Time is brain: Why you should ‘BE FAST’ when responding to a stroke

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May 19, 2020, 2:59 PM | Updated: May 20, 2020, 1:51 am


A stroke can happen to anyone at any time. In the United States, someone has a stroke every 40 seconds. Millions of nerve cells in the brain die every minute that a stroke goes untreated, which increases the risk of lasting neurological deficits.

“Time is a critical feature in getting the best possible stroke care,” said neurologist Michael Waters, MD, PhD, director of the Stroke Program at Barrow Neurological Institute. “The more quickly you present to a stroke center, the better the possibility of saving brain tissue and achieving a better outcome.”

While the risk of having a stroke more than doubles each decade after age 55, strokes can occur at any age. Nearly one-fourth of strokes occur in people under the age of 65. They include young adults and adolescents.

But knowing the signs and symptoms of a stroke can save lives.

“Oftentimes, the person suffering from a stroke is unaware of the symptoms or is not concerned about them,” Dr. Waters said. “Remember, our brain is our alert system, so if it is injured it may not sound an alarm. Knowing the signs and symptoms with the acronym BE FAST improves the response time from symptom onset to presentation to a stroke center.”

Signs of Stroke: BE FAST

B: Balance – Is there a sudden loss of balance or coordination?
Eyes – Is there sudden blurred vision, double vision or other vision trouble?

F: Face – Ask the person to smile. Is one side or are both sides of the face drooping?
Arms – Ask the person to raise both arms. Does one side drift downward? Is there weakness or numbness on one side?
Speech – Does the person have slurred or garbled speech? Can he or she repeat simple phrases?
Time – Call 911 for immediate medical attention if you notice one or more of these signs. Also, take note of when the symptoms began.

Barrow Stroke Program

It matters where you get your care. If you or your loved one has a stroke, rest assured that the stroke specialists at Barrow will be here for you 24 hours a day, seven days a week. Barrow offers comprehensive, compassionate care from prevention to diagnosis, emergency treatment and recovery.

The Barrow Stroke Program is a Stroke Center of Excellence, with accolades including a 2019 Get With the Guidelines Stroke Gold Plus Quality Achievement Award and an American Heart Association/American Stroke Association Target Stroke Honor Role Elite Plus Award.

The Barrow stroke team includes board-certified vascular neurologists, fellowship-trained cerebrovascular and endovascular neurosurgeons, stroke-certified and neuroscience-certified registered nurses, neuro-rehabilitation therapists, and care coordinators.

Stroke Prevention

Strokes caused by a clot, known as ischemic strokes, account for about 87 % of all strokes. The remaining 13 % are hemorrhagic strokes, which occur when a weakened blood vessel in the brain ruptures and bleeds into surrounding brain tissue.

Up to 80 % of clot-related strokes may be preventable. While we can’t change risk factors such as age, family history, race, and gender, we can mitigate several others through lifestyle changes and working with a health care provider. These include high blood pressure, high cholesterol, smoking, diabetes, physical inactivity, obesity and poor diet.

Barrow Neurological Institute offers a Stroke Prevention Clinic to help individuals understand and manage their stroke risk. Each patient receives an in-depth assessment from experts, educational materials, and access to support and resources for managing their risk factors.

Stroke Diagnosis & Treatment

Barrow has advanced the care of stroke patients in the pre-hospital setting through the Barrow Emergency Stroke Treatment Unit. Launched in partnership with the Phoenix Fire Department, the mobile stroke unit functions like an emergency room on wheels. It is equipped with a portable computed tomography (CT) scanner to identify whether stroke symptoms are caused by a clot, bleed or a condition mimicking a stroke.

The mobile stroke unit is always staffed with a CT technician and at least one stroke-certified registered nurse, who can administer the clot-busting drug tPA before the patient even arrives at the hospital. The team uses live telemedicine technology to connect with the on-call stroke neurologist, who evaluates the patient over video and reviews the CT images remotely.

“Phoenicians are fortunate to have one of a handful of mobile stroke units in the world,” Dr. Waters said. “We have already demonstrated that by taking the stroke center to the patient, rather than the reverse, we can shave critical time off initiating life-saving treatment.”

Barrow is also home to neurosurgeons with special training in cerebrovascular and endovascular surgery. Hemorrhagic stroke patients cannot be treated with tPA, and many ischemic stroke patients benefit from endovascular therapy.

“Barrow Neurological Institute has made a tremendous amount of progress over the past few years in refining our stroke systems of care,” said endovascular neurosurgeon Andrew Ducruet, MD. “We provide a tremendously effective treatment, mechanical thrombectomy, for patients with large vessel occlusion strokes—the most deadly subtype of stroke.”

At Barrow, we utilize the most advanced imaging technologies available, which allows us to screen patients for potential emergency treatment as far out as 24 hours from symptom onset. Centers without these technologies have a 4.5-hour treatment window.

Stroke Recovery

Neuro-rehabilitation is important for making the most complete recovery possible after a stroke. It can begin in the hospital in our inpatient unit, where patients have access to a diverse team of highly trained specialists. They include speech, physical and occupational therapists; rehabilitation physicians; neuropsychologists; neuroscience nurses; and social workers.

When patients are ready to return home, they can continue their physical, speech and occupational therapy in our Outpatient Neuro-Rehabilitation Center. Social workers and recreational therapists provide additional assistance with returning to work, school, and community activities.

“What continues to set Barrow apart in the treatment of stroke patients is our CARF-accredited team-based approach and access to cutting-edge technologies to facilitate the greatest change in the shortest period of time for our patients,” said rehabilitation program coordinator and physical therapist Al Biemond, DPT.

Barrow is a leader in the use of neuro-robotics for rehabilitation, enabling people with neurological injuries to reach a level of function and independence they never thought possible. Barrow has also partnered with Arizona State University’s engineering program to develop new neuro-robotic technologies.

Stroke Research

In addition to offering exceptional patient care, Barrow is a major center for stroke research in the Southwest—from basic science studies to clinical trials.

Barrow neurologist David Wang, DO, recently collaborated with researchers in Wuhan, China to study the effects of COVID-19 on the nervous system.

“One of the unexpected consequences of the COVID-19 pandemic is the neurological involvement of the disease,” Dr. Waters said. “Though it is correctly considered a respiratory illness, a multitude of neurological symptoms have been clearly identified, including prevalence of stroke, loss of taste and smell, and altered cognition with confusion and disorientation.”

Our stroke team reminds the public not to delay or avoid visiting the emergency room during the COVID-19 situation if they are having symptoms of stroke.

“It is critical to remember that stroke is a medical emergency,” Dr. Ducruet said. “Time is brain, and the faster you seek medical care the better your outcome can be. So if you or your loved one experiences signs and symptoms of a stroke, please do not hesitate to call 911.”

If you remember one thing about stroke, we hope it is to BE FAST.

To learn more about the Barrow Stroke Program, visit or call (602) 406-6262.

Barrow Neurological Institute


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