Stroke Services in Marshfield
Specialized acute stroke care, treatment, prevention and recovery
Each year, 4 out of 5 families in Wisconsin will be affected by stroke and approximately 750,000 people in the United States will suffer a new or recurrent
stroke. It is the third leading cause of death and the leading cause of serious disability. The longer a stroke goes untreated, the greater the chance of permanent neurological damage. Rapid intervention is crucial to the treatment of stroke. Time lost is brain lost!
The Comprehensive Stroke Center at Ministry Saint Joseph’s Hospital, the only one of its kind in central and northern Wisconsin, offering services such as:
- Ministry Spirit Medical Transportation, providing advanced air and ground life support.
- Dedicated stroke team that treats stroke patients immediately upon their arrival at Ministry Saint Joseph’s Hospital.
- Advanced brain imaging and diagnostic testing to help detect the exact location and cause of the stroke.
- Rapid-response stroke treatment, including the administration of t-PA, the clot-busting drug.
- Advanced endovascular treatments not offered anywhere else in central and northern Wisconsin:
- Intra-arterial administration of t-PA directly at the site of the clot for patients who may not qualify or arrive in time for intravenous t-PA.
- Mechanical removal of a clot lodged in a vessel in the brain.
- Coiling of aneurysms in the brain.
- Designated critical and acute care stroke units with full monitoring capability.
- On-site acute care rehab unit with stroke specialty certification.
- Working relationship with referring hospitals, physicians and emergency medical services to improve regional stroke care.
The comprehensive stroke services provided at Ministry Saint Joseph’s Hospital capture all aspects of stroke care, from stroke prevention, risk identification and treatment, to recovery and rehabilitation.
Ministry Saint Joseph’s Hospital has the experience and expertise that makes all the difference in the treatment of stroke.
The medical term for a stroke is “cerebrovascular accident” or CVA. It is an injury to the brain that occurs when it does not get enough oxygen and nutrients. Oxygen and nutrients are normally carried to the brain in blood vessels. With a stroke, there is a problem with one or more blood vessels in the brain or leading to the brain. When a stroke occurs, brain cells die because they cannot get enough of the oxygen and nutrients to that are needed to survive.
Types of Stroke
- Less common than ischemic strokes
- Symptoms usually occur suddenly
- May not have any warning signs, but is often associated with a severe headache, nausea and vomiting
- Higher fatality rate and poorer overall prognosis
- More likely to occur in younger people
A hemorrhagic stroke occurs when a blood vessel in the brain ruptures or breaks. There is bleeding into the surrounding brain tissue. There is a change in the normal flow of blood. Nerve cells in certain areas of the brain may not get enough oxygen and nutrients. The blood from the ruptured artery will usually form a clot. This clot may push on brain tissue and cause problems with brain function.
- Intracerebral Hemorrhage: This is when the bleeding occurs within the brain tissue itself.
- Subarachnoid: The bleeding occurs in the space under the membrane surrounding the brain (subarachnoid space).
TIA (transient ischemic attack)
- A warning stroke, or mini-stroke that produces stroke-like symptoms but no lasting damage.
- The short duration of the symptoms and lack of permanent brain injury is the main difference between TIA and stroke.
- Most common type of stroke
- Symptoms may occur over minutes to hours, or may occur suddenly
- Often have warning signs, such as weakness or numbness on one side of the body, problems with speech and language, vision or balance
- Often occurs at night or first thing in the morning
An ischemic stroke occurs because of the lack of blood flow to an area of the brain. The stroke occurs because the blood (along with oxygen and nutrients) is not able to reach a certain area of the brain. This type of stroke usually occurs because of a blood clot blocking the flow of blood.
There are two ways that this may occur:
- Cerebral Thrombosis: This is a blood clot that forms in the brain. It is one of the most common causes of stroke. It occurs when the blood flow is blocked off by a clot that forms along the blood vessel wall. A thrombus (or clot) may also form in any of the four neck arteries that carry blood from the heart to the brain.
