Your Stroke Questions Answered by Dr. Fadi Nahab

During May, Emory Healthcare likes to promote awareness and education about National Stroke Month. Below are the most common stroke questions answered by Fadi Nahab, MD.

Your Stroke Questions Answered

Q: How does someone know when they are having a stroke?
A: Strokes come on suddenly, and there are specific symptoms that show you are having a stroke. Know the acronym FAST:

  • Facial asymmetry – droop. If you are smiling, and one side is not rising.
  • Arms – If you put both arms in front of you, and one arm does not come up or one side is drifting down
  • Slurred speech – trouble getting your words out
  • Time- time to call 911

These three symptoms are present in 75% of strokes. Other symptoms include the worst headache of your life, trouble seeing (in one or both eyes), and confusion.

Q: If you have one of the symptoms, can that vary the type of stroke you will have or how severe it will be?
A: The number of symptoms that occurs depends on what part of the brain is involved. If a stroke occurs to a larger portion of the brain, you will have more symptoms.

Q: My sister passed away last year as a result of shower strokes. Will you explain what a shower stroke is?
A: It’s difficult to know exactly what is meant by a “shower stroke” however occasionally ischemic strokes can occur due to multiple blood clots going up to different parts of the brain causing simultaneous strokes. The multiple blood clots are sometimes referred to as a “shower” of clots to the brain.

Q: Does stroke ultimately lead to death?
A:  It can. Currently, the national numbers are 1 in every 4 stoke cases lead to death. However, it is more common for stokes to lead to disability.

Q: Will men and women experience stroke symptoms differently?
A: Most symptoms are actually similar between men and women. Some studies show that women are more likely to present with headaches, lightheadedness, or fatigue associated with additional stroke symptoms. However, symptoms between men and women are more similar than they are different.

Q: If someone is having a stroke at home, would a family member call 911 or drive the person to the hospital themselves?
A: Call 911. The stroke itself can actually worsen that can lead to difficulties breathing. Ambulance services also have the capability of pre-notifying the stroke center before their arrival. At Emory Healthcare hospitals this prenotification by EMS mobilizes our stroke team to be ready when the patient arrives, reducing the time to evaluation and treatment.

Q: Are some people more at risk of having a stroke than others?
A: Yes. The number of risk factors a person has contributes to their overall risk of stroke. The good news is that many of the risk factors for having a stroke are preventable and it is estimated that 80% of strokes are preventable. Following healthy dietary and exercise habits along with close monitoring of risk factors with your physician effectively reduces the stroke risk.

Q: Are there different types of certifications to be a stroke center?
A: Yes, the goal behind these different designations are to guide emergency medical services (EMS) to centers that specialize, manage, and treat stroke victims most effectively. The highest level is a comprehensive stroke center which provides all services required to manage a stroke patient from the most simple to the most complex stroke cases. This effectively covers emergency treatment available 24/7, rehabilitation, follow up, and prevention. Primary stroke centers provide some acute emergency needs but not all of the capabilities. Acute Stroke Ready Hospital are hospitals that have linked up with larger hospital systems that allow them to provide emergency care and then immediately transfer the stroke patient to the primary or comprehensive hospital.

Q: If someone has already had a stroke, do they need to be regularly checked by a doctor?
A: Typically after a stroke, we want to see patients within the first month after discharge. It is important to review lifestyle habits, if they are tolerating medications, etc. After risk factors are well controlled and the patient is on the right path in their rehabilitation, we usually recommend that patients follow-up on an annual basis at the minimum to maintain long-term goals of stroke prevention.

About Fadi Nahab, MD

Fadi Nahab, MD is the Medical Director for the Stroke Program. He is a Board certified vascular neurologist and his practice is based at Emory University Hospital, The Emory Clinic and Emory University Hospital Midtown where he sees new patient referrals. His research interests include evaluation and treatment of cryptogenic stroke (strokes of unknown cause), the role of dietary behaviors on stroke prevention, acute stroke treatment, the safety and role of intracranial stenting in the treatment of intracranial atherosclerotic disease, and the evaluation and management of transient ischemic attacks (TIAs).

To learn more about strokes, visit emoryhealthcare.org/stroke

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Traumatic Brain Injuries (TBI) Explained

Severe traumatic brain injuries affect people of all ages and are a leading cause of death and disability among young adults and adolescents. According to the Centers for Disease Control and Prevention, traumatic brain injuries were involved in 2.5 million emergency room visits, as well as the death of nearly 50,000 people in 2013. Motor vehicle accidents account for the majority of these injuries, but they can also result from falls and violence. Regardless of the cause, treatment is divided into three stages: early management of life-threatening conditions, prevention of secondary injury and long-term rehabilitation.

