What Happens When You Have a Stroke? A Behind the Scenes Look

Each year, the Acute Stroke Team at Baystate Medical Center cares for more than 1,700 patients who have experienced a stroke. That’s more than any other hospital in western Massachusetts. Learn what happens in the crucial first minutes and hours after a stroke, and what to expect when you arrive at the hospital.

If you notice you or someone you're with is having a stroke, be prepared to act fast. What happens after a stroke, in terms of brain damage, death or survival, depends on fast and appropriate action.

“Time is crucial and the longer you wait to get care, the more damage occurs to your brain cells,” says Dr. Rajiv Padmanabhan of the Department of Neurology at Baystate Health. 

How Does a Stroke Happen?

A stroke (also called a "brain attack") happens when something blocks or disrupts the brain's blood supply. Most strokes happen because a blood clot blocks an artery or a blood vessel in the brain or neck breaks. When this happens, the brain doesn’t receive the oxygen it needs and parts of the brain become damaged or die. Brain cells begin to die within minutes without the oxygen they need.

What Happens in the First Hours?

A person having a stroke may experience numbness or weakness on one side of the body, confusion or trouble speaking or seeing, and trouble walking. If you recognize the signs of stroke, call 911 right away — stroke is an emergency. The first minutes and hours are crucial.

When you get to the emergency department, the team will take action right away to prevent more damage to brain cells. They will work to stabilize you or your loved one and figure out what kind of stroke you have. Treatment depends on the type of stroke.

Emergency Departments Must Act Fast

Dr. Padmanabhan, who serves as medical director of the Stroke Program, notes that Baystate is also ready to act quickly once the Emergency Department receives notice that a stroke victim is on their way to the hospital.

Efficient and reliable communication between hospital emergency departments and emergency medical services (EMS) teams is essential for patients to get the immediate care they need, especially in time-sensitive cases such as a stroke.

Emergency Team Communication

Thanks to ground-breaking technology using secure two-way EMS to ED communications, paramedics can notify the Baystate Medical Center Emergency Department (or its EDs at Baystate Wing Hospital in Palmer, Baystate Noble Hospital in Westfield, and Baystate Franklin Medical Center in Greenfield) to mobilize its stroke team – neurosurgeons, neurologists, emergency doctors, radiologists, physiatrists, and other team members so they can be ready for the patient to arrive. Also, when local EMS providers transport a patient who has experienced a stroke, Baystate’s EDs stay in constant contact in order to speed up the patient’s care.

Timely Stroke Treatment

Two million brain cells die every minute during a stroke. As time passes, your risk of permanent brain damage, disability or death goes up. Stoke patients are rushed directly from the emergency department to radiology for a CT scan that takes pictures of their brain and blood vessels. If there is bleeding, the radiology team will consult a neurosurgeon. If there is no bleeding, the care team may recommend thrombolytics — a way of breaking up the blood clot causing the blockage.

When given within 4.5 hours of the stroke, thrombolytics may help reduce the impact of the stroke. Earlier is better, and people have the best results if treatment begins within 90 minutes of the start of the stroke.

If the care team finds that a large blood vessel is blocked, the patient may go to the cath lab (cardiac catheterization laboratory – a specialized area where provide minimally-invasive treatments) for a procedure to remove the clot and open the blood vessel back up. Mechanical thrombectomy involves inserting a thin metallic stent-like device into an artery in the leg. The surgeon then threads the device up to the blockage in the brain. The device opens up to immediately restore blood circulation, eventually grabbing onto the clot and pulling it out.

Making a Stroke Recovery Plan

After either receiving a clot busting drug and/or neuroendovascular intervention, patients are admitted to the ICU to be closely monitored for 24 hours. They move next to hospital’s Neuro Unit, where they will be evaluated by rehab physicians and therapists who will develop a personalized plan for their recovery.