With Vascular Neurologist David Stone, MD, & Stroke Program Coordinator Ben Doepker, RN

Patients across the U.S. continue to delay medical care amid COVID-19. A concerning repercussion of the pandemic, this trend is being seen at all levels — from people skipping routine screenings and preventative health checkups, to those ignoring the critical signs that emergency care is needed.

While skipping your annual physical may not have an immediate impact on your health, ignoring stroke symptoms likely will — and may have lifelong consequences, or worse. 

“A stroke is a life-threatening emergency that causes permanent brain damage,” explained Sarasota Memorial Vascular Neurologist David Stone, MD. “Approximately 1.9 million neurons die every single minute that you don't have blood flow going to that part of the brain. That significantly ages that person and causes disability and death.”

The faster you call 9-1-1 and get to the hospital, the faster doctors can start brain-saving measures and the greater your chance of recovery and retaining quality of life.

So what are the red flag signs for stroke? What should you do if you or someone else experiences them? 

To find out, we talked with Dr. Stone and SMH Stroke Program Coordinator Ben Doepker, RN. In this Ask An Expert Q&A, they discuss how to identify a stroke, when to call 9-1-1, how to prevent one and why COVID-19 is no cause for delay. 

Signs, Symptoms & Taking Action

What are the red flags of a stroke that indicate 9-1-1 should be called ASAP?

Doepker: If you have sudden onset of weakness on one side of the body, a sudden facial droop, a sudden speech impediment, not being able to speak — these are symptoms where you want to call 9-1-1 and seek medical attention immediately. 

People often delay coming in because they think their symptoms are going to improve or they're mild. They don't think it warrants a visit to the hospital. But all strokes present differently, and no one is ever the same as another. If you experience those symptoms, immediately call 911 and seek medical attention.

Even little strokes or little benign symptoms can lead to a bigger stroke, and could worsen very rapidly. 

Dr. Stone: Sometimes people have a Transient Ischemic Attack, a TIA, where they have stroke symptoms, but they resolve fairly quickly. It's still important for that patient to come to the hospital, because that means they are at a very high risk for stroke. The sooner we can figure out why that patient had that event, the sooner we can treat them effectively and reduce their risk of a major stroke. Do not wait.

Doepker: Strokes can happen very suddenly and be very devastating, but they can also happen over the course of minutes, hours and days. 

Why is it so important to seek care immediately for stroke symptoms?

Dr. Stone: Hospitals and comprehensive stroke centers like Sarasota Memorial have therapies that can limit the amount of damage that occurs to the patient's brain, but it's very important that these therapies are given quickly. 

The longer you wait, the less likely you are to be a candidate for these therapies, the less likely they'll work, and the more risky they are. The people who do the best are those who get here very early after recognition of their symptoms and are treated very quickly.

Why is it important to call EMS instead of driving to the hospital yourself?

Doepker: When you activate 9-1-1, a chain of events is put into action. The paramedics are going to respond. Then they're going to evaluate you, looking for symptoms of stroke. 

They will apply 2 different stroke scales, or stroke assessments. The first one is applied to the patient and says, “Yes, we think this is a stroke.” Then another is applied that says, “Yes, this is a possible major stroke. We need to bypass the primary center, and we need to go to a comprehensive stroke center like SMH, which can offer different therapies to care for this more severe stroke.”

At SMH, if we have that heads up, our Stroke Care team can assemble and be ready for you. If you drive your car and we don't have that heads up, it takes longer for our team to get together to treat you.

Have you seen people postponing necessary treatment for stroke symptoms because they're scared to come to the hospital amid COVID-19?

Dr. Stone: Unfortunately, yes. I have had patients who didn't come to the hospital at the onset of their stroke symptoms and they missed the opportunity for treatments to reduce disability from their stroke. 

I want to emphasize that the safest place for someone who's having stroke symptoms is the hospital. We take precautions to limit the spread of all infectious diseases, including COVID-19.

We have a team of doctors, nurses, pharmacists, technicians, phlebotomists and more waiting right inside of the ambulance bay doors to evaluate the patient. We get that patient to a CT scan or MRI and get a blood sample within a matter of minutes. We can make decisions and administer treatments quickly, in real time.

If stabilized, they're admitted to SMH’s specialized stroke unit for further testing and close monitoring. And during the hospitalization, we work hard to figure out why the patient had a stroke. We do this in order to treat the underlying cause of the stroke and to manage any risk factors that patient may have.

Stroke Risk & Prevention

“Stroke risk dramatically increases with age,” Dr. Stone explained. “A well-functioning 80-year-old person has about a 1-in-5 chance of having a stroke, though young people are also at risk, especially given increases in obesity and diabetes. It’s also estimated that 1 in 4 of those who have had a prior stroke will have another stroke in the next 5 years.” 

But the majority of strokes, about 80%, can be prevented. Preventing a stroke is not only important for saving lives, but also preserving quality of life.

“High blood pressure is far and away the greatest modifiable risk factor for ischemic and hemorrhagic stroke,” said Dr. Stone. “Controlling blood pressure would be one of the best things that people could do to reduce their risk of having a stroke.” 

Other risk factors include abnormal heart rhythm (A-fib), diabetes, high cholesterol, obesity, sedentary lifestyle, smoking, other types of vascular disease, excessive alcohol and illicit drugs.

“Unfortunately, half of all Americans have high blood pressure, and 1 in 3 don't realize it can significantly reduce life expectancy,” he added. “Talk to your primary care provider about your vascular risk factors. High blood pressure is something that's very easy to control, and it's a huge risk factor.”

Other stroke-prevention strategies include quitting tobacco, eating a healthy diet, having an active lifestyle and drinking alcohol in moderation.

Click here to learn more about Sarasota Memorial’s Comprehensive Stroke Center and our community resources for stroke survivors and their caregivers.