Early Management of Life-Threatening Conditions

Immediately after a trauma, paramedics identify injuries and begin treatments to stabilize a patient’s breathing and blood pressure. The patient is then rapidly transported to a trauma center that quickly diagnoses and begins treating a wide variety of injuries. Shortly after the patient arrives in the emergency room, a CT scan of the brain is obtained to identify life-threatening blood clots within the skull. A fracture of the skull or a torn artery can cause bleeding on top of the covering of the brain known as an epidural hematoma. Epidural hematomas are often emergencies requiring immediate surgery to remove the blood clot and stop the bleeding. Similarly, bleeding can occur underneath the covering of the brain and lay directly on top of the brain itself, which is referred to as a subdural hematoma. Subdural hematomas can occasionally resolve without surgery; however, many are large and require surgical removal. Surgery to remove blood from inside the skull is an emergency, with untreated patients suffering permanent disability or death.

Prevention of Secondary Injury

Once the life-threatening injuries have been treated and the patient has stabilized, doctors then focus on preventing “secondary” brain injuries. Just like your arm, when the brain is injured it can form a bruise and swell. If swelling becomes severe, pressure can build inside the skull and cause damage to the previously uninjured brain. It is often necessary to place a tube into the brain, called an external ventricular drain, to monitor the pressure inside the skull. This tube also drains spinal fluid to help decrease pressure. If the swelling continues to worsen despite this treatment, a decompressive hemicraniectomy may be necessary to temporarily remove a portion of the patient’s skull. This allows for the brain swelling to continue and not cause further damage to the normal, healthy brain. This stage can persist for over a week.

Long-Term Rehabilitation

As swelling begins to recede and injuries to other parts of the body are treated, the focus shifts towards maximizing a patient’s long-term recovery. This often requires a prolonged period of inpatient rehabilitation with vigorous physical and cognitive exercise, as well as a slow and frustrating process lasting for months.

The most important aspect of caring for patients with traumatic brain injuries is having an experienced and cohesive team capable of delivering rapid, high-quality care during all phases of a patient’s recovery. The first few hours and days can be stressful for families and loved ones as the patient’s condition changes rapidly while the later stages require patience as the progress is slow. It is important to ask questions of your doctors to understand the current goals of therapy. Taking notes and writing down questions can be helpful, particularly early on as you will meet many doctors and nurses with different roles. Many patients, especially young adults often affected by severe traumatic brain injuries can make remarkable recoveries with aggressive treatment.

Emory Rehabilitation for Brain Injuries

At Emory, we understand the complicated needs of patients during this recovery process and have a dedicated group of physicians and therapists focusing exclusively on rehabilitation following a severe brain injury. To learn more information about our rehabilitation services, visit www.emoryhealthcare.org/rehab.

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About Christopher Deibert, MD

Christopher Deibert, MD, is an Assistant Professor of Neurosurgery at the Emory University School of Medicine. His specialty interests include malignant and benign brain tumors, high and low-grade glioma, metastatic brain cancer, trigeminal neuralgia, hemifacial spasm, traumatic brain injury, acoustic neuroma, carpal tunnel, normal pressure hydrocephalus, Chiari malformation, idiopathic intracranial hypertension, spinal stenosis and degenerative disc disease.

Dr. Deibert’s research interests focus on neurocognitive outcomes in patients with brain tumors, functional applications of radiosurgery and clinical applications of fiber tractography/diffusion-tensor imaging. Dr. Deibert completed his neurosurgical residency at the University of Pittsburgh Medical Center, where he also received his medical doctorate.

Sleep Apnea and the Gender Difference

What is Sleep Apnea?

Sleep apnea is a common disorder where one’s breathing involuntarily and repeatedly starts and stops during sleep. There are three different types of sleep apnea with separate root causes:

  • Obstructive Sleep Apnea (OSA)– the most common form that occurs when the throat muscles relax
  • Central Sleep Apnea – occurs when the brain does not send the correct signals to the muscles that control breathing
  • Mixed Sleep Apnea – occurs when someone has both obstructive sleep apnea and central sleep apnea.

Obstructive sleep apnea can have serious health consequences including high blood pressure, heart disease, stroke, pregnancy complications, metabolic disorders, and cognitive and behavior disorders, and higher risks for car crashes and work-related accidents. Central sleep apnea has health consequences associated with heart failure, opioid use, strokes, and brain injuries.

Signs and Symptoms

Commons signs:

  • Reduced or absent breathing
  • Frequent loud snoring
  • Gasping for air during sleep
  • Restless sleep

Common symptoms:

  • Excessive daytime sleepiness and fatigue
  • Decrease in attention, concentration, motor skills, and verbal and visuospatial memory
  • Dry mouth or headaches when waking
  • Decreased libido
  • Waking up often during the night to use the bathroom
  • Irritability due to fatigue
  • Loud snoring followed by a period of silence

Did you know that sleep apnea in women is different compared to men?

