Safety and Health Reporter

Stroke

Fairfax Lawyer Brien Roche Addresses Stroke Issues

Brien Roche

Stroke: Ischemic or Hemorrhagic

Stroke is the fourth leading cause of adult death in the United States. By 2030 nearly one in every 25 adults will suffer a stroke.

Most strokes can be broadly categorized as either hemorrhagic or ischemic. Hemorrhagic strokes occur when a blood vessel ruptures, releasing blood into the brain tissue. An ischemic stroke results from reduced blood flow to the brain. Because 87% of all strokes are ischemic the medical focus is primarily on those types of strokes.

Strokes fall into four categories: resulting from injury; medication -induced; failure to recognize or treat a person about to have a stroke; negligent treatment of a person having a stroke.

As to strokes caused by injury, damage to the internal wall of an artery leading to the brain can cause a clot to form at the site of the injury. If the clot grows or a piece breaks off and travels to a smaller artery a stroke can result from the decreased blood flow to the brain. These types of injuries can result from blunt trauma to the neck or head or from rapid twisting of the neck or head as in a automobile collision.

Some people may experience increased propensity to clot due to medication they are taking. When these clots form in or travel to an artery leading to the brain a stroke may occur.

A transient ischemic attack (TIA) also called a mini stroke has the same symptoms as a stroke but goes away rapidly. They are an indication that a stroke may soon follow. One third of people who experience a TIA later experience a stroke and half of patients who suffer a stroke after a TIA do so within 48 hours.

Failure to timely treat a stroke generally involve the failure to recognize, appreciate or communicate its signs and symptoms; failure to implement treatment to restore blood flow; failure to implement treatment to prevent further interruption of blood flow. Stroke symptoms show themselves almost instantaneously when blood flow to the brain is interrupted. It is universally recognized that faster treatment improves the chance of a better outcome. The American Stroke Association maintains a information campaign stating that time lost is brain lost. Their acronym for symptoms and action is FAST: face drooping, arm weakness, speech difficulties, time to call 911.

Stroke Investigation

In investigating stroke cases it is important to determine the hospital’s stroke certifications and what promotional material it utilizes in the form of press releases or website information. It will be important to obtain the hospital policies and procedures pertaining to stroke, the criteria for activating a stroke code, the materials used to train personnel and standing orders on stroke treatment.

CT scanning is normally the first imaging done of a stroke patient. It is typically without contrast. This can be obtained rapidly and indicates whether the patient is neurologically fit for therapy that dissolves or breaks up a clot. It can take up to 24 hours for stroke to become visible on a plain, non-contrast CT. MRIs can detect brain ischemia within minutes of the onset of stroke but they are more commonly used to confirm the diagnosis. Brain scan images taken months after the stroke can be powerful exhibits as damaged brain tissue liquefies and is replaced with cerebral spinal fluid. Witnesses who have reviewed these images should be able to identify the parts of the body and bodily functions controlled by the area of the brain that the stroke appears to have damaged. These witnesses should also be able to confirm that there is no evidence of pre-existing damage on the images and that there is no known therapy that will restore these functions.

The damages that must be assessed are the loss of function, the effect on survivors, the cost of future care and future income loss.

A brain stroke involves the blockage or rupture of a blood vessel in the brain.  It can produce brain cell death.The first line of stroke treatment is the use of the clot busting stroke drug known as tPA.

Other treatment modes that are available consist of interventional radiology which uses catheters inserted into the brain to remove the clot.  This mode of treatment is important for those people who are not receptive to tPA.  The risk of tPA is that it enhances the possibility of bleeding. If the stroke is caused by a bleed then tPA makes the situation worse. The CT scan should detect any bleed.

In addition, if the stoke involved a rupture to a vessel then the catheterization process may result in closing the rupture.

The biggest danger of stoke is brain cell death.  Some of these brain cells can probably be saved if treated aggressively. 

Some research at the National Institute of Health has discovered that intravenous immunoglobulin can spare patients from this additional brain cell death. 

Although strokes are normally thought of as brain strokes there are other types of strokes that occur in other parts of the body that can likewise be quite devastating.

A ruptured aneurysm is typically a catastrophic event. An aneurysm may be in the brain or it may be in other parts of the body.  The ruptured aneurysm frequently leaves the patient barely conscious and in shock with massive internal bleeding.  Sometimes the heart may stop.

Ruptured Aneurysm: Abdominal Aorta

If the ruptured aneurysm is in the abdominal area then frequently it is found in the abdominal aorta.  That is the body’s largest artery.  What happens with an artery like that is that it slowly bulges, then balloons and then finally bursts.

Statistically only 50% of the people in this condition live to reach an operating room.  Of those, there is a 90% mortality rate.  Every minute that passes increases that mortality rate by 1%.