- Cerebral Embolic: This is a blood clot that travels in the bloodstream to the brain or to the main arteries leading to the brain. This kind of clot may get stuck in a blood vessel that is too small to pass through, blocking it and causing a stroke.
Knowing the warning signs of a stroke is important because many strokes can be prevented. People should call 911 and get medical attention right away if they or someone they know are having any of the following symptoms.
- Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body.
- Sudden confusion, trouble speaking or understanding.
- Sudden trouble seeing in one or both eyes.
- Sudden trouble walking, dizziness, loss of balance or coordination.
- Sudden, severe headache with no known cause.
What to do
- Immediately call 9-1-1
- Know when the symptoms first appeared
If given within three hours of the start of symptoms, a clot-busting drug called plasminogen activator (tPA) can reduce long-term disability for the most common type of stroke. tPA is the only FDA-approved medication for the treatment of stroke within three hours of stroke symptom onset.
- CT Scan. A very specialized and detailed X-ray. This is a sensitive study to check for signs of a stroke. It can also be sued to check for other problems that may cause stroke-like symptoms such as bleeding around the brain, tumors, cysts, and infections. Sometimes to make the picture clearer, a dye is injected into the patient through a vein. Other than a possible needle stick, a CT scan is painless and poses very little risk to the patient.
- MRI. A specialized scan used to view internal organs. This computer technology is especially good at viewing the brain and spinal cord. The MRI shows the same information as the CT scan, but it may be more detailed and more sensitive for signs of a stroke. The test is not painful, but the patient must remain still and relaxed during the scan.
- Carotid Duplex. This study examines blood flow through the carotid arteries (in the neck and brain) using an ultrasound machine. The carotid arteries are the major blood vessels carrying blood to the brain. This test can help to determine if there is any narrowing or blockage of blood flow to the brain. Carotid duplex is painless and poses no risk to patients.
- EKG (electrocardiogram). This test measures the electrical activity of the heart. It is useful in looking for rhythm abnormalities such as atrial fibrillation, which is a risk factor for stroke. It can also detect signs of a prior or current heart attack. It is performed by attaching a series of patches and wires to the chest. EKG is painless and poses no risk to patients.
- Echocardiogram. This test is an ultrasound of the heart. It uses sound waves to produce and record images of your heart. These images help to find abnormalities of heart muscles or valves, and fluid around the heart. Any abnormalities with the heart can increase the risk for stroke. Echocardiogram is painless and poses no risk to patients.
- Transcranial Doppler. This test uses the ultrasound machine to measure flow rates of blood through major brain arteries. This is done to look for blockages of blood flow to or in the brain. Transcranial Doppler is painless and poses no risk to patients.
- Cerebral Angiogram. This test provides information about the blood circulation in the brain. A small tube, or catheter, is threaded into a main artery in the leg until it is in position above the heart. A dye is injected through the catheter into the arteries in the neck and brain and x-rays are taken. This test can help identify problems with the major blood vessels of the neck and brain. Numbing medicine is used where the catheter enters the body, but there may still be some minor discomfort with this test.
Brain cells usually die within minutes to a few hours after the stroke starts. Other brain cells in the area of the stroke may also be affected, but have a chance of being saved. The ability for these surrounding brain cells to recover will depend on the type of treatment received and how soon it is obtained. Physicians now believe that early stroke treatment is most effective when the person is able to get to a hospital in less than 4 hours of the onset of symptoms.
- Thrombolytics. (Clot-busting or clot-dissolving drugs). These help to restore blood flow to the brain and prevent or lessen the damage by dissolving the clots. For maximum benefit, it must be given within a certain timeframe after the stroke symptoms start (generally about 3 hours). TPA or tissue plasminogen activator is one example of this type of medication. It has been shown to be effective in improving recovery after stroke. Patients must meet certain criteria to be eligible for TPA.
