Stroke is an emergency. Don’t take chances. Call 911 if you or a loved one has signs of stroke. Do not drive yourself, and go to the nearest emergency room immediately.
Don’t let a stroke or other cerebrovascular condition mean the end of your independence and quality of life. The team at the Tulane Health System Neuroscience Center offers comprehensive care — from diagnosis and treatment to follow-up care. We have the expertise, technology and resources to minimize damage, help recover your health and functioning, and make the most of your capabilities so you can get back to your life.
Symptoms of a Stroke: BE FAST!
- Balance unstable
- Eye sight blurry
- Facial weakness
- Arm weakness
- Speech slurred
- Time is Critical. Call 911!
Comprehensive stroke center
Our stroke center offers 24-hour endovascular stroke care, so no matter what time you come to Tulane Neuroscience Center with signs of stroke, a stroke specialist will see you in a matter of minutes. We have three neurosurgeons trained in open and endovascular techniques, a respected team of other specialists. We also use advanced telemedicine technology to offer our expertise for those in rural or distant locations by communicating electronically.
The Tulane Stroke Program is certified by the Joint Commission as a Comprehensive Stroke Center — the first in Orleans Parish. The American Heart Association has awarded the Tulane Medical Center Stroke Program with its “Gold Plus” recognition, and Tulane is the first in the state to receive the “Target: Stroke Honor Roll - Elite Plus” award, the highest achievement awarded by the American Heart Association.
What are cerebrovascular disorders?
A cerebrovascular disorder affects the arteries that supply blood to the brain. Some examples include:
- Arteriovenous malformation (AVM)
- Carotid, vertebral and intracranial stenosis
- Dural arteriovenous fistula (DAVF)
- Carotid-cavernous fistula
A stroke happens when poor blood flow to the brain results in cell death. It only takes a few minutes for cells to start dying, so time is critical. A stroke is a medical emergency that can cause lasting brain damage, long-term disability or even death.
There are two types of stroke — ischemic and hemorrhagic. Ischemic stroke is by far the most common and happens when an artery that supplies blood to part of the brain becomes blocked, often by a blood clot. A hemorrhagic stroke occurs when an artery in the brain leaks blood or ruptures (bursts). The pressure from the leaked blood damages brain cells. High blood pressure and aneurysms are often the cause of hemorrhagic stroke.
Your risk for stroke is higher if you:
- Have high blood pressure
- Have a lot of fat around your abdomen
- Have diabetes
- Are not physically active
- Have an unhealthy diet
- Have more than 30 drinks per month
- Have heart disease
- Are depressed or under great stress
- Have migraine headaches
Women may be at higher risk if they:
- Are pregnant
- Take birth control pills
- Use hormone replacement therapy (HRT)
Symptoms can depend on the part of the brain that is affected. Classic symptoms of stroke include:
- Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body
- Sudden confusion
- Trouble speaking, or difficulty understanding speech
- Sudden vision problems in one or both eyes
Women may not always have the classic signs of stroke, so symptoms can be mistaken for something else. Our team is highly experienced in recognizing and treating stroke in women.
Women’s symptoms can be vague and may include:
- Loss of consciousness or fainting
- General weakness
- Difficulty breathing or shortness of breath
- Confusion, unresponsiveness or disorientation
- Sudden behavioral change
- Nausea or vomiting
If blood flow to part of the brain is only temporarily blocked, the result is a transient ischemic attack (TIA) or “mini-stroke.” The Tulane Neuroscience Center provides comprehensive diagnosis, treatment and care for TIA, and will take steps to help prevent strokes in your future.
A brain aneurysm is a weak or thin spot on a blood vessel in the brain that balloons out and fills with blood. This bulge can put pressure on a nerve or surrounding brain tissue. The aneurysm may also leak or rupture, spilling blood into the surrounding tissue and possibly causing serious complications, including hemorrhagic stroke, permanent nerve damage or death.
Most aneurysms cause no symptoms until they rupture, but early symptoms may include:
- Pain above and behind the eye
- Numbness, weakness or paralysis on one side of the face
- Dilated pupils
- Vision changes
When an aneurysm ruptures, you may have:
- A sudden, severe headache
- Double vision
- Nausea or vomiting
- Neck stiffness
- Loss of consciousness
- Drooping eyelid
- Sensitivity to light
- Changes in your mental state or awareness
Anyone can get an aneurysm. Your risk for rupture may be higher with high blood pressure, alcohol abuse, drug abuse (particularly cocaine) and smoking.
Arteriovenous Malformation (AVM)
An AVM is a knotted tangle of arteries and veins that are connected to each other. They may form before birth, but they are usually diagnosed in adulthood. AVMs interfere with the blood circulation in the brain or other organs. The greatest danger is hemorrhage (sudden and severe loss of blood).
Symptoms of an AVM can include:
- Muscle weakness
- Loss of coordination
- Changes in vision
- Language problems
Carotid, Vertebral and Intracranial Stenosis
Stenosis is the narrowing of an opening in the body, such as in an artery or vertebrae. Three kinds of stenosis can affect different parts of the nervous system.
- Carotid stenosis. In carotid stenosis, the carotid arteries in the side of the neck are narrowed, which can lead to stroke.