An aneurysm of this nature is frequently difficult to diagnose.  First an EKG needs to be done in order to determine whether or not the patient has suffered a heart attack.  If the patient reports pain in the abdominal area, that certainly is a clue.  In addition swelling of the abdominal area likewise is a clue that the patient has a ruptured aortic abdominal aneurysm.  That diagnosis is typically confirmed with an ultrasound.  At that point the patient needs to receive immediate transfusions.

Throughout this period of time CPR is being administered in order to prevent cardiac arrest.

In addition an anesthesiologist needs to be available to provide monitoring and also to oversee the infusion and transfusion equipment necessary for the surgery to begin.

The administration of anesthesia frequently causes the blood pressure to drop.  The surgeon then needs to open the abdominal area and sometimes compress the aorta in order to allow for resuscitation of the patient.  The area of the aneurysm needs to be quickly identified.  Clamps are placed on the portion of the aorta that is affected.  This allows the surgical repair of that aneurysm.  That prevents the life-threatening bleeding.  Meanwhile transfusion is keeping the patient alive with fresh blood.

The surgeon typically will replace the ruptured section of the aorta with a strong, durable artificial graft which allows blood to pass through it normally.

Post-surgically the wound is typically left open since there is going to be significant swelling from the injury and also from the surgery.  The open wound allows the swelling to occur without further complications.

Ruptured Aneurysm: Prevention

Ruptured abdominal aneurysms are preventable.  There is a 98% success when the aneurysm is detected by testing and repair through elective surgery.

People that are particularly at risk are men that are over 60, those who have had an immediate relative who had an abdominal aortic aneurysm, people with high blood pressure, smokers.

The best cure of course is prevention.  Medicare covers a one-time screening for these types of aneurysm.  If an aneurysm is detected that appears to be dangerous then elective surgery can be scheduled and the aneurysm can be prepared.

For more information on medical malpractice see the other pages on the site. For more information on stroke see also the pages on Wikipedia.

About Brien Roche Law

Brien Roche is an experienced medical malpractice attorney serving all of Northern Virginia, including Fairfax, McLean, Vienna, Burke, Annandale, Falls Church Reston, Centreville, Manassas, Alexandria, Herndon, Arlington, and Loudoun County. Call, or contact us for a free consultation. At Brien Roche Law, we put your interest ahead of the insurance company. You should not sign any Releases relating to your personal injury claim without having them reviewed by counsel. Likewise, you should not accept any checks from the insurance company unless you are prepared to reach a settlement with them. Typically, it is not advisable to do that until you know the full extent of your injury.

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Stroke

Fairfax Lawyer Brien Roche Addresses Stroke Issues

Brien Roche

Stroke: Ischemic or Hemorrhagic

Stroke is the fourth leading cause of adult death in the United States. By 2030 nearly one in every 25 adults will suffer a stroke.

Most strokes can be broadly categorized as either hemorrhagic or ischemic. Hemorrhagic strokes occur when a blood vessel ruptures, releasing blood into the brain tissue. An ischemic stroke results from reduced blood flow to the brain. Because 87% of all strokes are ischemic the medical focus is primarily on those types of strokes.

Strokes fall into four categories: resulting from injury; medication -induced; failure to recognize or treat a person about to have a stroke; negligent treatment of a person having a stroke.

As to strokes caused by injury, damage to the internal wall of an artery leading to the brain can cause a clot to form at the site of the injury. If the clot grows or a piece breaks off and travels to a smaller artery a stroke can result from the decreased blood flow to the brain. These types of injuries can result from blunt trauma to the neck or head or from rapid twisting of the neck or head as in a automobile collision.

Some people may experience increased propensity to clot due to medication they are taking. When these clots form in or travel to an artery leading to the brain a stroke may occur.

A transient ischemic attack (TIA) also called a mini stroke has the same symptoms as a stroke but goes away rapidly. They are an indication that a stroke may soon follow. One third of people who experience a TIA later experience a stroke and half of patients who suffer a stroke after a TIA do so within 48 hours.

Failure to timely treat a stroke generally involve the failure to recognize, appreciate or communicate its signs and symptoms; failure to implement treatment to restore blood flow; failure to implement treatment to prevent further interruption of blood flow. Stroke symptoms show themselves almost instantaneously when blood flow to the brain is interrupted. It is universally recognized that faster treatment improves the chance of a better outcome. The American Stroke Association maintains a information campaign stating that time lost is brain lost. Their acronym for symptoms and action is FAST: face drooping, arm weakness, speech difficulties, time to call 911.

Stroke Investigation

In investigating stroke cases it is important to determine the hospital’s stroke certifications and what promotional material it utilizes in the form of press releases or website information. It will be important to obtain the hospital policies and procedures pertaining to stroke, the criteria for activating a stroke code, the materials used to train personnel and standing orders on stroke treatment.