- Antiplatelets (such as aspirin). These help to prevent blood clotting by preventing platelet function. Platelets are the part of the blood that have the capability of sticking to each other or to parts of the vessel wall, causing clots to form. There are several antiplatelet medications available. Some may have minor side effects. These should not be used without your doctor’s recommendation.
- Anticoagulants (such as Heparin and Warfarin). These work to delay blood clotting. They do this by interfering with the production of certain blood components that are necessary for the formation of blood clots. They tend to work by slowing down the blood clots from getting larger. This helps to prevent the current stroke from getting worse. It also helps to prevent new strokes from occurring.
- Antihypertensives (high blood pressure medication):
- When used for stroke prevention: Studies have shown that lowering blood pressure to normal ranges can greatly decrease the risk of stroke. There are several antihypertensive medications available. Each work in different ways and have various side effects.
- When used for acute stroke treatment: Adequate blood flow to the injured brain during a stroke is very important. So it is often necessary to allow blood pressure to run higher than normal during the first days after stroke. This is done so that oxygen and nutrients can reach the affected areas of the brain.
- Experimental/research medication. Several different types of medications are being tested for their effectiveness in stroke prevention and treatment. Certain criteria must be met before patients may be considered for any of the research studies in progress.
Other treatments for stroke:
Maintenance of blood chemistry. Further injury to brain tissue after stroke can be limited by control of blood chemicals such as magnesium, calcium, glucose, and sodium. Monitoring of blood chemistry may be ongoing until the physician recommends otherwise.
Supportive measures. More patients die from complications of stroke than from the stroke itself. High quality patient care with careful attention to known stroke complications (such as respiratory difficulties, lung infections, or blood clots in the legs) and early rehabilitation efforts have been shown to improve recovery and increase survival.
Surgical intervention. The carotid arteries, located on each side of the neck, are the main arteries that supply the brain with blood. Over time a build-up of fatty deposits may occur in these arteries and cause a narrowing or blockage. If the blockage is severe enough, it may cause a stroke by preventing the passage of blood up into the brain. An operation called a carotid endarterectomy may be recommended to remove the blockage and reduce the risk of having a stroke or stroke symptoms.
Other types of treatment involve removing blood clots or arteriovenous malformations. Clipping or coiling aneurysms to prevent further bleeding, and placing stents inside narrowed blood vessels may also be suggested or recommended.
What can be changed?
- High blood pressure. High blood pressure is one of the most important risk factors for stroke. It produces direct injury to blood vessels and increases the chance for stroke. High blood pressure that continues over a period of years also damages the heart. Blood pressure can often be controlled by maintaining a low-fat, low-salt diet and by maintaining proper weight. Exercising regularly, and drinking alcohol only in moderation, if at all, will help. Medications to control blood pressure are available, and may be prescribed by your physician. If blood pressure is controlled, the risk of stroke is significantly reduced.
- Cigarette smoking. People exposed to tobacco smoke—their own or someone else’s—develop atherosclerosis more frequently and more severely than people not exposed to it. Smoking also raises blood pressure and makes the heart work harder. Quitting smoking and avoiding second-hand smoke will help to decrease the risk for stroke.
- TIA’s (Transient Ischemic Attacks) People who have had a TIA are at an increased risk for having a stroke. Recognizing and treating TIAs can decrease your chance of having a stroke. TIAs should never be ignored—seek medical attention immediately.
- Cartoid or other artery diseases
- Heart disease. People with heart problems have a much greater risk for stroke than people with normal hearts. Some people who have had a stroke have a heart condition called atrial fibrillation. In this disease, the upper chambers of the heart do not beat normally. They are said to beat irregularly. This may lead to the formation of blood clots in the heart. If a clot is pumped out of the heart, it may block the blood flow to the brain and cause a stroke. Atrial fibrillation and other heart diseases may be managed with help from your physician. Reducing the risk of heart disease will reduce the risk for stroke.
