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Care after a stroke just as critical as the initial treatment

The first step to control a stroke is to break down the clot or stop the bleeding that caused it, but that’s only the beginning of a stroke emergency.

The after-effects of the stroke can be just as serious. UF Health Jacksonville closely monitors post-stroke patients and begins their rehabilitation process in its specially-designated Neuroscience Intensive Care Unit.

“Many of these patients are very, very complicated,” explained the unit’s medical director, neurointensivist Stuart Glassner, DO, an assistant professor of neurology at University of Florida College of Medicine – Jacksonville. “The brain affects the heart and the lungs in a number of ways. Most people don’t realize it’s not just the stroke itself that causes damage.”

Depending on what part of the brain was affected by the stroke, breathing can become labored, temperatures can fluctuate and secretions can leak into a patient’s airway. Heart problems can arise, such as an extreme change in blood pressure. Risk factors like hypertension, diabetes and high cholesterol can further complicate the patient’s condition.

Glassner said stroke patients should be observed in the unit before returning home regardless of any initial symptoms of secondary effects.

“A stroke is an insult to the brain, and it swells kind of like when you get an external injury,” he explained. “We see maximum swelling generally three to five days (after a stroke). I bring patients to the unit because they’re likely to decline before they get better.”

An intensive care unit dedicated to neurology patients

The Neuroscience Intensive Care Unit is always staffed with two attending physicians and seven advanced registered nurse practitioners (ARNPs) who are highly trained in neurocritical care. Facilities with less-specialized stroke programs don’t have the luxury of keeping stroke patients together in a specialized unit, and their staff is less likely to have the specific neurology training that makes a Comprehensive Stroke Program so effective in treating stroke patients.

The specialized ICU monitors patients’ motor responses, pressure in the brain, breathing, temperature, blood pressure and other factors that could reveal secondary effects of a stroke, the onset of another stroke or a conversion from an ischemic stroke to a hemorrhagic stroke. The staff uses a continuous EEG to keep an around-the-clock watch on the patient’s brain function. The velocity of blood flow is even monitored through the brain’s blood vessels with a transcranial Doppler (TCD).

“The unique technology we have and our expert, super-subspecialized team offers therapies that aren’t available elsewhere,” said neurointensivist Christopher Hopkins, MD, an assistant professor of emergency medicine specializing in surgical critical care, who is Glassner’s counterpart in the ICU.

Hopkins said the unit has the technology to “take over” a patient’s breathing, blood pressure, sugar levels and body temperature as needed to help guide the person through the secondary effects of the stroke.

Thanks to the program’s association with the College of Medicine, the Comprehensive Stroke Program is also involved in research that keeps the team on top of the ever-evolving modalities used to combat strokes.

“We’re participating in cutting edge clinical trials and constantly discussing new ways to treat strokes,” Hopkins said.

In addition to treating the emergency changes in patients’ vital signs, the Neuroscience Intensive Care Unit helps stroke patients begin rehabilitation. Studies have shown the sooner a patient begins rehab, the more likely that person is to have a successful recovery.

The long-term effects of a stroke can include paralysis, mental issues, trouble speaking and emotional problems. Pain or numbness is also a common side effect. The hospital’s neurologic rehabilitation program provides physical, occupational and speech therapy.

A longstanding record of excellence

UF Health Jacksonville’s stroke program has been in place for 18 years, leading the way in care for stroke patients. The Comprehensive Stroke team is also teaching future stroke specialists through multiple fellowships and residencies related to stroke treatment.

The stroke program was one of the first in the nation to use helicopters to transport stroke patients, vastly increasing the reach of the Stroke Center. It continues to serve Duval and 12 surrounding counties in Northeast Florida and Southeast Georgia. UF neurologists also were the first in Jacksonville to routinely administer tissue plasminogen activator (tPA), the only clot-busting drug approved by the FDA for stroke patients nationwide. And there will be many more firsts.

As the program continues to grow, it’s an exciting time for vascular neurologist Scott Silliman, MD, an associate professor of neurology who has been the stroke program’s medical director since it began in 1996.

“We’ve entered a new era in the stroke program that’s allowing us to take care of the entire gamut of stroke patients,” he said. “A stroke can lead to a wide variety of problems, and we have the unique skill set and team members to be able to treat them.”

To learn more about the Comprehensive Stroke Program, visit ufhealthjax.org/stroke.

 

This is the final article in our five-part Striking Out Strokes series. Click on the links below to read the rest of the series:

Striking out strokes with an all-star stroke team

Stroke patient grateful for receiving the “clot buster,” IV-tPA

Treating hemorrhagic strokes a different ballgame than ischemic strokes

Neuroradiology is a key component in a stroke emergency

Featured Faculty

Scott L. Silliman, MD

Scott L. Silliman, MD

Professor
Medical Director, Comprehensive Stroke Program; Program Director, Neurology Residency; Program Director, Vascular Neurology Fellowship