Vol. 8 No. 2
October 1998

  • Winthrop Dedicates The New Life Center for Labor/Delivery/Recovery

  • Multiple Sclerosis Treatment Program Opens at Winthrop

  • Elected Officials Congratulate Winthrop-University Hospital on Receiving New York's Largest Individual Hospital Award from the New York State Health Workforce Retraining Initiative

  • Winthrop is Designated a Community Training Center for Life Support

  • Winthrop-University Hospital's Stroke Team....A Team Approach to Saving Lives

  • Winthrop Opens New Breast HealthCare Program Educational Health Forums Are Planned for October

  • Winthrop's Center for Crohn's Disease and Colitis Helps Patients Achieve Relief and Remission

  • Winthrop's Pulmonary Rehabilitation Program and Lung Center Participate in a Prestigious International Trial

  • Winthrop Home Health Care Gives People the Option of Living at Home - Rather than in a Long Term Care or Skilled Nursing Facility

  • Winthrop Dedicates The New Life Center

  • Dr. Douglas Katz Is a Co-Developer of CTVPA: A Modification of Spiral CT Scanning of the Chest for Suspected Blood Clots

  • A Third Cardiac Catheterization Laboratory Opens at Winthrop

  • Pediatric Cardiology at Winthrop

  • Women's Cardiology Program at Winthrop-University Hospital Takes Three-Pronged Approach

  • Winthrop's First Multiple Myeloma Patient Acheives Complete Remission through Stem Cell Autologous Transplantation Therapy

  • Perspectives In Health

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    • Sudden weakness or numbness of the face, arm, or leg
    • Sudden dimness or loss of vision, particularly in one eye
    • Sudden difficulty in speaking or understanding speech
    • Sudden severe headache with no known cause
    • Unexplained dizziness, unsteadiness, or sudden falls, especially in combination with any of the above signs.
    Adopted from the National Stroke Association

    If someone you love were stricken with stroke, would you recognize the symptoms? It pays to know the symptoms of stroke, now more popularly known as "brain attack" - and to become familiar with the stringent time frame for the most effective treatment.

    Diagnosis and treatment of a brain attack must begin as soon as possible. That's why it is reassuring to know that Winthrop-University Hospital's dedicated Stroke Response Team initiates care for stroke patients, right in the Emergency Department. Every team member wears a special stroke beeper, to alert them immediately to the admission of potential stroke patients. Led by Elzbieta J. Wirkowski, MD, Winthrop's Director of Cerebrovascular Disorders, Division of Neurology, the Stroke Response Team includes Board Certified neurologists, neuroradiologists, neurosurgeons, vascular surgeons, cardiologists, Emergency Department physicians, and rehabilitation specialists. The Stroke Nurse, Stephanie Manzella, RN, BS, is also the Stroke Educator for Winthrop's Nursing staff, and for patients and their families.

    "Time is essential in treating stroke patients effectively, and the Winthrop Emergency Department does an excellent, coordinated, highly skilled job," says Dr. Wirkowski. "Triage, blood work, examination, and CT Scan are accomplished within one hour of the stroke patient's arrival in the Winthrop Emergency Department." As CT Scan and MRI imaging are used to diagnose stroke, the department's two CT Scan Rooms are ready for action 24 hours a day. (CT Scanning is also a preliminary diagnostic screen for brain hemorrhage.) And as a Level I Trauma Center, Winthrop's Emergency Department is also equipped with a helicopter pad.

    Stroke is the third leading cause of death in the United States, just behind heart disease and cancer, and is one of the leading causes of disability. More than 500,000 people will develop a new or recurrent stroke this year, and 50,000 people will experience a Transient Ischemic Attack - TIA - with 1/3 developing stroke within five years. More than 3,000,000 people in the United States are stroke survivors.

    There are two types of stroke. Ischemic strokes, accounting for 85% of all strokes, are caused by blood clots, either stationary (thrombosis) or circulating through the blood stream (embolism). Hemorrhagic stroke - causing 15% of total strokes - is most commonly caused by hypertension, or high blood pressure. The real danger of hemorrhagic stroke lies in the potential flow of blood from the damaged brain, causing increased intracranial pressure, swelling, and herniation or strangling of the brain tissue. Aneurysms, trauma, and tumors can also cause hemorrhagic stroke. Stroke occurs in people of all ages. Young stroke patients show a greater incidence of dissection of the major blood vessels than other age groups. Abusers of cocaine or steroids are also more prone to strokes than non-abusers.

