Stroke Awareness: What You May Not Know About Treatment Advances, Recognizing All Symptoms

Stroke Awareness Month in May is an observation that has educated the public about common stroke symptoms to look out for in themselves or others – and take action immediately. Every 40 seconds, someone in the U.S. has a stroke, and every 3 minutes and 14 seconds someone dies of stroke, according to the U.S. Centers for Disease Control and Prevention (CDC).

Interventional neuroradiologists and neurosurgeons from Baptist Health Miami Neuroscience Institute at Baptist Hospital, who are available 24 hours a day, seven days a week, treated 1,047 strokes during fiscal year 2021-2022. More people are being treated for strokes because symptoms are being recognized more often, explains Italo Linfante, M.D., medical director of Interventional Neuroradiology at Miami Neuroscience Institute and Miami Cardiac & Vascular Institute, both part of Baptist Health.

“We are not necessarily seeing an increase in rates of strokes,” said Dr. Linfante. “We're seeing an increasing instance of patients with stroke which is recognized promptly and fast, and then they come to us. So, we're seeing more patients because people are more aware about signs and symptoms of a stroke.”

Comprehensive Stroke Center

When stroke victims arrive at Baptist Hospital, Dr. Linfante and his team administer clot-busting medications and/or perform a mechanical thrombectomy, a procedure during which doctors remove blood clots using a device threaded through brain arteries. These stroke treatment measures mean that Baptist Health has met or exceeded the requirements for a Comprehensive Stroke Center designation by the Joint Commission, which accredits U.S. healthcare organizations, along with the American Heart Association and the American Stroke Association.

“Mechanical thrombectomies are saving lives,” said Dr. Linfante. “It's a very powerful treatment. And we are involved in spreading the message. Not all stroke centers, unfortunately, can deliver this treatment, because you need an Angiography Suite (where advanced imaging technology supports a variety of interventional vascular procedures) and the people who perform the procedures. You need a very fast team to bring the patient from the emergency room into the Angio Suite. In 60 minutes, a patient here at Baptist Health goes from the emergency room to a device inside the brain to treat the stroke. It’s very impressive, and a very few centers have that.”

Types of Strokes

A stroke occurs when a blood vessel that supplies blood to the brain is blocked by a blood clot, or when a weakened blood vessel in the brain bursts. In the past, victims who survived a stroke were often left permanently disabled. But new technologies and advances in therapies, have made it possible to not just survive a stroke -- but to fully recover and live an active, fulfilling life.

An ischemic stroke, the most common type, is caused by a blockage cutting off the blood supply to the brain. A hemorrhagic stroke is caused by bleeding in or around the brain. A transient ischemic attack, or TIA, is also known as a mini-stroke.

Dr. Linfante said that more people are recognizing the telltale F.A.S.T. symptoms – face drooping; arm weakness; speech slurred; and time to call 911 (see below for more details.) But many people may not now that there are a separate group of similar symptoms that represent about 20 percent of strokes. The referred to as the “5 D’s” of Posterior Circulation (PC) Strokes.

• Sudden onset dizziness
• diplopia (double vision)
• dysarthria (speech problems)
• dysphagia (swallowing problems)
• dyspraxia (lack of bodily coordination)

“There’s more awareness about F.A.S.T. stroke symptoms, and then when they recognize them they can go to the hospital. Symptoms of PC strokes, which are somewhat different, are not getting enough publicity. These symptoms are not often recognized as a stroke. The symptoms are more subtle than symptoms associated with F.A.S.T.”

Advances in Treating More Complex Strokes

Dr. Linfante is the lead investigator of a multi-institution research team which recently completed Phase I of the HEMERA-1 study. HEMERA 1 (CarboxyHEMoglobin OxygEn delivery for Revascularization in Acute Stroke) is a Prospective, Randomized Phase 1 Clinical Trial (ClinicalTrials.gov NCT04677777).

This clinical trial investigated the safety of the neuroprotectant and oxygen carrier PP-007 (a very promising investigational biopharmaceutical product) in patients experiencing acute ischemic stroke (AIS) and large vessel occlusions, or blockages.

Treatment for AIS has changed rapidly over the past decade. For example, mechanical thrombectomy emerged in 2015. That procedure allowed clinicians to treat AIS by directly removing blockages from arteries. However, mechanical thrombectomy leaves an unresolved issue: brain damage is occurring even before treatment.

Explains Dr. Linfante: “With mechanical thrombectomy, we went from 85 percent death or disability to maybe 20 percent death or disability. However, even though we could open the arteries in most patients, not all had good results. Why is that? Because by the time we opened the artery, brain damage had occurred to the tune of, on average, 1.2 million neurons destroyed per minute.”

The clinical trial shows promise in addressing this unresolved issue with current treatment options. This biopharmaceutical product limits the loss of neurons by improving circulation around the blockage even before surgeons can remove a clot.

“This is another great field that is evolving -- neuro protection, adds Dr. Linfante. “So, on top of the mechanical thrombectomy, you give medication to protect the brain until we recanalize (reopen) the occluded artery. That's something with which we are very involved.”

Think F.A.S.T. if you see someone with one or more of these symptoms:

F – Face drooping: Does one side of the face droop or is it numb? Ask the person to smile. Is the person’s smile uneven or lopsided?
A – Arm weakness: Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downwards?
S – Speech: Is speech slurred? Is the person unable to speak or hard to understand? Ask the person to repeat a simple sentence.
T – Time to call 911: When someone suffers a stroke, time is of the essence. If the person shows any of these symptoms, even if this symptom goes away, call 911 and get them to the hospital immediately.