Neurologist: Rising number of strokes can be curbed by Americans adopting a healthier lifestyle

Lloyd Runnett had started walking three days a week and lost 30 pounds in the months before he suffered a severe stroke that nearly killed him.

The 63-year-old diabetic, who received three positive health check-ups in the year prior, said even getting down to his ideal weight of 215 pounds couldn’t stop the spontaneous stroke he miraculously survived. Doctors say those with diabetes are inherently at a higher risk for stroke.

Runnett is a well-trained emergency medical technician (EMT) with nearly 50 years of experience; however, on Aug. 27, he became the patient and recalls lying flat on a stretcher in the back of an ambulance with his eyes laser-focused on the EKG machine. He was looking for any irregularities but said his heartbeat seemed normal.

Lloyd Runnett, a retired EMS chief, was treated at Sentara Martha Jefferson Hospital after suffering a stroke in August.

Runnett remembers seeing medics taking his vitals and hearing the commotion all around him, but he couldn’t talk or move normally.

“I knew I had left-side weakness and I knew I was having a serious stroke,” Runnett said. “It was like being in a movie where I didn’t have a speaking part.”

Stroke cases, deaths increasing globally   

Runnett is one of 7,418 stroke patients seen across Sentara’s 12 hospitals in 2023 – a seven percent increase from 6,933 stroke patients in 2019.

System-wide data shows nearly 1,900 patients have been treated for a stroke in the first three months of this year, which puts 2024 on track to surpass last year’s numbers.

While 61% of Sentara stroke patients last year were 66 years or older, 32% were between 45 and 65 years old and 6% were between 18 and 44 years old.  The Centers for Disease Control and Prevention (CDC) reports one in seven strokes occur in adolescents and young adults ages 15 to 49 years old.

Nearly 800,000 strokes occur every year in the U.S. and stroke is the fifth leading cause of death, according to the CDC.

A recent report from the World Stroke Organization projects stroke mortality globally will increase 50% by 2050 – from roughly 6.6 million to 9.7 million deaths annually.

Dr. Alexander Grunsfeld is a neurologist and medical director of neurosciences at Sentara Health.

Alexander Grunsfeld, M.D., who serves as medical director of neurosciences for Sentara, attributes the rise in strokes largely to increases in metabolic conditions, including diabetes, insulin resistance, high blood pressure (hypertension), obesity, as well as depression.  

“We have made huge technological advances in how to survive after a stroke and with a stroke, but we have gone terribly backwards in the prevalence of incidents of strokes and we are now seeing stroke more and more in younger populations,” said Dr. Grunsfeld. “The best way to reduce stroke is to prevent people from having metabolic disease in the first place and that has to happen with education and lifestyle.”

Dr. Grunsfeld advocates significantly reducing the intake of processed foods, regular exercise and closely managing chronic conditions under the direction of a medical provider.

 

“Instead of sitting, stand. Instead of taking the elevator, take the stairs. Try to find the parking space farthest away from the store,” Dr. Grunsfeld encouraged. “Any opportunity for physical activity, take it. That’s what the human body was built for — to use this energy.”

 

Technology helps improve stroke outcomes

 

Within moments of arriving at Sentara Martha Jefferson Hospital in Charlottesville, Va., Runnett was quickly assessed by an emergency department physician and then rushed to get a CT scan. Minutes later, a neurologist appeared live on video from Runnett’s bedside.

 

“I couldn’t communicate very well, but I remember the doctor doing the neurological assessment through telemedicine from his home library,” Runnett recalled. “He was on the big screen right in front of me. It was amazing.”

 

In 2020, Sentara deployed TeleStroke technology across all its hospitals after a successful multi-year pilot program that proved having a virtual-based neurologist on-call 24 hours a day, seven days a week could significantly improve patient care.

 

“We spent years running to the bedside of patients, but it could have been 15 minutes or more if we were tied up doing something else,” Dr. Grunsfeld said. “Now, technology allows me to care for patients much quicker. Sometimes I can turn on my camera within seconds of getting a call.”

 

Dr. Alexander Grunsfeld appears virtually at the bedside shortly after stroke patients arrive in the emergency department to determine the best course of treatment. 

 

Sentara has also implemented a new advanced imaging software, Viz.ai, that uses artificial intelligence to quickly analyze CT angiograms and CT perfusions to determine if blood clots are visible in a patient’s blood vessels and how the blood is flowing or not flowing in parts of the brain affected by the stroke.

