Stroke

MD Nursing Home Stroke Injury Lawyers

The elderly face dozens of health problems that most young people do not. In Maryland nursing homes a stroke is many times preventable if the standard of care is up to par. In Maryland long term care facilities where a resident suffers a stroke it can easily be misdiagnosed as something else. In each case your loved one may be entitled to benefits, medical care and financial compensation for their injuries, pain and suffering. Let our Maryland stroke injury lawyers help you.

Please click here to arrange a free consultation with our Maryland nursing home negligence attorneys. They will review your stroke injury claim and identify any and all liable parties. From there they will file a civil lawsuit against all liable parties in an effort to obtain the full, fair and just amount of benefits and financial compensation.

Stroke Facts & Statistics

Stroke is the leading cause of long-term disability in the US, affecting more than 2.5 million people, and killing nearly 200,000 a year. As a rule, a stroke takes 10 hours to evolve and involves about 3 cubic inches of brain tissue. Oxygen deprivation causes the brain to age about 3.6 years per hour. This builds a strong case for rapid treatment with thrombolytic drugs.

  • Stroke is the third leading cause of death in the United States. Over 143,579 people die each year from stroke in the United States.
  • Stroke is a leading cause of serious long-term disability.
  • About 795,000 strokes occur in the United States each year. About 610,000 of these are first or new strokes. About 185,000 occur in people who have already had a stroke before.
  • Nearly three-quarters of all strokes occur in people over the age of 65. The risk of having a stroke more than doubles each decade after the age of 55.
  • Strokes can—and do—occur at any age. Nearly one quarter of strokes occur in people under the age of 65.
  • Stroke death rates are higher for African Americans than for whites, even at younger ages.

About 80% of strokes are ischemic strokes, and will respond to thrombolytics, if given early. As a rule, thrombolytic strokes occur in elderly persons. Hemorrhagic strokes are more common in those under age 50. However, they can occur in persons of any age who have high international normalized ratio (INR) levels as a result of anticoagulant drugs. About 15% of all strokes are hemorrhagic strokes, in which a blood vessel in the brain ruptures. Hemorrhagic stroke is much more deadly and difficult to treat.

Types of Stroke

Embolic stroke: A clot develops in a part of the body other than the brain (commonly the heart). It travels through the bloodstream into the brain, where it lodges in a small artery. This stroke occurs suddenly and without warning. Approximately 15% of embolic strokes occur in persons with atrial fibrillation.

Ischemic stroke: The most common type of stroke; accounts for approximately 80% of all strokes. Caused by a clot or other blockage within an artery leading to the brain.
Thrombotic stroke: A clot forms in the blood vessels of the brain; usually one of the cerebral arteries. It remains attached to the artery wall until it grows large enough to occlude blood flow. May be preceded by one or more TIAs.

Lacunar infarct:
 Small, deep infarcts located mainly in the basal ganglia and thalamus. May also affect the brain stem, internal and external capsules and periventricular white matter. When a stroke occurs due to small vessel disease, a very small infarction results, sometimes called a lacunar infarction. Most likely caused by atherosclerotic occlusion of perforating branches. Accounts for approximately 25% of all ischemic strokes.

Cerebral hemorrhage: Caused by the sudden rupture of an artery in the brain. Blood spills out, compressing brain structures. Approximately 20% of strokes are caused by hemorrhage.

Subarachnoid hemorrhage: Caused by the sudden rupture of an artery. The location of the rupture leads to blood filling the space surrounding the brain rather than inside of it.

Warning signs 
The National Institute of Neurological Disorders and Stroke notes these five major signs of stroke, which should be familiar to all staff members in a nursing home:

  • Sudden numbness or weakness of the face, arms, or legs.
  • Sudden confusion or trouble speaking or understanding others.
  • Sudden trouble seeing in one or both eyes.
  • Sudden trouble walking, dizziness, or loss of balance or coordination.
  • Sudden severe headache with no known cause. 

All of the major symptoms of stroke appear suddenly, and often there is more than one symptom at the same time. 

transient ischemic attack (TIA) is an event that lasts only a few minutes and is often a precursor to a stroke. A TIA occurs when the blood supply to part of the brain is briefly interrupted. TIA symptoms, which usually occur suddenly, are similar to those of stroke but do not last as long. Staff should assess and be alert to any of the warning signs of TIA and stroke. 

Risk factors 
Lifestyle and health conditions such as high blood pressure, heart disease, diabetes, and smoking are just a few of the factors that can put a person at a higher risk for stroke. The Centers for Disease Control and Prevention highlight the following risk factors:

