You are enjoying dinner at home with your family, when, without warning, you have trouble understanding the conversation. Perhaps the vision in one eye blurs, or you suddenly have what feels like the worst headache of your life. You call 911. Your brain is under attack, and you have to fight back immediately.

When a stroke strikes, an invisible clock starts ticking, and every second that passes without medical help decreases your chance of survival and a full recovery. About 780,000 Americans suffer strokes each year, making stroke a major cause of adult disability and the third leading cause of death nationwide, according to the American Stroke Association (ASA).

The Stroke & Cerebrovascular Center at The George Washington University Hospital evaluates and treats stroke emergencies -- 24 hours a day, seven days a week. The program recently was certified by The Joint Commission, a national organization that evaluates and accredits healthcare organizations based on strict quality standards.

When a patient with stroke symptoms arrives, GW Hospital's "Brain Attack Team" of emergency room physicians, radiologists, neurosurgeons, neurologists, nurses and technicians swings into action. The team quickly will perform a physical evaluation, brain imaging scans and blood tests to conclusively diagnose stroke.

Kathleen Burger, DO, Director of Cerebrovascular Neurology Vivek Deshmukh, MD, Director of Cerebrovascular Neurosurgery and Interventional Neuroradiology

Advanced Treatment Provides Options
"The Center actually goes above and beyond The Joint Commission requirements," says Kathleen Burger, DO, Director of Cerebrovascular Neurology. "Its standards call for treatment with clot-busting medications such as tissue plasminogen activator [tPA] within three hours, when determined safe for an individual patient. At GW, we offer other therapeutic options for patients presenting beyond three hours when indicated."

Treatment depends on the type and severity of stroke and the time elapsed between the start of symptoms and a definitive diagnosis, according to Vivek Deshmukh, MD, Director of Cerebrovascular Neurosurgery and Interventional Neuroradiology. Patients with ischemic stroke who arrive within three hours might receive tPA through a vein in the arm. Patients arriving beyond the three-hour window might be eligible for intra-arterial tPA, which is administered by threading a catheter up to the brain through an artery in the groin and delivering it directly to the clot.

Dr. Deshmukh can remove the clot mechanically with a wire loop device or flatten it by inflating a small balloon within the blood vessel. He also performs procedures to help prevent stroke by removing cholesterol deposits in the carotid arteries, the large vessels on either side of the neck that carry blood from the heart to the brain.

"What sets GW Hospital apart is the ability to offer a range of open and endovascular [within the blood vessel] techniques that prevent and treat stroke, even in particularly challenging situations, such as when the patient has multiple medical issues or when the clot does not respond to medications," says Dr. Deshmukh.

Education and Rehabilitation Help Patients
After initial treatment, patients are moved to a dedicated four-bed Stroke Unit staffed by nurses who are specially trained to care for stroke patients. After discharge, physicians follow up with patients in The George Washington University Medical Faculty Associates neurology office. In addition to medical care, the neurology team provides education on stroke prevention and risk factor modification, including diet and exercise advice, as well as action plans for primary care physicians.

Depending on the severity of the stroke, patients also may receive inpatient rehabilitation, including speech, occupational and physical therapy, in GW Hospital's Acute Rehabilitation Unit. The unit is accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF), an independent organization that establishes quality standards.

Know the Signs and Act Immediately
For stroke treatment to be effective, you must recognize the signs of stroke and act quickly. According to the ASA, the five typical signs of stroke are:

• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden, severe headache with no known cause

If you or a loved one experiences any of these symptoms, call 911 immediately.

Control Your Risk Factors
The following risk factors for stroke can be controlled or treated:

• High blood pressure
• Cigarette smoking
• Diabetes
• Carotid or other artery disease
• Atrial fibrillation (a heart rhythm disorder that can lead to the formation of a clot in the heart, which can travel to the brain)
• Sickle cell disease
• High blood cholesterol
• Poor diet
• Physical inactivity and obesity

Two Types of Stroke
Ischemic strokes are caused by blocked blood flow. This restricts oxygen to the brain and accounts for nearly 88 percent of strokes, according to the American Stroke Association. Tissue plasminogen activator (tPA), a drug that dissolves clots, must be administered within a three-hour window of the onset of symptoms to work effectively.

Hemorrhagic strokes are caused by bleeding into or around the brain and account for about 12 percent of strokes. These strokes may be treated with medications to control further bleeding, manage high blood pressure and reduce brain swelling. Surgery also can seal off or repair bleeding vessels.

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