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Manitoba Health, Healthy Living and Seniors

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Manitoba Stroke Strategy

Stroke Information for the Public


Frequently Asked Questions about the Manitoba Stroke Strategy


What is a stroke?

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.

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What is a mini-stroke or transient ischemic attack (TIA)?

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.

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What are the warning signs of a stroke?

  • sudden weakness or loss of strength or sudden numbness the face, arm or leg, even if temporary  
  • sudden trouble speaking or understanding or sudden confusion, even if temporary
  • sudden vision problems, even if temporary  
  • sudden severe headache and unusual headache
  • sudden loss of balance or dizziness, especially with any of the above signs  

If you experience any of these symptoms, call 911 or your local emergency number and tell them you think that you are having a stroke.

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How to recognize and treat a TIA

Video courtesy of the Heart and Stoke Foundation of Canada, hosted on YouTube.
Click the image to play.

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What are the symptoms of a hemorrhagic stroke?

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:
http://www.heartandstroke.mb.ca

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What are risk factors for stroke?

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:

  • high blood pressure doubles the risk of stroke
  • smoking more than triples the risk of stroke
  • obesity increases the risk of stroke by 20 to 30 per cent
  • diabetes elevates the risk of stroke by three times
  • irregular heart rhythm contributes to half of stroke caused by blood clots
  • physical activity could prevent 25 per cent of strokes in Canada  
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.

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Are there treatments for stroke?

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.

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Should I call "911" if I think that I am having stroke symptoms?


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), Thompson or The Pas.  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 major hospitals throughout the province by 2016/17. 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.

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Is this ambulance transportation covered by my Manitoba Health Insurance?

Manitoba Health covers medically-necessary, land ambulance inter-facility transports when 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.

Manitoba Health does not currently cover transportation between the patient’s “911” point of call and the facility to which the patient will be transported. This can result in significant cost to the patient, particularly in the event of being bypassed to a facility at significant distance to the patient’s original call. Work is underway to determine how to address these costs for Manitobans to ensure that financial challenges due to ambulance transfer fees are not cause for Manitoban’s opting not to seek emergent care for stroke.

Manitoba Health is working on determination of inter-facility costs for the Manitoba Stroke Strategy.

Eligibility criteria for coverage of inter-facility medical transports includes:

  • the patient must be a resident of Manitoba with a valid Manitoba Health card,
  • the patient must medically require transportation by ambulance as determined by a physician, and
  • the patient is being transferred 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.

Consistent with practices in many other provinces, patients will still be responsible for emergency ambulance transportation costs. These costs may be covered by other insurance coverage such as Blue Cross.  

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What is tPA?

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.

Your local hospital may not have the ability to do so. The ambulance team will know which hospital has the capability.

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Why is tPA used?

Tissue plasminogen activator (tPA) can be used to treat some people who are having a stroke caused by a blood clot. It is given in a vein (intravenously, or IV) and in some cases it may be given directly into an artery.

The medicine works best if it is given right away after stroke symptoms begin. Strict criteria must be met in order to use the medicine. The medicine can be used to prevent disability after a stroke.

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Who should not take tPA?

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.

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What is a CT scan?

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.

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What is the Manitoba Stroke Strategy?

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:

  • Improving public awareness of the warning signs of stroke
  • strengthening the identification and management of risk factors for stroke through family physicians/primary health care teams
  • developing innovative health systems for distance delivery of health care services
  • providing access to specialized services such as neurology and rehabilitation

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Why does Manitoba need a provincial stroke strategy?

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 is planning and collaborating with Regional Health Authorities of Manitoba, to develop innovative distance health care strategies such as telestroke, telemedicine, emergency land and air ambulances, and innovative models of stroke rehabilitation to improve patient access to stroke expertise and care.  

As of 2015 there are 5 hospitals that provide acute strokes services 24/7 for Manitobans: Brandon General Hospital, Thompson General Hospital, St. Anthony’s Hospital in The Pas, Health Sciences Centre and St. Boniface Hospital in Winnipeg.  The MSS plan is to build health system capacity by 2016/17 to enable all Manitoba hospitals with CT scanner capacity  to provide acute and specialized services for stroke care that meet the Canadian Best Practices Recommendations for Stroke Care.

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What is telestroke?


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.

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What are the Canadian Best Practice Recommendations for Stroke?


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.

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Where will I stay after I have had my stroke? Can I go to my community hospital?

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 such as Riverview Health Centre.  If you have had a mild to moderate stroke,  you may be discharged home, and, depending on your needs, you may be provided with home based or out patient based rehabilitation support by various providers such as physiotherapists, occupational therapists or speech language therapists.

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Will I have access to rehabilitative services if I live in rural Manitoba?

Manitoba Health, Healthy Living and Seniors and the Regional Health Authorities (RHAs) of Manitoba are working together to improve resources and provide increased access to rehabilitation services throughout the province.

The Northern Regional Health Authority has implemented an innovative approach to providing speech language therapy by telehealth in partnership with a Speech Language Pathologist in Winnipeg.  The telehealth program has demonstrated improvements in communication even though all participants had chronic communication impairments post stroke.

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What is community reintegration?

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.

The Heart and Stroke Foundation of Manitoba (HSFM) provides a program called the Living with Stroke that is a facilitated learning group for people living with stroke and their families.  Please contact HSFM at 431-949- 2000 or toll free 1-888-473-4636 for more information.

Stroke Survivors’ Association of Manitoba (SAM)

Stroke Survivors’ Association of Manitoba is a non-profit organization that regular programs, events and support for stroke survivors and their families. SAM provides:

  • Referral services to other community resources
  • Information packages
  • Educational materials
  • Guest Speakers
  • Volunteer opportunities
Website: www.strokerecovery.ca/services.html
Phone: 204-942-2880

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What is the Driver Assessment and Management Program (DAMP)?

The Driver Assessment and Management Program (DAMP) is a comprehensive two-part assessment designed specifically for people with functional impairments as a result of medical condition such as a stroke. It is coordinated with the Health Sciences Centre in Winnipeg and conducted by an occupational therapist (OT) and a driving instructor.

Please contact Manitoba Public Insurance about the Driver Assessment and Management Program:

In Winnipeg: 204-985-7000
Toll Free: 1-800-665-2410
TTY/TTD: 204-985-8832

Or go to the website below to find out more about the Driver Assessment and Management Program:
https://www.mpi.mb.ca/en/DL/DL/MedicalConditionsAndDriving/Pages/driveable-Assessment.aspx

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