Neurology

Stroke

The Penn Stroke Center offers evaluation, diagnosis and treatment for stroke and other critical neurologic conditions. A stroke occurs when there is an interruption of blood supply to the brain. As a result, nerve cells in the affected area of the brain are deprived of oxygen and die rapidly. When nerve cells die, the areas of the body controlled by these cells are unable to function. A stroke is an emergency and receiving immediate urgent care is critical to minimizing brain damage and preventing disability.

Comprehnsive Stroke Center logo

The Penn Stroke Center is a Joint Commission-certified Comprehensive Stroke Center. As a comprehensive center, patients that have suffered a stroke receive immediate emergent treatment, ongoing follow up care and have access to the most advanced resources available for the treatment of stroke and other critical conditions 24-hours a day.

Types of Stroke and Related Disorders

The Penn Stroke Center treats all types of stroke and other critical neurologic conditions. If you think you may be having a stroke, it is critical to receive immediate care at a qualified, comprehensive stroke center, to minimize the possible long-term debilitating effects.

There are two main types of strokes, ischemic and hemorrhagic:

Ischemic stroke occurs when blood vessels supplying blood to the brain are blocked by a blood clot. This can occur in two ways:

  • A thrombotic stroke-is caused by a clot that forms in an artery and completely blocks it (thrombus).
  • Embolic stroke- is caused by a clot that forms in the body and travels to the brain blocking a smaller artery (embolism).

Hemorrhagic stroke occurs when weakened blood vessels in the brain burst, causing blood to leak into the brain. Two types of weakened blood vessels cause hemorrhagic strokes:

  • Aneurysm — a ballooning of a weakened blood vessel that if left untreated can burst and bleed into the brain.
  • Arteriovenous malformation (AVM) — a cluster of abnormal, weakened blood vessels that can rupture and bleed into the brain.

Other types of stroke and critical neurologic conditions include:

  • Transient ischemic attack (TIA) — A TIA is different from a stroke because it is caused by a blood clot that is temporary or "transient." TIA blood clots break up quickly and usually do not cause permanent brain damage.
  • Stroke in the young — A higher proportion of young people (under the age of 55) may be at risk for stroke due to higher instances of diabetes, hypertension and obesity.
  • Arterial dissection — An abnormal and abrupt tear along an artery wall. As the tear becomes larger a pouch called a false lumen forms and may produce blood clots and block blood vessels, leading to stroke.
  • Stroke related to patent foramen ovale (PFO) — A heart condition characterized by a hole in the heart that did not close at birth.
  • Moyamoya disease — A condition characterized by arteries that are blocked at the base of the brain.
  • Vasculitis — A condition characterized by the inflammation of blood vessels.
  • Carotid stenosis — A condition caused by the progressive narrowing of the carotid arteries.
  • Intracranial stenosis — A narrowing of an artery inside of the brain.
  • Migraine related stroke
  • Recurrent stroke despite treatment
  • Venous sinus thrombosis — A clot forms in one of the large veins which drains blood out of the brain.
Symptoms of Stroke

Stroke symptoms usually come on suddenly and with little warning. Symptoms of stroke include:

  • Paralysis of the face, arms or legs
  • Headache
  • Difficulty walking
  • Cognitive impairment, trouble thinking and speaking
  • Blurred vision or impairment in one or both eyes
Stroke Diagnosis

At the Penn Stroke Center we offer patients the latest advanced technology in diagnostic testing for stroke and critical neurologic conditions. In addition, patients at risk for stroke are evaluated and preventative strategies and risk-factor modifications are instituted.

Diagnostic testing includes:

  • Neurovascular ultrasound — Uses a non-invasive ultrasound to image the cerebral circulation for detection of conditions such as TIA, carotid stenosis, ischemic stroke and subarachnoid hemorrhage.
  • Carotid duplex ultrasound — Uses sound waves to image the carotid and vertebral arteries in the neck. This imaging modality provides information on atherosclerotic plaque formation and blood flow velocity within the arteries.
  • Transcranial doppler ultrasound (TCD) — Uses sound waves to measure blood flow in the intracranial blood vessels. This imaging modality provides information on blood flow velocity and is primarily used to detect stenosis, or narrowing of the vessels supplying the brain. TCD is also used to detect narrowing due to vasospasm after subarachnoid hemorrhage.
  • Transcranial doppler microembolic signal detection — An advanced imaging modality that uses TCD to detect emboli travelling in the blood vessels of the brain.
  • Transcranial doppler cerebral vasoreactivity studies — An advanced technique that uses TCD to measure the ability of cerebral blood vessels to properly regulate blood flow to the brain.
  • Magnetic resonance imaging (MRI) — Including diffusion and perfusion imaging.
  • MR-angiography
  • Computed tomography (CT), CT-angiography
  • PET (positron emission tomography)
  • SPECT (Single-photon emission computed tomography)
  • Diagnostic and interventional angiography
Stroke Treatment

After experiencing a stroke, a patient will benefit from a team of experts who will develop an individualized recovery plan. We work collaboratively with a diverse group of specialists from multiple disciplines including:

The Center offers both traditional and advanced treatment approaches, including:

  • Risk-factor modification
  • Medical prevention of stroke
  • Physical rehabilitation
  • Acute thrombolytic therapy
  • Clinical trials of new stroke therapies administered as soon as possible after a stroke
  • Clinical trials of new approaches to stroke prevention
  • Carotid endarterectomy
  • Interventional neuroradiologic techniques (including angioplasty, stent placement and thrombolysis)
  • State-of-the-art neurocritical care unit and multimodality monitoring
  • Bypass and revascularization
  • Surgery for stroke
  • Endovascular interventions (including angioplasty and stent placement, mechanical thrombolysis, and aneurysm coiling)
  • Bypass and revascularization
  • Extracranial-intracranial bypass surgery
Why Does Being a Comprehensive Stroke Center Matter?

The Penn Stroke Center was awarded certification as a Comprehensive Stroke Center from the Joint Commission and American Heart Association/American Stroke Association. We are the first in the Philadelphia region to become certified as both a primary and comprehensive stroke center. This new level of certification recognizes the significant resources in staff and training that comprehensive stroke centers must have to treat complex stroke cases.

Joint Commission-certified Comprehensive Stroke Centers are required to have:

  • A dedicated neurocritical care unit
  • A high volume of stroke cases
  • Advanced resources for the acute treatment of stroke patients available 24 hours a day
  • Advanced neurodiagnostic tools
  • Certified vascular neurologists, neurosurgeons, neuroradiologists and vascular surgeons
  • Advanced practice nurses
  • A system that optimizes the benefits of carotid artery procedures
  • Participation in stroke research

In addition to this prestigious designation The Penn Stroke Center is a recipient of the following awards:

  • Get With The Guidelines Target Stroke Honor Roll Gold Plus logo Get With The Guidelines® — Stroke Gold Plus Quality Achievement Award from the American Heart Association/American Stroke Association for its commitment to and success in implementing excellent care for stroke patients.
  • The "Target: Stroke Honor Roll" award recognizes that over a recent three month review period, at least 50 percent of all eligible ischemic stroke patients at the Hospital of the University of Pennsylvania received the important clot-busting drug known as intravenous recombinant tissue plasminogen activator (tPA) within 60 minutes of arriving at the hospital.
  • Several faculty members have received the American Academy of Neurology Michael Pessin Stroke Leadership Award. This award recognizes emerging neurologists who have demonstrated a passion for learning and expanding the field of stroke research.