Comprehensive Stroke Care
It takes a specialized team to diagnose and treat strokes. Recognized by the Joint Commission as a Comprehensive Stroke Center, patients at the University of Michigan are treated by emergency medicine, neurology, neurosurgery and neurointerventional radiology physicians who are specially trained in stroke care. Vascular surgeons, cardiologists, internal medicine, and physical medicine and rehabilitation physicians are also part of the care team allowing U-M to offer care for those with a minor stroke to those in a more complex situation. Our team treats patients before, during and after suffering a stroke, through preventive, emergent and rehabilitative care.
Stroke Warning Signs
Abrupt onset of:
- Difficulty with speech
- One side of the face drooping or feeling numb
- Weakness or numbness on one side of the body
- Unexplained clumsiness or falling
- Sudden severe headache
If you or someone you know is experiencing these signs, call 911 or have someone get you to the nearest emergency room immediately.
Types of Strokes
Ischemic stroke – the most common form of stroke occurs when a blood vessel is clogged, thus preventing blood from flowing to the brain. Timing is critical for treating patients with ischemic stroke. Clot-busting medication (tPA) can be administered if the patient arrives quickly and tPA can be started within 3 hours after the symptoms started (up to 4.5 hours in some cases). In the last 18 months, UMHS has been 100% with administering IV tPA within 3 hours of the last known well time.
- Michigan average 81%
- National average 83%
In 2014 and 2015, UMHS demonstrated quick IV tPA treatment to eligible patients. More than 50% of patients were treated within 45 minutes or less and more than 75% of patients were treated within 60 minutes or less.
Providing IV tPA within 60 minutes:
- State of Michigan average is 65%
- National average 86.5%
In addition, those who are not getting better with clot-busting medication can be considered for minimally invasive procedures to remove the clot from clogged vessels. Equally important is to make sure that we understand why the stroke occurred. Some common reasons include:
- Clot from the heart
- Blockage of the blood vessels going to the brain
- Irregular rhythm of the heart that causes a blood clot to form
- High levels of cholesterol causing blockage
Once the reason for the stroke is identified, then proper medications are prescribed and preventive measures are taught to the family and patient so future strokes can be prevented.
Hemorrhagic stroke – is also referred to as a bleeding stroke and usually happens when a blood vessel becomes weak enough that it ruptures. High blood pressure is a major risk factor leading to blood vessel weakness. Sometimes the weakness leads to the development of brain aneurysms (an area of the blood vessel wall bulging out). Aneurysms can be treated before they bleed with open surgery to snap them shut with clips or minimally invasive surgery with coils. Our physicians have led national writing groups on the care of hemorrhagic stroke as well as participating in new trials in improving the treatment of patients with aneurysms.
Transient ischemic attack (TIA) – is also referred to as a "mini-stroke" or "warning stroke" and is a temporary interruption of the blood flow to an area of the brain. TIAs are an indication that someone is at risk for having a stroke. We are very aggressive about lowering the risk of a stroke in patients who have received this warning.
Patients who are high risk for stroke, like those with carotid artery disease and a history of high blood pressure, are screened and preventive measures are discussed and encouraged to decrease their risk for stroke. Patients are seen in the stroke clinic located in the Frankel Cardiovascular Center. Being part of a comprehensive team, we are able to collaborate with cardiologists, neurosurgeons, neuroradiologists and vascular surgeons for a preventive treatment plan. Together we use the latest scientific information to put the best stroke prevention plan into action for each patient. This may range from lifestyle changes to the most sophisticated testing and treatment to decrease stroke risk.
Stroke remains the fourth leading cause of death in the United States and is the leading cause of serious, long-term disability. Once a stroke has occurred, all attempts should be made to decrease the time from symptom onset to stroke treatment. The following performance measures were developed by the Joint Commission in collaboration with the American Heart Association/American Stroke Association (AHA/ASA).
We have systems set up so the Stroke Team is notified the moment a patient arrives in the Emergency Department. Members of the Stroke Team are in house 24/7 and promptly evaluate the situation and recommend appropriate treatment. For patients with the most severe strokes, our radiologists and neurosurgeons are available to perform interventions that may reduce the risk of disability including:
- Carotid endarterectomy, where a surgeon opens the carotid artery, removes plaque and sutures the artery back in place
- Stent placement, to open the clogged vessel
- Mechanical Thrombectomy, where a surgeon removes clot from brain blood vessels to prevent a permanent stroke
- Cerebral bypass, where a neurosurgeon attaches a normal artery to a blocked artery as to increase the blood flow to the brain
- Hemicraniectomy, procedure to reduce the pressure within the brain once a stroke has occurred
- Clipping/coiling, where a neurosurgeon removes an aneurysm from the blood vessel to prevent a subarachnoid hemorrhage
In the approximately 200 clipping and coiling procedures performed in 2015, none of our patients had any major complications.
Inpatient Stroke Care
Stroke patients at U-M are cared for in a dedicated Stroke Unit and Neuro-Intensive Care Unit (NICU). During the patient’s stay, vascular neurologists, neurosurgeons, neuroscience nurses with advanced training in stroke care, and a medical team containing experts in stroke treatment and complications, including physical and occupational therapists, speech and language pathologists and rehabilitation specialists all work together so patients can have optimal recovery for their individual situation. It has been shown that being treated on a dedicated stroke unit improves survival and functional outcome following stroke, as well as decreasing complications and length of hospital stays. The use of these specially-trained physicians and nurses has also been shown to significantly improve stroke patient outcome.
Patients begin working with occupational and physical therapists, and speech and language pathologists as soon as they are medically ready. If therapy is needed after discharge, we work with patients and their families to plan the best recovery strategies.
Accreditations and Recognition
The Stroke Program is accredited as a Comprehensive Stroke Center by the Joint Commission. Team members from the stroke program helped in authoring as well as participating in the American Stroke Association "Get With The Guidelines®" Quality Initiative. We have repeatedly been designated as an American Heart Association Gold Plus stroke hospital, the highest stroke quality designation. This award recognizes hospitals that provide consistently excellent care following evidence based guidelines. The AHA has recognized the quality of stroke care provided at U-M since 2005.
In May 2016 AHA/ASA presented UMHS with two awards – Stroke Get With the Guidelines Gold Plus and Target Stroke Honor Roll Elite Plus. UMHS is the first hospital in Michigan to receive the Target Stroke Honor Roll Elite Plus award.
If you think you or a loved one might be having a stroke, call 911. If you have had a stroke in the past or think you might be at risk for one call us at 1-888-287-1082.
If you are a stroke coordinator and want to find out more about our process or have questions, please contact Jenevra Foley, Operations Director, U-M Comprehensive Stroke Center at 734-615-9747 or CSCfirstname.lastname@example.org.