Sleep Apnea in Women Compared to Men

Sleep apnea in women differs from men due to their individual set of hormones. Women’s sleep cycles are typically shorter and women deal with sleep deprivation differently compared to men. However, the prevalence of obstructive sleep apnea in women is similar to men after women experience menopause.

Studies have shown that women are less likely to be diagnosed with sleep apnea because of the subtle symptoms they experience, therefore many go undiagnosed. The signs in a female may not be as obvious as it is for men. It is commonly mistaken for depression, hypertension, hypochondria, and other disorders. Women experience subtle symptoms including:

  • More insomnia
  • Daytime sleepiness and fatigue
  • Trouble functioning during the day
  • Morning headaches and moodiness
  • Anxiety
  • Sleep disruption

If you think you are potentially suffering from sleep apnea, please call HealthConnection at 404-778-7777.

About Emory Sleep Center

The Emory Sleep Center provides state-of-the-art care for all types of sleep disorders, with the goal of providing expert service in a relaxed environment with comprehensive diagnostics and therapeutics. We offer all forms of sleep diagnostic testing, as well as traditional and cutting-edge therapies.

Learn more about the Integrated Memory Care Clinic

Getting Help for Dementia in Your Community

Getting Help for Dementia in Your CommunityAt Emory’s Integrated Memory Care Clinic (IMCC), we know that caring for family members or loved ones with Alzheimer’s disease or related dementias can be challenging, especially on your own. Thankfully, options for care exist within the community. Different options will be right for different patients, as some patients in the early stages of dementia won’t need nearly as much assistance or supervision as people with advanced dementia. We’ve included several options for community-based care below, ranked from the options with the least restrictions that provide the lowest amount of hands-on care to those with increased security and restrictions that provide the highest level of hands-on care.

Senior Centers

The Older Americans Act (OAA), originally enacted in 1965, provides resources for Senior Centers. There are currently more than 10,000 centers in the U.S. serving more than a million adults each day. These centers offer services like meal and nutrition programs, health, fitness, and wellness programs, transportation programs, social activities, education and arts programs and public benefits counseling. These are a good option for people in the very early stages of Alzheimer’s or related dementias.

Adult Day Programs

These programs offer a place for your loved one with dementia to go, interact with others, socialize and engage. These programs typically exist in a secure environment so patients can’t wander off and leave the facility. This becomes important for patients with cognitive impairment who could become lost in unfamiliar settings. The programming at facilities like these is created specifically for people with limited attention spans and cognition, so your loved one won’t become frustrated, and will be able to enjoy the activities.

Adult Day Programs are focused either on a medical or social model. Most programs are the social version. Adult Day Programs designed with a medical model can provide a higher level of care. For example, patients experiencing urinary incontinence will typically need to be in a program with a medical model.

Hours and days of the week vary by program, some offer weekday care only and others offer care on weekends. These programs typically offer a more affordable option to in-home care, as you can expect to pay anywhere from $35-$80 a day vs. paying in-home help a higher hourly rate.

Adult Day programs help keep dementia patients in their homes longer by keeping them socially engaged and giving them a structured routine. This may help your loved one sleep better, improve their health and give caregivers like you a much-needed break.

Respite Care: Residential or in-home

Respite care is very time-limited and can happen either in-home or in a residential facility. It provides temporary care when family members or caregivers need a break, has an emergency or needs to travel. You can arrange for shifts with home care to ensure coverage while you’re gone, and some assisted living or personal care homes do offer respite care in their facility. In this scenario, the patient would move into the community for a set amount of time, sometimes into a fully furnished room. Expect to pay for this out of pocket.

Assisted Living/Personal Care Home

These facilities can vary in size and in the level of care they provide. They can be large 100-apartment senior living communities or small 4-bed home with one person providing care. The biggest difference between the two is the ability of assisted living facilities to provide more help for people needing a higher level of care. And while these facilities can provide care for a loved one who needs more socialization or is difficult to care for at home, they still feel like homes, not skilled nursing communities. Larger communities can have activity directors with daily programming. These homes can have secure memory care units that include extra staff and increased security.

Skilled Nursing

Long-Term Skilled Nursing facilities (SNF) provide nursing home level care and are staffed by nurses and a medical director. These are usually the last option for many families, but they can be the best option for medically complicated patients or patients who can’t walk, transfer and ambulate. For bed-bound patients living outside their home, this level of care is almost required.

When IMCC patients move to Long-Term skilled nursing facilities like these, we transfer their medical care to the facility. From that point on, the SNF medical director manages all of the patient’s care. Medicare does not cover custodial care, and it can be expensive. Medicaid can pay for care in a skilled nursing facility. This can become the only option available for many families.

