Duncan Borland, MD
Neurology, Vancouver Neurology
Folks who are rushed to PeaceHealth Southwest’s ER with stroke symptoms are likely to see a specialist called a neurologist. A neurologist deals with diseases of the nervous system, which includes the brain, the spinal cord, the peripheral nerves of the legs and arms, and the muscles themselves. The neurologist’s role is to diagnose and treat diseases in these areas, so treating stroke is a primary area of focus.
Neurologists provide medical treatment of stroke, which is generally the first step in stroke management, and depends on the characteristics of the particular type of stroke occurring. In order to determine what kind of stroke is taking place, the neurologist performs a physical examination and looks at brain scans performed by the radiology department. A CT brain scan and often MRI can help confirm the nature and location of the kind of stroke the patient is suffering, and ultrasound studies are may also be used to locate the sources of blood clots or important blockages in the vascular system feeding blood to the brain. This information is essential in determining the most appropriate treatment.
There are some very effective medications for the treatment of stroke, but they must be provided promptly in order to be effective. Sometimes a drug as simple as aspirin can thin the blood and keep it flowing around the injured area until further treatment can be provided. Clot busting drugs like "t-PA" (tissue plasminogenactivator) can be injected to break up the blood clot that is blocking the blood vessel in the brain and causing the stroke. During the first several hours after a stroke starts occurring, the damage to the brain may not be permanent and it is frequently possible to reverse or limit damage to injured cells. After approximately three hours, it is much less likely that damage can be reversed using current technologies.
Prompt treatment of stroke depends on the following:
In the medical profession, we’ve started using the term ‘brain attack’ to emphasize to the public that a stroke is just as serious as a heart attack. You can’t wait until the next day to receive treatment. If your life is going to be saved and potential disabilities prevented or reduced, you need immediate treatment. Even if you’re in doubt about stroke symptoms, you must get to the hospital.
While medication is almost always the first step in stroke treatment, sometimes when medication is not working or when a stroke is particularly severe, surgery may be warranted. When surgery is necessary, neurologists frequently work closely with neurosurgeons in diagnosing the condition and planning surgical treatment.
Neurologists also work closely with other members of the stroke team to provide follow-up care after a stroke has occurred and been initially treated. Many stroke patients need comprehensive rehabilitation, including speech, physical and occupational therapy in order to regain some of the functioning lost during the stroke.
Neurologists are also involved in stroke prevention. If a person has had a TIA (transient ischemic attack) or mini-stroke, where stroke symptoms typically disappear within 24 hours, this can be a sign of blockages or bleeding that may lead to a major stroke. Then the neurologist may work with the patient to prevent a future stroke by providing medications and recommending lifestyle changes that will control such conditions as hypertension, heart disease, diabetes and high cholesterol. The neurologist may also arrange necessary testing to identify potential stroke sources or areas where a blood vessel blockage is occurring so that these problems can be treated in time.
While stroke is still a devastating incident in a person’s life, with prompt treatment, we can have good outcomes. Also, research continues on the treatment of stroke and in the next few years we may have even more effective interventions that can stop a stroke in its tracks. Meanwhile, to protect yourself and your family, learn the symptoms of stroke and seek immediate medical attention if they occur.
Dr. Borland has a fellowship (advanced medical training) in stroke care from Emory University, Atlanta.
He part of Vancouver Neurology, one of physician groups who work together as part of PeaceHealth Southwest’s Brain and Spine Center.
Published Summer 2008.