise both arms. Does one arm drift downward?
- S- Speech: Ask the person to repeat a simple phrase. Does the speech sound slurred or strange?
- T- Time: If you observe any of these signs, then it's time to call 911.
Stopping a stroke in its tracks
Our center is equipped to respond quickly and effectively to an evolving stroke. When a patient with a possible stroke comes in, the emergency department physician activates the stroke team and begins a battery of tests that will determine the patient’s course of treatment. Our team, which will work with patients from the ER through rehabilitation, conducts CT scans, X-rays, EKGs, blood tests, and neurological exams within minutes to assess what type of stroke is occurring and what treatment options are available. Patients are admitted directly into our center from the emergency department in order to receive treatment as soon as possible.
Not only is it important to diagnose if someone has just had a stroke, physicians must also determine the type of stroke. The treatment is different, based on whether it is a hemorrhagic stroke or an ischemic stroke. Depending on the type and severity of the stroke, treatment options will vary, and may include surgery.
Our specialists will order a variety of diagnostic tests to determine the location and extent of brain injury, as well as evaluate the condition of the arteries in your heart and neck that supply blood to your brain.
- Ischemic stroke: The most effective medicine for the treatment of ischemic stroke is the FDA-approved drug, t-PA (tissue plasminogen activator). Taken intravenously, it works with your body's enzymes to dissolve blood clots. This highly-effective treatment must be given within three hours of the onset of stroke so it is imperative to seek medical care without delay.
- Hemorrhagic stroke: The best and safest way to remove blood from the brain after a hemorrhage, and minimize damage to the brain, include surgical removal of the clot, clot busting medication to dissolve the clot, and medications to minimize swelling caused by the clot. For hemorrhages caused by aneurysms and arteriovenous malformations, a skilled neuroradiologists or neurosurgeon can repair or block the vessels to prevent further bleeding. Many of these procedures can be performed through a minimally invasive technique.
Certain strokes originating from carotid artery disease, brain aneurysms, AVMs, and hypertensive hemorrhages benefit greatly from surgical interventions. Using the most advanced surgical and microsurgical techniques available today, MedStar Health neurosurgeons perform:
- Surgical clipping of complex (ruptured and unruptured) brain aneurysms
- Surgical resection of arteriovenous malformations/fistulas
- CyberKnife radiation, which delivers concentrated beams of radiation from multiple positions while sparing healthy tissue
- Carotid stenosis treatment using a surgery to remove the plaque causing the narrowing
Recovery and rehabilitation
Quick intervention in a stroke can save a life, but long-term rehabilitation can give many victims back their quality of life as well. The specialists at MedStar Health include occupational therapists, physical therapists, and case managers who provide guidance and encouragement to help the patients “retrain the brain.” Therapy is available on an inpatient and outpatient basis and is customized to each individual’s needs.
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7503 Surratts Rd. Clinton, MD 20735
9000 Franklin Square Dr. Baltimore, MD 21237
Facebook Live: Stroke prevention and treatment options
Stroke national performance measures
Stroke performance measures Compliance rate* VTE prophylaxis by hospital day 2 99.2% Anti-thrombotic Medication at hospital discharge 100% Anticoagulation therapy prescribed at hospital discharge for patients with atrial fibrillation or atrial flutter 100% Antithrombotic medication by end of hospital day number 2 96.2% Stroke education provided 98.7% Assessed for rehabilitation services 100%
*National Target Benchmark is above 85% compliance
Outcome measure MedStar Georgetown Patients without signs and symptoms of stroke who had good outcomes* after carotid procedure 100% Patients with signs and symptoms of stroke who had good outcomes* after carotid procedure 100% Patients who had good outcomes after diagnostic cerebral angiogram 100%
Stroke national performance measures
Stroke performance measures Compliance rate* VTE prophylaxis by hospital day 2 97% Anti-thrombotic Medication at hospital discharge 100% Anticoagulation therapy prescribed at hospital discharge for patients with atrial fibrillation or atrial flutter 100% Antithrombotic medication by end of hospital day number 2 96% Statin prescribed at discharge 99% Stroke education provided 97% Assessed for rehabilitation services 100%
*National Target Benchmark is above 85% compliance
Stroke volume 2020
Patient type # of admissions Ischemic stroke 563 Intracerebral hemorrhage 184 Subarachnoid hemorrhage 90 Transient ischemic attack 92 Total 929
U.S. News Stroke Scorecard
MedStar Washington Hospital Center Overall rating High Performing Survival Excellent Discharge patients to home Excellent Reperfusion therapy >10% Number of patients Very High
Nurse staffing Very High Intensive care unit (ICU) specialists Yes Public transparency Yes
*Hospitals that earned a high performing rating were significantly better than the national average.
- Survival: Relative survival 30 days after hospitalization for stroke, compared to other hospitals treating similar patients.
- Discharging patients directly to home: How often patients can go directly home from the hospital rather than being discharged to another facility. Recovery at home is preferred by most patients and families.
- Reperfusion therapy: Percentage of stroke patients treated with reperfusion therapy (Greater than 10% = Above average amount of therapy provided). This measure quantifies how often the hospital provided time-sensitive medical intervention such as intravenous tissue plasminogen activator or mechanical thrombectomy.
- Number of patients: Relative volume of Medicare inpatients age 65 and over who had this procedure or condition in 2015-2019. Higher volume is associated with better outcomes.
- Nurse staffing: More nursing care per patient is associated with better outcomes and better patient experience.
- Intensive Care Unit (ICU) Specialists: Whether the hospital has at least one adult intensive-care unit staffed by a doctor specifically certified or trained to care for ICU patients.
- Public transparency: Whether hospital publicly shared its stroke data through the American Heart Association. Hospitals participating in transparency programs foster sharing of data and adoption of best practices.
Additional stroke performance measures for procedures and interventions
Additional stroke performance measures for procedures and interventions at MedStar Washington Hospital Center (2019):
- Serious complication rates for carotid endarterectomy and carotid stenting are better than the national benchmark (<6% for symptomatic ICA stenosis and <3% for asymptomatic ICA stenosis).
- Serious complication rates for diagnostic cerebral angiogram are better than the national benchmark (<1%).