- Alcohol. It has been noted that heavy alcohol consumption appears to be strongly associated with stroke. More than two alcoholic beverages per day may raise blood pressure levels, and high blood pressure is a strong risk factor for stroke. It is recommended that alcohol intake be limited to no more than one glass of wine or the alcohol equivalent per day.
- Blood cholesterol and Lipids. Elevated blood cholesterol and lipids (fats) increase the risk of heart disease. This is because it contributes to the development of atherosclerosis, or “hardening of the arteries.”
- Obesity. Obese people are more likely to develop high blood pressure or diabetes, and to develop heart disease. All of these will increase the risk for stroke. Losing excess weight and maintaining a low-fat diet will decrease the risk for stroke.
- Physical inactivity. Regular exercise helps to fight heart disease and other conditions related to stroke, such as high blood pressure, obesity and elevated blood lipid levels. Staying active will help to prevent stroke. Check with your physician before starting a new exercise program.
- High Red Blood Cell Count. Increased red blood cells in the body will thicken the blood. This increases the risk for clots to form. A high red blood cell count may be detected on a routine physical exam by doing a complete blood count. It is treatable by removing blood or by giving medications such as “blood thinners.”
What cannot be changed?
- Age. The older a person gets, the greater the risk of stroke. Stroke can occur at any age, but most strokes affect people age 65 or older.
- Heredity. The risk for stroke is greater if there is a family history of it. This may be because some of the risk factors of stroke may also be linked to heredity.
- Gender. Men have a slightly higher risk for stroke than women. But women in the U.S tend to live longer than men, so most people over age 65 who have had a stroke are women.
- Prior stroke, TIA or heart attack. Having had one stroke increases the likelihood of having another.
- Race. African Americans are more likely than other ethnic populations to have a stroke. This may be because African Americans are also more likely to have high blood pressure, which is a major risk factor for stroke.
- Diabetes Mellitus. Diabetes seriously increases the risk of heart disease, which is a risk factor for stroke.
Marshfield Area Stroke Support Group
What is the purpose of the support group?
- To offer a forum for stroke survivors to meet others facing similar challenges and to support each other in a positive way.
- To provide caregivers and family members a structured approach for supporting each other.
- To offer stroke survivors and their families resources and support to live active and satisfying lives, including recreational and social opportunities.
- To promote a better understanding of stroke recovery, rehabilitation, prevention and overall wellness.
Who can attend?
This group is open to stroke survivors, their family members, friends and caregivers.
When and where does it meet?
Meetings are held once a month. Location may vary.
For more information about this group, including up-to-date meeting dates/location, or to be added to our mailing list, call Ministry Saint Joseph’s Hospital, Monday – Friday at 715.389.3969.
The following is a list of possible resources for your use. Ministry Saint Joseph's Hospital does not endorse any of the resources.
Local (Marshfield) Resources
Marshfield Clinic Department of Neurosciences: Operates an active stroke program, with emphasis on the identification, treatment and prevention of cerebrovascular disorders. 800.0782.8581 ext. 75350
Marshfield Area Stroke Support Group: Provides an opportunity for stroke survivors and their families to attend educational sessions as well as socialize. For more information, call 715.389.3969.
American Academy of Neurology: Provides valuable resources for medical specialists worldwide who are committed to improving the care of patients with neurological diseases. aan.com 651.695.1940
American Association of Retired Persons: A non-profit membership organization dedicated to addressing the needs and interest of persons 50 years and older; through information and education, advocacy and service, the AARP seeks to enhance the quality of life for all by promoting independence, dignity and purpose. aarp.org 888.687.2277
American Heart Association: Provides information and referrals, videotapes and newsletters about stroke. americanheart.org 800.242.8721
American Stroke Association: Ask for the stroke family warmline to talk with a stroke survivor or caregiver, receive a list of stroke support groups in your area. strokeassociation.org 888.478.7653
National Stroke Association: Organized to save lives, improve quality of care and increase patient outcomes of those who have had a stroke by providing education, services and community based activities in prevention, treatment, rehabilitation and recovery of stroke. stroke.org 800.787.6537