Connecticut doctors explain stroke warning signs and treatment after Sen. Murphy’s hospitalization

After U.S. Sen. Chris Murphy was hospitalized following a stroke, and with doctors expressing confidence that he will recover fully, Connecticut medical experts offered guidance on the warning signs of a stroke and what steps to take if symptoms appear.

The American Stroke Association, part of the American Heart Association, uses the acronym B.E. F.A.S.T. to help identify symptoms. It stands for balance loss, eye changes, face drooping, arm weakness, speech difficulty and the need to call 911 right away.

“A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts (or ruptures). When that happens, part of the brain cannot get the blood (and oxygen) it needs, so it and brain cells die,” the American Stroke Association said.

The association says strokes are the No. 4 cause of death and a major source of disability in the United States.

Dr. Megan Shue, a vascular surgeon at Middlesex Health, said symptoms can include sudden numbness or weakness in an arm or leg, abrupt confusion and trouble speaking, and that any of these signs should prompt an immediate trip to the emergency room.

“There may be sudden confusion and difficulty speaking. You might think that you’re speaking, and whoever you’re speaking to has difficulty understanding you. If you have sudden vision loss in one or both eyes. A severe headache, very, very severe headache without any other known cause. For some people, it shows up as difficult walking, dizziness, lack of coordination or balance,” Shue said.

Strokes can happen when a clot blocks blood flow to the brain, known as an ischemic stroke, or when a blood vessel ruptures, causing a hemorrhagic stroke. The American Stroke Association also describes a mini stroke, or transient ischemic attack, as a temporary clot. Shue noted that most strokes are ischemic.

Gary L. Bernardini, MD, PHD, chief of Neurology and director of the Stroke Center at Bridgeport Hospital, said a stroke is essentially a blockage in a brain vessel that prevents oxygen and nutrients from reaching the brain. He stressed that stroke symptoms come on suddenly and that anyone experiencing B.E. F.A.S.T. signs should call 911 immediately.

Bernardini said one treatment depends heavily on speed, making it important to note the exact time symptoms begin.

“Don’t call your primary care, don’t go to urgent care. Call 911 so you can go to the closest stroke center,” Bernardini said.

For an ischemic stroke, which makes up about 80% of cases, the first treatment is often a clot-busting drug given intravenously in the emergency room, Bernardini said.

“The clot buster can go to where the clot is in the brain and dissolve it,” Bernardini said. “We have a time window for that to get to the emergency room within 4 1/2 hours of the stroke onset.”

He said determining the start time is more difficult when symptoms are first noticed upon waking.

“What’s happening now is that stroke care is advancing, so we’re about to extend that intravenous thrombolysis time window to nine hours if you meet certain criteria, based on some of the brain imaging,” Bernardini said.

Another option is endovascular therapy, a more invasive procedure that can be used within 24 hours. In that treatment, doctors guide a catheter from a groin vessel up into the brain and remove the clot.

“Sometimes either or both of those procedures can completely reverse the stroke symptoms,” Bernardini said.

Bernardini said strokes can happen at any age, and that Murphy, at 53, is within one of the peak age ranges for stroke. He said major risk factors for ischemic stroke include high blood pressure, high cholesterol, heart disease and diabetes.

“Although he’s young, sometimes you can have an arrhythmia of the heart called atrial fibrillation, which comes on suddenly and you wouldn’t feel anything. It’s a risk for stroke, when the heart is not pumping correctly and you go into a-fib. You can actually flow clots up to the brain vessel,” Bernardini said.

“I don’t know the mechanism of what they found with Senator Murphy and sometimes it takes a little while to figure that out. It could really happen at any age. It’s all the risk factors of diabetes, cholesterol and high blood pressure,” he added.

Hartford HealthCare neurologist Catherine Hosley said it is critical to seek treatment as soon as stroke symptoms begin.

“Every minute, every second we are losing brain cells from (a) stroke,” Hosley said. “The chance of recovery goes lower and lower and, unlike the liver and other parts of the body, once they die, they don’t come back. We have to save each and every brain cell from dying as much as possible, and time is one of the major reasons.”

Hosley said the public updates on Murphy suggest a very encouraging outcome. She also said routine visits with a primary care doctor are important for controlling risk factors and choosing the right treatment to help prevent stroke.

“Before even having stroke symptoms, if you are on the right medications, you can prevent (a) stroke. If you had a mini stroke or a small stroke, and once you are found to have risk factors if you focus on them, you can really prevent strokes from happening,” Hosley said.

Dr. Jennifer Russo, medical director of Gaylord Specialty Healthcare’s Inpatient Acquired Brain Injury Service, said she treats stroke patients across age groups.

“I think because Senator Murphy is so prominent and someone we all know, it highly brings home the fact that stroke can happen to anybody at any time,” Russo said. “We have a full young stroke recovery program here at Gaylord that specifically focuses on taking care of folks who are still in a phase of their life where they’re working.”

Russo said high blood sugar, high blood pressure, weight concerns and smoking are modifiable risk factors that can be addressed through regular medical care and yearly checkups to help lower long-term stroke risk.

“Our goal of regular medical care is to try to keep you healthy as long as possible. I think in my field, things happen to people that we don’t expect, and those things happen at any time, and you just have to do your best,” Russo said.

“I do think having somebody who’s young and who’s, in all accounts, seems very vital and engaged and active to hear that he’s had a stroke, I think is shocking for a lot of folks with his youth and visibility. It points out that we never know what is coming,” she said about Murphy. “I do think as we also see him recover and return to his job and his roles and in our society, I think it also can highlight, in a positive way, what can come after that. We hope he is able to have the success story that he gets back to the life that he’s used to living.”