A stroke is a medical emergency. Strokes occur when the blood supply is cut off to part of the brain. It is usually caused by blocked or narrowed blood vessels which decrease the blood flow to the brain cells (ischemic stroke) or the rupture of blood vessels in the brain (hemorrhagic stroke). About 80% of strokes are ischemic. As we get older, a waxy plaque can build up inside the arteries (atherosclerosis) and can block blood flow to the brain; or blood clots that form someplace else in the body can move to the brain and also block the blood flow. If the blood supply is not restored to the affected part of the brain, nerve cells die resulting disability or death. The effects of a stroke depend on where the brain was injured, as well as how much damage occurred. A stroke can affect any number of functions including the ability to move, see, remember, speak, reason, read and write.
A mini-stroke is a temporary interruption of blood flow to the brain which causes symptoms similar to a stroke but does not destroy brain cells or cause permanent disability. A mini-stroke may be a warning. The symptoms happen suddenly and can last from a few seconds, a few minutes or up to an hour and can go away completely and are often ignored. About one in three people who have a mini-stroke eventually have a stroke, with half occurring within a year of the mini-stroke. Do not ignore the symptoms even if they go away. Tell someone and seek medical attention immediately.
Symptoms include sudden onset of severe headache (sometimes described as "thunderclap headache") that people will often characterize as the worst of their life. The headache is usually associated with nausea, vomiting, confusion, weakness, facial droop, disorientation and sensitivity to light. People with suspected hemorrhagic stroke should be treated as a medical emergency and evaluated by physicians with expertise in stroke management. A brain haemorrhage is a life-threatening emergency and requires prompt recognition and action. Brain haemorrhage occurs in about 12 to 15% of all stroke patients admitted to Canadian hospitals. People who survive brain haemorrhage are often left with moderate to severe disability.
For more information go to Heart and Stroke Foundation of Manitoba:
Most strokes are preventable and identifying and managing risk factors can help decrease the risk of having a stroke. About 80 per cent of strokes are ischemic strokes which are the result of the effects of lifestyle habits and risk factors. The risk of stroke can be reduced by maintaining a healthy lifestyle and managing risk factors listed below:
*Retrieved from www.bcstrokestrategy.ca/awarenessPrevention/primaryPrevention/index.html
Choosing a healthy lifestyle depends on where we live, where we work and our social support networks. Creating circumstances that encourage healthy lifestyle choices requires education and support. For more information on how to take control of risk factors go to your family physician, nurse practitioner, community clinic, nursing station or a health care provider.
For more information go to Heart and Stroke Foundation of Manitoba:
Treatments are now available which can stop or reduce the effects of a stroke. It is important to seek treatment immediately when you have symptoms of stroke. When you go to the emergency department presenting with stroke symptoms, doctors must first determine whether your stroke is caused by a blood clot or bleeding in the brain (hemorrhage). This is determined by having a CT scan. For a patient who is having an ischemic stroke, a clot-busting drug called tPA may be administered to dissolve the clot. If treated within the first 4.5 hours from onset of symptoms some stroke patients may experience a partial or complete reversal of symptoms.
Regardless of whether you are a candidate for tPA or not, the first 24-48 hours after the onset of symptoms of stroke is a critical time to receive care and treatment. You will need a team of health care providers such as physicians, nurses, dietiticians, and rehabilitation professionals to assess the effects of the stroke and prevent complications.
Yes, calling “911” will help you connect to an EMS paramedic who will screen or ask you some questions about your symptoms and determine whether you need an ambulance to the local community hospital for treatment or if your symptoms meet the criteria for transportation to an acute stroke centre in Winnipeg (Health Sciences Centre or St. Boniface General Hospital) or to Brandon (Brandon General Hospital). If you meet the criteria for an acute stroke centre, this means that the ambulances will by-pass the closest hospital where you live.
Manitoba Health, Healthy Living and Seniors is working with the regional health authorities to provide acute stroke care services in northern Manitoba by 2012/13. This will involve education and training, funding and resources for telestroke and telemedicine services to provide acute stroke care as per the Canadian Best Practice Recommendations for Stroke.
Manitoba Health, Healthy Living and Seniors covers medically-necessary, land ambulance inter-facility transports when the patient is being transported between designated health-care facilities for diagnostic tests or treatment, or from a more specialized level of care to another facility closer to home for rehabilitation or recovery.
Patients transported from rural areas to access acute stroke care service centers such as in Brandon and Winnipeg by ambulance, will be included in the provincial inter-facility transport (IFT) program. The service charge difference between the local destination hospital that was by-passed and the distant stroke centres in Winnipeg and Brandon will be absorbed by the IFT program rather than the patient. The patient would still be responsible for the payment of the “primary call”.
Manitobans are encouraged to have ambulance insurance coverage such as Blue Cross to cover the cost of the primary call.
Eligibility criteria for coverage of inter-facility medical transports (IFT) includes:
Recent medical advances have occurred in the treatment of strokes. Medications such as thrombolytics or "clot-buster" drugs are now available. The actual name of the drug is tPA or tissue plasminogen activator. It works by dissolving blood clots. To be most effective in ischemic stroke, tPA must be administered as early as possible after the onset of symptoms. From the time the stroke symptoms begin you only have a period of 4.5 hours to be considered for and receive treatment. This means you have 3.5 hours from onset of stroke symptoms to get to a hospital that can treat stroke with the clot busting drug. The team of health care providers at the hospital require about one hour to fully examine you, do some tests and a CT scan, and make decisions about your treatment.
tPA dissolves blood clots, so giving it to someone who has bleeding in the brain can be life-threatening. A computed tomography (CT) scan of the head must be done before giving the medicine, to make sure there is no bleeding present in the brain. People who have had prior bleeding problems, recent surgery or have problems with blood clotting cannot take tPA.