 

Dr. Grunsfeld says the accessibility of Viz.ai, which can be used on a computer or a cell phone, is especially helpful when a stroke patient arrives in the middle of the night or when a neurologist is away from their desk. The software is also how the medical team communicates about patient care and time-sensitive treatment.

 

“If the program detects there is a blood clot it will send out an alarm to let you know the patient has a blood clot and you can potentially do something about it,” Dr. Grunsfeld said. “Viz.ai is able to identify salvageable parts of the brain in less than 10 minutes.”

 

Dr. Alexander Grunsfeld reviews a CT scan at his desk at Sentara Martha Jefferson Hospital.

 

Patients who suffer an ischemic stroke – when a blood clot blocks flow to the brain – can be quickly treated with the clot-busting drugs, Alteplase and Tenecteplase, but the medicine must be administered within 4.5 hours of when the patient first starts experiencing symptoms. If the blood clot is large enough to be detected in one of the larger blood vessels supplying the brain, it can be removed through a surgical procedure called an endovascular thrombectomy. Patients will only undergo this procedure if the advanced imaging shows that the part of the brain involved in the stroke can still be saved.

 

Sentara doctors administered the clot-busting drug 457 times in 2023 – a 47% increase from the 311 patients who received thrombolytic therapy in 2019. Thrombectomy procedures are also on the rise. The 192 thrombectomies in 2023 represent a 40% increase from four years ago.

 

“Our ability to improve outcomes after a stroke has taken ginormous strides due to technology,” Dr. Grunsfeld said. “On the flip side of this, more people than ever before are having strokes.”

Sentara raises stroke awareness in the community

When it comes to stroke, every moment matters because brain cells are dying and it can cause a life-altering disability or even death.

Sentara employs 14 stroke program coordinators who are responsible for leading stroke quality initiatives, improving processes and serving as a stroke expert within their hospital. The coordinators also participate in community events to spread awareness and provide education classes for local EMS crews.

In April, three coordinators provided on-site training at Virginia Beach EMS headquarters for nearly 40 EMTs and paramedics. The training focused on stroke identifiers, like face and arm weakness or slurred speech, and the importance of EMS crews finding out when the patient was last known to be well.

Three stroke program coordinators with Sentara pose with paramedics and EMTs during a stroke training at Virginia Beach EMS headquarters in April.

“What I am hoping our providers understand is the true emphasis on the emergency of a stroke,” said Sabrina Werner, stroke and patient outcomes coordinator at Sentara Princess Anne Hospital in Virginia Beach, Va. “Time is brain and it is critical that we start stroke treatments as soon as possible.”

In 2023, 96% of patients eligible for the clot-busting treatment received the medication within an hour of arriving to the emergency department. An overwhelming majority, 81%, received the medicine even quicker in under 45 minutes of arrival.

‘B.E. F.A.S.T.’ helps identify strokes quickly

Runnett’s wife, Lynne, noticed her husband was slumped in an unusual position while reading on what was a typical Sunday afternoon. She called their son who instructed her to call 911 immediately.

Her quick actions and the quick response from medics in under nine minutes are what Runnett believes saved his life.

“The funny thing about being married for a long time…is that intuition kicks in,” said Runnett, about his wife checking on him. “I knew within 10 seconds something was wrong but I couldn’t communicate.”

The symptoms of a stroke happen suddenly and may differ based on the part of the brain that is involved. Runnett’s left-side weakness is one common symptom, as explained in the ‘B.E. F.A.S.T.’ acronym that helps people more quickly identify a person suffering a stroke:

B – Balance (Dizziness or trouble walking)

E – Eyes (Sudden change in vision)

F – Face (Weakness or numbness or eyelid drooping on one side)

A – Arms (Sudden weakness or numbness on one side)

S – Speech (Trouble speaking, slurred speech, or trouble understanding)

T – Time (Call 911 as soon as possible and record when symptoms started)

Sabrina Werner, stroke program coordinator at Sentara Princess Anne Hospital, educating members of Virginia Beach EMS about strokes.

Runnett experienced a gradual improvement in his condition immediately after receiving the clot-busting drug; however, he suffered a second stroke the next day. Doctors determined he needed open-heart surgery due to an underlying mechanical issue — a complication rarely seen in someone of his age.

Seven months later, Runnett is “98% back to normal” and only notices a bit of deficiency with his memory and reading comprehension. He’s also continuing to live a healthy lifestyle and wears a Garmin smartwatch that keeps tabs on his heart rate, stress level, daily steps, and sleep.

“I’m lucky. I don’t have a lot of problems,” Runnett said. “If my wife had not been home or I had gone to sleep, we would not be having this conversation. I call that a God moment.”