  • High blood pressure, or hypertension, is a major risk factor for stroke. It is a condition where the pressure of the blood in the arteries is too high. There are often no symptoms to signal high blood pressure. About 60 million people in the United States have high blood pressure. Lowering blood pressure can lower the risk of stroke. Medicines to lower blood pressure can decrease the risk of stroke among those with high blood pressure.
  • Common heart disorders such as coronary artery disease can also increase a person’s risk for stroke. Coronary artery disease (CAD) occurs when the arteries that supply blood to the heart muscle become hardened and narrowed due to the buildup of plaque. Plaque (a mixture of fatty substances, including cholesterol and other lipids) and blood clots can build up inside the artery walls, causing thickening, hardening, and loss of elasticity. They can result in decreased or blocked blood flow and lead to a heart attack. Also, heart problems such as valve defects, irregular heart beat, and enlargement of one of the heart’s chambers can result in blood clots that may break loose and cause a stroke. Persons with heart disease may be given medicines such as aspirin to help prevent clots from forming.
  • A heart condition known as atrial fibrillation is a major concern. Atrial fibrillation is irregular beating of the upper chambers, or atria, of the heart. When the atria quivers instead of beating in a regular pattern, blood is not fully pumped out of them and may pool and clot. The clots can then leave the heart and travel to the brain, causing a stroke. Atrial fibrillation affects as many as 2.2 million Americans. About 15% of stroke patients have had atrial fibrillation before they experience a stroke.
  • Diabetes is another disease that increases a person’s risk for stroke. With diabetes, the body does not make enough insulin, cannot use its own insulin as well as it should, or both. This causes sugars to be unavailable to the body tissues and to build up in the blood. People with diabetes have 2 to 4 times the risk of stroke compared to people without diabetes. Further, having diabetes can worsen the outcome of stroke.
  • Smoking almost doubles a person’s risk for ischemic stroke, independently of other risk factors. Cigarette smoking increases the risk of stroke by promoting atherosclerosis and increasing the levels of blood clotting factors, such as fibrinogen. Also, nicotine raises blood pressure, and carbon monoxide reduces the amount of oxygen that blood can carry to the brain.
  • Blood cholesterol levels also factor into a person’s stroke risk. Strokes can be caused by a narrowing of the arteries through the buildup of plaque, a mixture of fatty substances, including cholesterol and other lipids. This is called atherosclerosis. Plaque and blood clots build up inside the artery walls, causing thickening, hardening, and loss of elasticity. These can lead to decreased blood flow and to stroke if they occur in the arteries to the brain.
  • Generally, excessive alcohol use can lead to an increase in blood pressure, which increases the risk for stroke.
  • Genetic risk factors also play a part. Stroke can run in families. Genes play a role in stroke risk factors such as high blood pressure, heart disease, diabetes, and vascular conditions. It is also possible that an increased risk for stroke within a family is due to factors such as a common sedentary lifestyle or poor eating habits, rather than hereditary factors. 

Time is of essence 
The presence of an acute stroke is a “load and go” event. Nursing home staff members should:

  • Immediately contact the physician.
  • If the resident is to be transferred to the hospital, request emergency (911) transport to a hospital capable of providing acute stroke care, with 24-hour availability of a CT scan and its interpretation.
  • Ask another nurse to call the destination emergency department to inform them of the resident’s impending arrival.
  • Ask another nurse to notify the responsible party.
  • Make sure someone remains in the room with the resident at all times. Do not leave him or her alone.
  • Apply oxygen and treat other emergency symptoms, as needed based on your assessment.
  • Keep the resident NPO (nothing by mouth).
  • Continue nursing monitoring pending ambulance arrival. This includes vital signs, neurological checks, and Glasgow Coma Scale. Send copies of your findings to the emergency department.
  • One of the most important aspects of the nursing history is the time of onset of the symptoms. Note this time in the facility nurses’ notes, and in a prominent location on the transfer form. Inform the hospital.
  • Send a copy of the resident’s advance directive to the hospital with the ambulance personnel or fax to the emergency department.
  • Carefully document your assessment, nursing actions, resident response, and notifications after the resident is out of danger. 

Aphasia 
Aphasia is a neurological disorder caused by damage to the portions of the brain that are responsible for language, is a late effect of a stroke. Adults who have suffered a stroke may have aphasia, which is a symptom of the brain damage. Primary signs of the disorder include:

  • Difficulty in expressing oneself when speaking
  • Trouble understanding speech
  • Difficulty with reading and writing

In the United States, it’s estimated that about 1 million people suffer from aphasia. Asphasia can be divided into four categories:

  • Expressive aphasia involves difficulty in conveying thoughts through speech or writing. The resident knows what he wants to say, but cannot find the words he needs.
  • Receptive aphasia involves difficulty understanding spoken or written language. The resident hears the voice or sees the print but cannot make sense of the words.
  • Residents with anomic or amnesia aphasia, the least severe form of aphasia, have difficulty in using the correct names for particular objects, people, places, or events.
  • Global aphasia results from severe and extensive damage to the language areas of the brain. Residents lose almost all language function, both comprehension and expression. They cannot speak or understand speech, nor can they read or write. 

Is there any treatment? 
For residents who don’t recover from aphasia, speech therapy should begin as soon as possible. A speech pathologist will conduct exercises that involve residents reading, writing, following directions, and repeating what they hear. 

Communication 
When communicating with residents suffering from aphasia, staff members should:

  • Use short, uncomplicated sentences
  • Repeat the content words or write down key words to clarify meaning
  • Maintain a natural conversational manner appropriate for an adult
  • Minimize distractions, such as a loud radio or TV
  • Include the resident with aphasia in conversations
  • Ask for and value the opinion of the resident with aphasia
  • Encourage any type of communication, whether it is speech, gesture, pointing, or drawing
  • Avoid correcting the resident’s speech
  • Allow the resident plenty of time to talk

Nursing home residents who have aphasia and require tube feeding fall into a payment category.