When it comes to accurately diagnosing whether someone has suffered a stroke, “one can never be too smart,” says Dr. Gary Belt.
Belt, a stroke neurologist at Atlantic Neuroscience Institute in Overlook Medical Center, has more than three decades of experience in making those tricky diagnoses. He knows that superficial signs that seem to indicate a stroke can’t always be trusted and that a stroke neurologist must think like a detective.
In a presentation he titled “Stroke Mimics,” Belt recently spoke to a roomful of nurses at the 2017 Atlantic Health System Neuroscience Nursing Symposium. His goal: To help them become more adept at what he called “the stroke or no-stroke game.”
Getting it right is crucial, because an accurate diagnosis – and the quick administration of the clot-busting drug Alteplase (tPA) – can have wonderful results.
“Since the mid-1990s, we’ve had a drug called tPA which, essentially, is like Drano for a blood vessel,” Belt said. “We know that if we open the vessels quickly enough, we can prevent a stroke or keep the damage from a stroke to a minimum.”
The nurses listening to Belt were all trained in The National Institutes of Health Stroke Scale (NIHSS) test. Nurse practitioner Angela McCall-Brown, an expert in the NIHSS, also spoke at the symposium, relaying anecdotes that showed the importance of medical staff experience and knowledge during that first observation.
In addition to carefully assessing the cognitive capabilities of possible stroke patients, nurses must dutifully follow – in a specific order – the NIHSS tests of motor skills. These include having patients do simple tasks such as touching their noses, holding their arms out and rubbing one heel against the opposite shin.
In addition to carefully assessing the cognitive capabilities of possible stroke patients, nurses must dutifully follow – in a specific order – the NIHSS tests of motor skills. The value of speed in performing the NIHSS comes to play in helping doctors decide when patients should be treated with tPA.
Both Belt and McCall-Brown said they are sometimes surprised by the effectiveness of fast treatment.
“I had a patient … They brought her into Overlook Medical Center emergency department and she was totally mute,” McCall-Brown said. “She could sit and look at us and she was shaking her head, but she was not saying anything.”
The woman was administered alteplase and while the stroke team monitored the patient, McCall-Brown left the Emergency Room.
“I went back upstairs, saw some more patients on the unit, and came back downstairs to the emergency department,” she said. Knowing the patient could not speak, she started talking to the family. I said, ‘So how’s everybody doing? My name’s Angela.’ And the patient says, ‘I’m much better now.’”