Time is brain: for every minute a stroke is left untreated, 2 million brain cells are destroyed. The sooner patients are treated, the higher the chances of survival with fewer disabilities. Patients with acute strokes and transient ischemic attack (TIA) are assessed and treated at the right place, the right time and by the right professionals thanks to ultra-specialized stroke centres at the Montreal General Hospital and The Montreal Neurological Institute and Hospital.
THE NEURO BECOMES A CENTRE FOR TERTIARY STROKE CARE
The Quebec government has designated the Montreal Neurological Hospital - The Neuro, part of the McGill University Health Centre as a centre for Tertiary Stroke Care. Designated centres treat victims of hyper-acute stroke, which is a stroke that has occurred within 10-12 hours before the patient’s arrival at the centre. To qualify for this distinction, the centre must have an Intensive Care Unit, an interventional radiologist, neurosurgeons, and beds dedicated to stroke patients.
SPECIALIZED RECEIVING AREA FOR STROKE PATIENTS
Rapid medical treatment is crucial for someone who suffers a stroke, which is why The Neuro has opened a highly-specialized Receiving Area (RA) for incoming stroke patients. The RA has taken over handling stroke patients who were being seen at the Royal Victoria Hospital Emergency Room before it moved from downtown Montreal to the Glen Yards site.
Now, patients with stroke symptoms get immediate attention in the RA, which is inside The Neuro’s Intensive Care Unit (ICU), when they arrive by ambulance. Ambulance staff rate stroke patients according to the Cincinnati scale. A positive Cincinnati rating considers symptoms such as slurred speech, facial droop and arm drift. Urgences Santé alerts the RA staff through a direct line to expect a patient’s arrival. Only about 10 per cent of patients are referred to the RA by doctors and clinics. The RA does not accept walk-in patients or telephone calls from patients or their families. On average, the RA admits about four stroke and non-stroke patients a day.
“Even though a patient has signs of stroke, it doesn’t necessarily mean a stroke,” says Siva Moonsamy, Managing Nurse at The Neuro’s ICU. “So within 15 to 30 minutes of a patient’s arrival to the RA, a neurological examination, CT scan and other tests are performed to confirm the diagnosis and a rapid course of treatment.”
The RA is managed as part of the ICU. A neuro intensivist and ICU nurses cover the unit 24 hours 7 days per week ensuring that emergency stroke patients are cared for at The Neuro expertly and without delay.
THE MGH BECOMES A CENTRE FOR SECONDARY STROKE CARE
The Montreal General Hospital (MGH) has been designated a secondary stroke centre. “The MUHC is the only medical institution in Quebec to have a tertiary and a secondary stroke centre,” says Neurologist Dr. Robert Côté, medical director of the MUHC Stroke Program. “Both units are ultra-specialized and provide rapid assessment, diagnostics and treatment for any type of stroke intervention.” The transformation of services is part of a stroke strategy put in place by the Ministry of Health to improve stroke prevention and healthcare services offered to the more than 12,000 Quebeckers who experience a stroke every year. For every one of them, time is of essence.
UPGRADED STROKE PREVENTION CLINIC IMPROVES HEALTH CARE SERVICES
The accreditation work at the two stroke centres had another major positive result. For the past year, the MUHC Stroke Prevention Clinic located at the MGH has been offering enhanced acute evaluation services to patients with a transient ischemic attack (TIA). A TIA produces similar symptoms to those of a stroke such as sudden weakness on one side of the body, face droopiness or difficulties finding words. It usually lasts only a few minutes and often causes no permanent damage, but should be taken seriously, because these patients are at higher risk of having a stroke. The clinic accepts referrals from emergency departments , general practitioners in the community and also has referral agreements with several GMF (Groupe de Médecine Familiale). It has the same access to radiology and ultrasound equipment as the Emergency Department so that all exams can be done as soon as is needed. It also follows up on patients recovering from a stroke and quickly refers them to rehab specialists. In addition, there is an agreement with Villa Medica for rapid stroke rehabilitation.
