Dr. Alison Nohara is a brain surgeon who is the head of neurointerventional surgery at Vassar Hospital. Dr. Nohara came to the Hudson Valley because she learned that there was not special unit for treating strokes anywhere nearby, Her new facility at Vassar Hospital opened last year. Her group handles treatment of brain, spine, carotid arteries, nosebleeds, and—the subject of her talk—strokes.
Warning Signs for Stroke  
(Dr. Alison Nohara)
There are three types of disease that are termed strokes:
Ischemic strokes are caused by blood clots in the brain or other important parts of the nervous system (these are the most common type);
  • hemorrhagic stokes are caused by blood flooding a part of the brain;
  • transient ischemic attacks (TIAs), which are small ischemic strokes that last for a short period (typically 20 minutes) and leave the person with no lasting symptoms—although they are warning signs of trouble and need to be dealt with by physicians. A TIA is a “shot across the bow” and a person experiencing one should come to the hospital.
There are some conditions that predispose a person toward strokes: atrial fibrillation (irregular heart beat), PFO (a hole in the heart), or hypercoagulable state (a blood-clotting disorder).
Survivors of ischemic or hemorrhagic strokes usually have lasting damage—about 31% need help with living in some way; 20% need help walking; and 71% have some disability that interferes with work. 
The best ways to prevent strokes are mostly the same as the ways to prevent heart attacks, such as keeping blood pressure and cholesterol levels low, maintaining a healthy weight, getting regular exercise.
Until recently the main treatment for ischemic stroke was TPA, a medicine that dissolves clots.  However, recent studies have shown that thrombectomy, or physical removal of the clot, is more effective. TPA worked in about 1 out of 5 patients, but thrombectomy was more effective in 3 out of 5. In either case, speed in trying to resolve the problem is essential.  TPA only works during the first  three or four hours after a stroke and every minute that blood is cut off, 10,000 neurons die in the area deprived of blood.
Since 90% of strokes are ischemic, her unit uses a catheter equipped with a cage at the end to capture the blood clot and remove it, although this may only work in larger blood vessels.
Unlike a heart attack, an ischemic stroke does not cause pain—instead it is common for the person experience the stroke to go to sleep and not be able to speak to saying about what the problem is. People with a hemorrhagic stroke may experience a powerful headache.
  • Facial drooping.  Ask the person to smile. If a stroke, the smile is often asymmetrical.
  • Arm weakness or inability to move arm.
  • Speech difficulty, including inability to understand speech as well as difficulty in selecting the correct words.