Stroke is the No. 3 cause of death across the United States after heart disease and cancer, as well as the leading cause of disability, wreaking havoc physically and mentally. In Rhode Island, 421 people died from stroke in 2006. Nationwide, about 795,000 strokes occur each year, killing 137,000 people.
Last year, following the advice of a statewide task force, the General Assembly approved the Stroke Prevention and Treatment Act of 2009, which created a comprehensive stroke care system in the state and required rescue units to take stroke patients to hospitals able to provide specialized care.
Dr. Brian Silver, the new director of the Rhode Island Hospital Stroke Center, answered questions about stroke and how to improve outcomes for patients.
PBN: You have done quite a great deal of specialized training in cerebrovascular disease, including three fellowships. What drew you to that field in particular?
SILVER: My father had a series of strokes while I was a teenager. At the time, I didn’t really understand why he was unable to speak and didn’t know what to do or expect. When I was in medical school and learned about how the brain worked, I decided that I wanted to pursue a career in stroke neurology. My interest is in improving access to emergency interventions such as tPA (a clot buster), improving prevention strategies, and discovering novel treatment strategies to improve brain recovery after stroke.
PBN: What is a stroke, and how is that different from a transient ischemic attack? How do you tell them apart, and are there differences in how you treat them?
SILVER: Stroke and TIAs both manifest as sudden weakness (usually on one side), sudden change in sensation (usually on one side), sudden loss of vision in one or both eyes, sudden confusion or difficulty speaking, and sudden difficulty walking. Strokes typically last more than an hour and show injury on a CT or MRI scan, while TIAs typically last less than an hour and do not show an injury pattern. Nevertheless, both are emergencies, and we employ the same treatment strategies, such as blood thinners (e.g. aspirin, warfarin), blood pressure control, cholesterol medications, cessation of smoking, carotid artery repair when appropriate, diet modification and exercise.
PBN: What does it mean to be a primary stroke center, and what difference does it make for patients when they’re treated at one?
SILVER: Primary stroke center designation means that an institution has achieved a standard of care that is in compliance with [national] Joint Commission requirements, from advising patients about smoking at the time of stroke, to prescribing the correct medications for stroke prevention, etc. These interventions are driven by research that shows improved patient outcomes when they are implemented.
The number of patients being treated at primary stroke centers has increased significantly in the last few years as more centers have become certified. The R.I. Stroke Prevention Act of 2009 is very important, because it helps hospitals to self-audit and improve their care. Most states do not have such an act, so Rhode Island is definitely a leader in that area.
PBN: I presume Rhode Island Hospital’s stroke center is the largest in the state, but are you also different in other ways?
SILVER: Rhode Island Hospital sees approximately 500 patients per year with ischemic stroke (blocked artery), 100 patients with TIA (a temporary stroke), and 300 patients with hemorrhagic stroke (a burst artery). Rhode Island Hospital has the only primary stroke center in the state with comprehensive services, including state-of-the-art neuro-imaging, a neuro-intensive care unit, interventional neuro-radiology, vascular neurosurgery, emergency medicine, medical critical care, pediatric neurology, physical therapy, occupational therapy, speech and language pathology, and many more.
PBN: Do you have specific goals as the center’s new director?
SILVER: One of my goals is to increase the percentage of stroke patients who receive early treatment with clot-busting drugs. We know that the earlier these medications are given, the better the outcomes. Another goal is to improve the options for stroke recovery treatments that are available to stroke victims. These options may include pharmacological, cellular and robotic interventions. Recovery treatments will be the next major advancement in stroke treatment. It’s feasible that some of these treatments will be available in the next decade.