Use the link below or call 404-712-6929 to learn more about how the Integrated Memory Care Clinic can help.

Learn more about the Integrated Memory Care Clinic

The Integrated Memory Care Clinic

The Integrated Memory Care Clinic (IMCC) is a nationally recognized patient-centered medical home that provides primary care individualized for someone living with dementia and is designed to replace your current primary care provider. Our goal is to provide the best dementia-sensitive primary care. If you’d like to learn more about the IMCC, or think one of your patients or family members could benefit from our services, please contact our patient services coordinator at 404-712-6929.

To learn more, please visit Integrated Memory Care Clinic.

You’re Not Alone: A Mental Health Message for our Veterans

Veterans are 15x more likely to suffer from PTSD. If you have a service-related mental health issue, you’re not alone. Get help today.Our veterans and service members are some of the most brave men and women in our country. They’re passionate and disciplined when it comes to protecting and serving our country, which is a commitment we’re grateful for every day.

The invisible wounds of war

That bravery continues off duty as well — many carry the heavy weight of the sights and experiences they encountered while serving. Consider these statistics:

  • 20 percent of veterans who served in Iraq or Afghanistan suffer from depression or post-traumatic stress disorder (PTSD).
  • A 2014 JAMA Psychiatry study found PTSD to be 15 times more likely for veterans and service members compared to civilians. The same report found depression to occur 5 times more frequently among military members than civilians.
  • The same study from JAMA found 1 in 4 active duty military members suffer from a mental health condition.

PTSD, anxiety, traumatic brain injury (TBI), military sexual trauma (MST) and other mental health conditions can all occur as a result of military service. And, these health issues are every bit as serious as injuries we can see.

Healing these wounds

Our veterans and service members need access to quality mental health programs. They also need to know it’s okay to talk about their experiences. If someone you love may be suffering from a mental health issue, please check in with them regularly. Ask them how they’re doing and be ready to simply listen.

If you’re a veteran or service member suffering from any mental health symptom or condition, please reach out for help. Talk to a friend, family member or fellow veteran. Most importantly, don’t be afraid to seek professional help. You should never be embarrassed to get treatment for a mental health issue.

Honor our veterans and service members this Veterans Day by sharing this message with others. You can also help change the way the world sees mental health by taking the stigma-free pledge.

Do you want to learn more about the Emory Healthcare Veterans Program?

Yes, I want to learn more now.

Emory’s Veterans Program is Helping Heal the Invisible Wounds of War

military-familyEmory Healthcare launched Emory’s Veterans Program Sept. 1, a new program for veterans offering clinical care, research and education, focusing on comprehensive treatment for post-9/11 veterans suffering from Posttraumatic Stress Disorder (PTSD), Traumatic Brain Injury (TBI), anxiety, depression and conditions stemming from Military Sexual Trauma (MST). Comprised of several initiatives committed to the health and wellbeing of veterans, including Wounded Warrior Project’s newly established Warrior Care Network, Emory is one of four academic medical centers that make up the national network offering quality mental health care for post-9/11 veterans, at no cost to qualified individuals.

“Our program focuses on helping heal the invisible wounds of war, particularly posttraumatic stress disorder and traumatic brain injury,” says Barbara Rothbaum, PhD, director of Emory’s Veterans Program and professor of psychiatry and behavioral sciences at Emory University School of Medicine.

According to research conducted by RAND Corporation, about 18.5% of Operation Iraqi Freedom and Operation Enduring Freedom veterans suffer from PTSD or depression, and 19.5% report having experienced a traumatic brain injury during deployment.

Emory’s Veterans Program is collaborative by design and incorporates top specialists in psychiatry, psychology, neurology, rehabilitative medicine and wellness into a treatment team that assess each veteran’s needs in order to develop a comprehensive, individualized treatment plan.

“It is important to be able to meet a veteran where he is, and provide individualized treatment plans using a collaborative approach,” says Rothbaum. “We’re so committed to this that we have hired veterans to fill critical positions within the program to ensure we are appropriately meeting the needs of the service members we treat.”

Treating victims of military sexual trauma is another aspect of Emory’s Veterans Program. According to the Department of Veterans Affairs, an estimated 20,000 service members, both male and female, endured military sexual trauma in 2014 alone, ranging from sexually hostile work environments to rape. Treatment often involves prolonged exposure therapy that incorporates virtual reality technology as well as other types of therapy and medications.

Collaborating with the Center for Deployment Psychology and several other organizations, Emory’s Veterans Program strives to enhance providers’ ability to deliver quality care to veterans. The program provides free, specialized training to community behavioral health providers in understanding military culture and how it plays a part in the treatment of service members.

For more information about Emory’s Veterans Program, visit www.emoryhealthcare.org/veterans. To reach the Care Coordinator, call 888-514-5345.