    Elzbieta J. Wirkowski, MD, Director of Winthrop's Cerebrovascular Disorders Unit, Division of Neurology (seated, left) and Stephanie Manzella, RN, BS, Stroke Nurse (right), are members of Winthrop's Stroke Team, and wear special Stroke Beepers.

    If the diagnosis is stroke, and the patient is deemed medically appropriate, the Stroke Team will oversee the intravenous administration of Tissue Plasminogen Activator - TPA - one of the most effective pharmaceutical treatments for stroke. TPA must be administered within the golden timeframe of up to three hours from the onset of symptoms. "TPA cannot be given in other cases, because of the potential of a serious intracranial bleed," warns Dr. Wirkowski.

    TPA is still a fairly new therapy, approved by the United States Food and Drug Administration in l996. Winthrop administered TPA to its first patient in September, l996, and during l997, treated 14 of a total of 600 stroke patients with TPA. Winthrop patients who receive TPA are found to be hospitalized only half as long as those who receive standard treatments. Those who miss the window of opportunity for TPA receive standardized treatment with antiplatelet or antithrombotic agents. Some medications can be administered intra-arterially by a neuroradiologist.

    "The Winthrop Emergency Department does an excellent, coordinated, highly skilled job," says Dr. Wirkowski. Triage, blood work, examination, and CT Scan are accomplished within 60 minutes of the stroke patient's arrival in the Winthrop Emergency Department."
    Elzbieta J. Wirkowski, MD
    Director of Cerebrovascular Disorders
    Sequence of Events:
    Winthrop's Comprehensive Response to Stroke

    In a typical stroke episode, the diagnosed stroke patient would be admitted to Winthrop's Medical Intensive Care Unit for approximately 24 hours, to undergo continuous monitoring of oxygen levels, vital signs, and neurological status. The nurses' role is particularly demanding, because many stroke patients are aphasic - suffering a loss of language - and cannot alert their nurses to pain, numbness, dizziness, deterioration, or changes in status.

    Ms. Manzella, the Stroke Nurse, coordinates all stroke-related services, assesses hospitalized stroke patients, ensures that stroke patients begin physical therapy within 24 hours of admission, and actively participates in Winthrop's ongoing research trials. Ms. Manzella has also initiated a monthly Stroke Support Group as part of her education program for patients and their families. Sometimes surgery is the best option. "Stroke patients with a significant degree of stenosis - vascular narrowing - are recommended for vascular surgical interventions," adds Dr. Wirkowski, who works closely with Winthrop's Thoracic and Cardiovascular Surgical Service, which supports the stroke program with surgical interventions.

    As Winthrop's stroke patients might be referred to external skilled nursing facilities and rehabilitation centers, Stroke Team members personally visit every facility, to ensure that they meet Winthrop's requirements, in terms of programs and quality.

    Research Trials Will Save Lives and Speed Recovery Tomorrow
    Two years ago, Dr. Wirkowski initiated a stroke database at Winthrop, to track and map the occurrence and type of strokes treated. She also documents Winthrop's TPA experience, and presented the findings in October 1998, to the North American Stroke Association's meeting of the Canadian, American, and Mexican Stroke Associations in Cancun, Mexico.

    New pharmaceutical trials of experimental medications are beginning at Winthrop, to determine more about neuroprotective agents that improve patient outcome by helping to save areas of the brain which are ailing. Winthrop is also participating in a National Institute of Health (NIH) sponsored Vitamin Stroke Study focussing on outpatients. Dr. Wirkowski is actively recruiting other innovative pharmaceutical trials to Winthrop. As part of the community outreach plan, Dr. Wirkowski will speak with local Senior Citizens and their families about "Stroke and Mini Stroke" at an upcoming Winthrop Health Update program on March 8, l999 at the Mineola Community Center, 155 Washington Avenue, Mineola, 9:30 AM - 11 AM. For further information on any component of the Stroke Program at Winthrop, call Dr. Wirkowski at 516/663-4525.

    • Sudden blackouts
    • Loss of consciousness
    • Dizziness
    • Transient weakness of the face, leg, or arm
    • Blurring of vision
    • Slurring of speech
    The symptoms are transient, abating within several minutes to a day, usually with no obvious functional deficits.

    Be vigilant: TIA is not just an afterthought. It can be a precursor of a Cerebrovascular Accident (CVA), which occurs in 25% of TIA patients within one year.

    Tips to help avoid stroke:

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