RESEARCHER AT THE NEURO WINS AWARD OF EXCELLENCE
The Heart and Stroke Foundation of Quebec bestowed the 2014 John J. Day Award of Excellence on Dr. Edith Hamel, a principal investigator at The Neuro. Her research focuses on neurons and other parts of the brain whose neurovascular interaction ensures a proper blood supply to activated brain areas. The prize includes a $10,000 award.
A multidisciplinary team provide expert care to stroke patients:
• Dr. Robert Côté, Vascular Neurologist, co-lead, MUHC stroke program
• Teresa Mack, Administrative Director, Neuroscience Mission, co-lead, MUHC stroke program
• Dr. Denis Sirhan, Vascular Neurosurgeon
• Dr. David Sinclair, Vascular Neurosurgeon
• Dr. Donatella Tampieri, Interventional Neuroradiology, co-lead MNH
• Dr. Jeanne Teitelbaum, Neurointensivist, co-lead MNH
• Dr. Lucy Vieira, Vascular Neurologist, co-lead MGH
• Dr. Mark Angle, Director, Professional Services
• Lucia Fabijan, Associate Director, Neuroscience Mission
• Antoinette Di Re, Director, Therapeutic hospital services
• Rosa Sourial, Senior Counsellor, Specialized Nursing Care
• Georgia Niarchos, Nurse Manager
• Christine Bouchard, Nurse Manager
• Heather Perkins, Nurse Clinician
• Nidale El Hachem, Nurse Clinician
• Elizabeth Pereira, Patient representative
FACTS ABOUT STROKE THAT YOU SHOULD KNOW
• 14,000 Canadians die of stroke each year---the third leading cause of death in Canada
• A total of fifty thousand strokes occur in Canada annually. That’s one stroke victim every 10 minutes
• Strokes kill more women than men
• Canada’s economy loses billions of dollars of productivity as a result of stroke patient treatment and lost time at work
• For someone who had a stroke, the risk of having a second one within two years increases by 20 %
WHAT IS A STROKE?
A stroke occurs when the natural blood flow to the brain is disrupted. An ischemic stroke occurs when there is an interruption in blood flow. Ischemic strokes are by far the most common stroke. There are also hemorrhagic strokes, caused by a ruptured blood vessel in the brain. Transient Ischemic Attacks (TIA) signify a high risk for stroke and need immediate attention. Someone who has had a TIA should be seen the same day for assessment and treatment.
Disrupted blood flow can cause brain damage, the extent of which depends on the brain region affected and for how long. For this reason, it is essential that a stroke victim seek medical treatment as soon as possible. If a victim can reach a hospital within three or four hours, doctors can administer drugs in cases of ischemic stroke, to limit significantly the extent of any potential brain damage.
The effects of stroke can be minor, in which case a victim can expect full recovery. But major effects of stroke can leave victims unable to speak, read or write, remember, or move normally.
People should be aware of the main warning signs of stroke: weakness, speech or vision problems, severe headaches, and disequilibrium. If these symptoms occur, people should see a physician immediately. The greatest risk factor for stroke is high blood pressure (hypertension), which affects one out of five Canadians.
The Montreal Neurological Institute and Hospital – The Neuro---is a world-leading destination for brain research and advanced patient care. Since its founding in 1934 by renowned neurosurgeon Dr. Wilder Penfield, The Neuro has grown to be the largest specialized neuroscience research and clinical centre in Canada, and one of the largest in the world. The seamless integration of research, patient care, and training of the world’s top minds make The Neuro uniquely positioned to have a significant impact on the understanding and treatment of nervous system disorders. The Montreal Neurological Institute is a McGill University research and teaching institute. The Montreal Neurological Hospital is part of the Neuroscience Mission of the McGill University Health Centre. For more information, please visit www.theneuro.com