- Vertebral (spinal) stenosis. This involves the narrowing of the open spaces within your spine, which can put pressure on your spinal cord and nerves, and cause numbness, weakness and other symptoms.
- Intracranial stenosis. Intracranial stenosis is the narrowing of an artery inside your brain, which can lead to stroke.
Dural Arteriovenous Fistula (DAVF)
A dural arteriovenous fistula (DAVF) is an abnormal connection between arteries and the dural sinuses, which are venous channels (veins) in the outermost membrane of the brain. The dural sinuses collect blood from veins of the brain. A DAVF can cause stroke-like symptoms, seizures and brain hemorrhage, which can lead to permanent disability and death. If the DAVF is behind the eye, you may have decreased vision and redness and swelling of the eye. If it is behind your ear, you may hear a pulsating noise (tinnitus) from the blood flowing rapidly through the fistula.
A carotid-cavernous sinus fistula (CCF) is an abnormal connection between an artery in your neck and the network of veins at the back of your eye. This condition can put pressure on the cavernous sinuses (small spaces behind the eyes) and the surrounding nerves.
Symptoms can include:
- A bulging or red eye
- Double vision
- A loss of vision
- A swishing or buzzing sound coming from your eye
- Trouble moving your eyes
- Facial pain
- Ringing in your ears
How are cerebrovascular disorders diagnosed?
When it comes to diagnosing cerebrovascular disorders, time is critical. For instance, the most effective treatments for reversing stroke must be provided very soon after a stroke — within no more than three hours — in order to be effective. The Tulane Neuroscience Center has a comprehensive system for rapid diagnosis and treatment of cerebrovascular disorders.
To diagnose your condition and assess its severity, we may perform:
- Neurological exams
- Blood tests
- Electrocardiogram (ECG, EKG). This test records the heart's activity by measuring electrical currents through the heart muscle.
- Brain and blood vessel imaging by:
- Computed tomography (CT). This type of X-ray uses a computer to make pictures of the brain.
- Magnetic resonance imaging (MRI). This test uses magnetic waves to make pictures of the brain.
- Ultrasonography. This test uses sound waves to examine the brain.
Depending on your situation, you may also need:
- Arteriography (angiography). This test uses a catheter placed in a blood vessel in the groin and threaded up to the brain to show arteries in the brain.
- Magnetic resonance angiography (MRA). This technology shows brain blood vessels by mapping blood flow.
- CT angiogram (CTA). This test uses a CT scanner and can give images of the blood vessels inside the brain, after a dye is injected into the veins.
- Functional MRI. This type of MRI shows brain activity by picking up signals from oxygenated blood.
- Doppler ultrasound. This test shows narrowing of the arteries supplying the brain and evaluates the flow of blood in the brain.
- Echocardiography. This technology uses high-frequency sound waves (ultrasound) to examine the size, shape and motion of the heart, and to show if a clot comes from one of the heart's chambers.
How are cerebrovascular disorders treated?
Many cerebrovascular disorders can be treated through advanced endovascular surgical techniques to remove or bypass the problem so that blood can flow freely to the brain. Whenever possible, our surgeons will use minimally invasive techniques, using catheters and imaging techniques to pass through arteries to reach the clot, aneurysm or malformation causing your disorder.
Depending on your condition, you may need medications to:
- Control blood pressure
- Reduce the chance of additional clot formation
- Reduce brain swelling
- Correct irregular heart rhythm
If you are found to be having a stroke, our team will immediately take steps to stop it, by removing or dissolving the blockage for ischemic stroke, or stopping the bleeding causing a hemorrhagic stroke. You may need to take medicine, such as:
- Clot-dissolving drugs given within three hours intravenously (IV), or within six hours intra-arterially (IA)
- Blood-thinning drugs (anticoagulants)
- Antiplatelet drugs
After a stroke or other cerebrovascular disorder, you may need surgery to help prevent another one. Our specialists are skilled at surgical techniques that may be needed, including:
- Carotid endarterectomy. This procedure removes blockage in a carotid artery.
- Carotid angioplasty and stenting. This procedure uses a catheter with a small balloon on the end. The catheter is threaded through an artery to your neck, and the balloon is expanded to reopen the artery. A stent, a small piece of wire mesh, may be inserted to hold the artery open.
- Extracranial/intracranial bypass. This procedure connects a blood vessel outside the brain to a vessel inside the brain to reroute blood flow around a damaged or blocked artery.
- Craniotomy. This term refers to removal of part of the bone from the skull to allow surgeons to access the brain.
- Stereotactic radiosurgery. This technology uses precise beams of radiation to treat clots, tumors and other problems affecting the brain and nervous system.
As you recover, we can draw from all the resources provided by the Tulane Neuroscience Center and Tulane Health System to help you heal and live as fully and independently as possible. We’ll make sure you have all the resources, services and information you need to help you and your family as you recover and reclaim your life.
Many organizations and agencies are working to help those affected by stroke and other cerebrovascular disorders. Here are some online resources that can help you learn more.
Medline Plus from the National Institutes of Health and the National Library of Medicine
PubMed Health from the National Library of Medicine