CT scanning is normally the first imaging done of a stroke patient. It is typically without contrast. This can be obtained rapidly and indicates whether the patient is neurologically fit for therapy that dissolves or breaks up a clot. It can take up to 24 hours for stroke to become visible on a plain, non-contrast CT. MRIs can detect brain ischemia within minutes of the onset of stroke but they are more commonly used to confirm the diagnosis. Brain scan images taken months after the stroke can be powerful exhibits as damaged brain tissue liquefies and is replaced with cerebral spinal fluid. Witnesses who have reviewed these images should be able to identify the parts of the body and bodily functions controlled by the area of the brain that the stroke appears to have damaged. These witnesses should also be able to confirm that there is no evidence of pre-existing damage on the images and that there is no known therapy that will restore these functions.

The damages that must be assessed are the loss of function, the effect on survivors, the cost of future care and future income loss.

A brain stroke involves the blockage or rupture of a blood vessel in the brain.  It can produce brain cell death.The first line of stroke treatment is the use of the clot busting stroke drug known as tPA.

Other treatment modes that are available consist of interventional radiology which uses catheters inserted into the brain to remove the clot.  This mode of treatment is important for those people who are not receptive to tPA.  The risk of tPA is that it enhances the possibility of bleeding. If the stroke is caused by a bleed then tPA makes the situation worse. The CT scan should detect any bleed.

In addition, if the stoke involved a rupture to a vessel then the catheterization process may result in closing the rupture.

The biggest danger of stoke is brain cell death.  Some of these brain cells can probably be saved if treated aggressively. 

Some research at the National Institute of Health has discovered that intravenous immunoglobulin can spare patients from this additional brain cell death. 

Although strokes are normally thought of as brain strokes there are other types of strokes that occur in other parts of the body that can likewise be quite devastating.

A ruptured aneurysm is typically a catastrophic event. An aneurysm may be in the brain or it may be in other parts of the body.  The ruptured aneurysm frequently leaves the patient barely conscious and in shock with massive internal bleeding.  Sometimes the heart may stop.

Ruptured Aneurysm: Abdominal Aorta

If the ruptured aneurysm is in the abdominal area then frequently it is found in the abdominal aorta.  That is the body’s largest artery.  What happens with an artery like that is that it slowly bulges, then balloons and then finally bursts.

Statistically only 50% of the people in this condition live to reach an operating room.  Of those, there is a 90% mortality rate.  Every minute that passes increases that mortality rate by 1%.

An aneurysm of this nature is frequently difficult to diagnose.  First an EKG needs to be done in order to determine whether or not the patient has suffered a heart attack.  If the patient reports pain in the abdominal area, that certainly is a clue.  In addition swelling of the abdominal area likewise is a clue that the patient has a ruptured aortic abdominal aneurysm.  That diagnosis is typically confirmed with an ultrasound.  At that point the patient needs to receive immediate transfusions.

Throughout this period of time CPR is being administered in order to prevent cardiac arrest.

In addition an anesthesiologist needs to be available to provide monitoring and also to oversee the infusion and transfusion equipment necessary for the surgery to begin.

The administration of anesthesia frequently causes the blood pressure to drop.  The surgeon then needs to open the abdominal area and sometimes compress the aorta in order to allow for resuscitation of the patient.  The area of the aneurysm needs to be quickly identified.  Clamps are placed on the portion of the aorta that is affected.  This allows the surgical repair of that aneurysm.  That prevents the life-threatening bleeding.  Meanwhile transfusion is keeping the patient alive with fresh blood.

The surgeon typically will replace the ruptured section of the aorta with a strong, durable artificial graft which allows blood to pass through it normally.

Post-surgically the wound is typically left open since there is going to be significant swelling from the injury and also from the surgery.  The open wound allows the swelling to occur without further complications.

Ruptured Aneurysm: Prevention

Ruptured abdominal aneurysms are preventable.  There is a 98% success when the aneurysm is detected by testing and repair through elective surgery.

People that are particularly at risk are men that are over 60, those who have had an immediate relative who had an abdominal aortic aneurysm, people with high blood pressure, smokers.

The best cure of course is prevention.  Medicare covers a one-time screening for these types of aneurysm.  If an aneurysm is detected that appears to be dangerous then elective surgery can be scheduled and the aneurysm can be prepared.

For more information on medical malpractice see the other pages on the site. For more information on stroke see also the pages on Wikipedia.

About Brien Roche Law

Brien Roche is an experienced medical malpractice attorney serving all of Northern Virginia, including Fairfax, McLean, Vienna, Burke, Annandale, Falls Church Reston, Centreville, Manassas, Alexandria, Herndon, Arlington, and Loudoun County. Call, or contact us for a free consultation. At Brien Roche Law, we put your interest ahead of the insurance company. You should not sign any Releases relating to your personal injury claim without having them reviewed by counsel. Likewise, you should not accept any checks from the insurance company unless you are prepared to reach a settlement with them. Typically, it is not advisable to do that until you know the full extent of your injury.

Contact Us For A Free Consultation

Contact Us For A Free Consultation