Very high blood pressure, a recent bleeding ulcer or brain cancer are other reasons not to use tPA.
CT or CAT scans are special x-ray tests that produce cross-sectional images of the body using x-rays and a computer. These images allow the radiologist, a medical doctor who specializes in images of the body, to look at the inside of the body just as you would look at the inside of a loaf of bread by slicing it. This type of special x-ray, in a sense, takes "pictures" of slices of the body so doctors can look right at the area of interest. A head or brain CT examines the various structures of the brain to look for a mass, stroke, area of bleeding, or blood vessel abnormality.
The Manitoba Stroke Strategy 5 year plan builds on a framework of health system pillars: primary health care, health system innovation and access to care. The goals of the strategy are to improve health outcomes and support appropriate and effective stroke health services by:
The Manitoba Stroke Strategy (MSS) provides a roadmap for arranging existing and future stroke prevention and care services to meet The Canadian Best Practice Recommendations for Stroke Care. Manitoba Health, Healthy Living and Seniors is planning and collaborating with Regional Health Authorities of Manitoba, to develop innovative distance health care strategies such as telestroke, telemedicine and emergency land and air ambulances to improve patient access to stroke expertise and care.
Currently there are 3 hospitals that provide acute strokes services 24/7 for Manitobans: Brandon General Hospital, Health Sciences Centre and St. Boniface Hospital in Winnipeg. The MSS five year plan is to build health system capacity so that by 2015/16 all major hospitals in Manitoba that have CT scans will be able to provide the acute and specialized services for stroke care that meet the Canadian Best Practices Recommendations for Stroke Care.
Telestroke is a 24/7 emergency telemedicine application that provides emergency physicians with immediate access to neurologists with expertise in stroke care who can support both the assessment and treatment of patients experiencing acute stroke.
A telemedicine link using videoconferencing and CT image sharing technology, allows stroke specialists from acute care hospitals such as in Winnipeg or Brandon to examine patients in remote hospitals miles away to help diagnose the patient's condition and recommend a plan of care. Hospitals can deliver acute stroke care for patients without physically transferring the patient for an exam.
The Canadian Best Practice Recommendations for Stroke Care presents high-quality, evidence-based stroke care commendations developed by a team of researchers, specialists and clinicians to support health care professionals in all disciplines such as nurses, physicians, and rehabilitation therapists. Implementation of these recommendations is expected to contribute to improved patient outcomes for overall recovery of strokes.
Once your stroke symptoms are stabilized and you have been assessed by a physician and rehabilitation team, your discharge plans will be made according to your health status and need for care and rehabilitation. You may be discharged to your community hospital or a hospital in another region close to where you live or you may go to a rehabilitation facility. If you have had a mild to moderate stroke, discharge plans may be made for you to have out-patient rehabilitation and/or a referral to Home Care.
Manitoba Health, Healthy Living and Seniors and the Regional Health Authorities (RHAs) are working together to improve resources, increase access to rehabilitation services across the province and to help people move through the stroke continuum, from symptom onset to diagnosis, to treatment and recovery. The province has hired a regional stroke coordinator for rehabilitation who will work with the regions to assess and plan for alternative or innovative models of rehabilitation and provide education on best practices recommendations for stroke rehabilitation.
The transition from hospital discharge to the community is consistently reported by people who have had a stroke and their families to be a difficult time. The person living with stroke often experiences anxiety and depression, and the family also experiences stress, physical exhaustion and depression which influence the quality of relationships and the post-stroke adaptation. Both patient and family need social support, motivation and hope to prevent exhaustion, depression and a decline in health.
Often a team of health care providers and community support is needed to enhance recovery. In order to reintegrate the person who has had a stroke back into the workforce and into the community; ongoing rehabilitation therapy, vocational counselling and supports for returning to work, modifying work environments, communication and mobility aids, driving assessment and transportation services, and home support services are can facilitate this transition. The goal of community reintegration is to promote safety, independence and meaningful daily activities.
Manitoba Health, Healthy Living and Seniors and the RHAs of Manitoba are planning for obtaining increased funding and resources for community and out-patient rehabilitation therapy and to develop community strategies to assist people living with stroke to maintain, enhance, and develop appropriate social support, and to re-engage people living with stroke in vocational, social and recreational activities.
The Manitoba Stroke Strategy also includes the regional stroke coordinator for rehabilitation services to research and develop alternative rehabilitation models for the province as well as provide training and education on stroke rehabilitation and protocols for transitional care from hospitals to community and long term care.
The Heart and Stroke Foundation of Manitoba (HSFM) is also planning to expand the Living with Stroke, a facilitated learning group for people living with stroke and their families. Please contact HSFM at 204-949- 2000 or toll free 1-888-473-4636 for more information.
The DAMP is a two-part program that evaluates the needs of potential drivers who have been affected by a medical condition. An occupational therapist (OT) provides a pre-screen to evaluate the driver’s ability to operate a vehicle and then an on-road evaluation is done by a DAMP Driving Instructor and the OT. Following the on-road evaluation, feedback and recommendations are provided to the client. Manitoba Public Insurance and the client’s physician may require drivers with residual effects from stroke to complete the DAMP to assess the effect of stroke on their ability to drive.
Manitoba Health, Healthy Living and Seniors and MPI are working collaboratively to expand this program throughout the province to increase access to the driver testing program.
For information call: MPI Medical Compliance and Assessments at 204-985-1900.