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If you or someone you know is experiencing stroke symptoms.

Signs of Stroke

Stroke Care

When it's a stroke, every second counts. That's why stroke care is a priority at EvergreenHealth.

Successful stroke care involves many hospital departments, all working together according to our stroke care protocol.

Our specialized stroke team is ready for action the minute a stroke patient arrives at the Emergency Department. The team knows what to do so treatment can begin quickly—improving every stroke patient's chances for recovery.

Our success treating stroke has earned us certification as a Primary Stroke Center with The Joint Commission since 2007, transitioning to a Primary Plus Stroke Center certification with DNV in 2020.

Speedy Diagnosis

Our stroke care begins with the first responders. When paramedics suspect a stroke, they phone ahead to alert the emergency department. This prompts a chain of events that makes the stroke patient a priority.

The stroke team—emergency physicians, neurologists, hospitalists and nurses all with special training in treating stroke—prepares for the patient's arrival. Interventional radiologists and neurosurgeons are brought in as needed.

Diagnostic imaging prepares for immediate CT scans, with a radiologist on hand to read the results. The lab prepares to rush blood tests.

Learn more about diagnosing stroke

Dr. David Likosky interviewed on New Day NorthwestDr. David Likosky talks about stroke treatment using biplane imaging. (New Day Northwest) Read as a blog.


Once the patient arrives, the team will work quickly to make a diagnosis and recommend the best treatment.

The stroke team has a number of possible treatments for stroke, including clot-busting drugs and minimally-invasive procedures guided by advanced biplane imaging.

Learn more about treating stroke

Inpatient Care

Once a stroke patient has been treated and stabilized, their recovery will begin in one of our stroke units—either the critical care or progressive care unit—where they will be closely monitored by our team of neurologists, hospitalist physicians and nurses, all with extensive training in stroke care.

They work together with the rehabilitation staff, social workers and discharge planning nurses to manage each stroke patient's care, from monitoring vital signs and neurological status in order to prevent complications, to providing the education needed about medications, risk factor management, diet and lifestyle changes to prevent secondary strokes.

Our rehabilitation specialists begin working with stroke patients as soon as their condition is stabilized, because the sooner a patient works to regain normal function the quicker that can happen. Rehab staff will continue to work with patients after they are discharged.

Learn more about inpatient stroke rehabilitation

Rehabilitation Care

While some stroke patients are able to leave the hospital back to normal, many will need some therapy to help them recover function.

Patients who need more close medical monitoring before being discharged home may be admitted to the medical center's Acute Rehabilitation Unit, where they can receive intensive rehabilitation in a home-like environment.

Learn more about the Acute Rehabilitation Unit

After going home, stroke patients can continue their therapy on an outpatient basis through EvergreenHealth Rehabilitation Services, with the goal of returning to work, school and community activities.

Learn more about outpatient rehabilitation care

Certified as a Primary Plus Stroke Center

EvergreenHealth stroke services is recognized as a Primary Plus Stroke Center with certification from DNV Healthcare, which means we meet the highest national standards for stroke care.

EvergreenHealth also received the 2021 American Heart Association/American Stroke Association's Get With The Guidelines–Stroke Gold Plus Quality Achievement Award for the fifth year in a row. This recognizes our stroke program's commitment and success in providing excellent care to stroke patients - care that makes a difference in how people recover.

As part of our commitment to stroke care, all of our emergency and hospitalist physicians have gone through specialized training from the National Institutes of Health Stroke Scale Certification Program. Emergency department and stroke unit nurses receive annual stroke education, to keep updated on the latest guidelines in stroke care.

For More Information

  • Inpatient Stroke Program: Call (425) 899-2478
  • Inpatient Acute Rehabilitation Unit: Call (425) 899-2550
  • Outpatient Stroke Rehabilitation: Call (425) 899-3100

Stroke Warning Signs

If you think you or someone else might be suffering a stroke, you need to act fast. You can use the word FAST to help remember the warning signs:

FACE - Ask the person to smile. Does one side of the face droop?

ARMS - Ask the person to raise both arms. Does one arm drift downward?

SPEECH - Ask the person to repeat a simple phrase. Is their speech slurred or strange?

TIME - If you observe any of these signs, call 9-1-1 immediately.

Other signs of stroke include sudden onset of:

  • Change in alertness (including sleepiness, unconsciousness, and coma)
  • Severe headache with no known cause
  • Confusion or trouble understanding
  • Difficulty seeing in one or both eyes
  • Difficulty walking, dizziness, loss of balance or coordination

Write down the time when symptoms first began. This information is important and might affect treatment decisions.

Causes and Risk Factors

What is stroke?

A stroke occurs when there is a blockage of blood and oxygen to the brain, which can kill or damage brain cells.

When someone experiences a stroke, every minute is critical. The more quickly they can receive care, the better chance they have of recovering.

About 80 percent of strokes are ischemic, which occur when the arteries to the brain become narrowed or blocked, causing severely reduced blood flow.

The two types of ischemic stroke include thrombotic stroke and embolic stroke:

  • a thrombotic stroke occurs when a blood clot forms in an artery that supplies blood to the brain
  • an embolic stroke occurs when a blood clot or other debris forms away from the brain and is swept through the bloodstream, and becomes lodged in narrower brain arteries.

The other main type of stroke is a hemorrhagic stroke, which occurs when a blood vessel in the brain leaks or ruptures.

What causes stroke?

The top risk factors of stroke include:

  • High blood pressure
  • Heavy tobacco and alcohol use
  • Heart disease
  • High cholesterol
  • Diabetes
  • Obesity and lack of exercise
  • Use of anti-coagulant medication (blood thinners)
  • Old age
  • Family history of stroke

Stroke Statistics

Stroke affects over 600,000 Americans annually and is the third leading cause of death and the leading cause of disability in the United States.

For strokes that occur within regions of the brain fed by the carotid arteries, 17% of patients die within 30 days of their stroke while 40% die within five years.

Of the long term survivors, the impact is significant as 15% require institutional care, 1/3 require assistance with activities of daily living, and 2/3 have decreased socialization.

The economic effects pf stroke, including both the cost of additional care and lost productivity, are estimated at $30 billion annually in the US alone.

There are primarily 2 types of stroke: ischemic (lack of blood supply) and hemorrhagic (bleeding in the brain).

Hemorrhagic strokes account for about 15% of all stroke events and are due to chronic hypertension (burst blood vessel), trauma, ruptured cerebral aneurysm, arteriovenous malformations, and bleeding disorders.

Ischemic strokes account for 85% of strokes and are related to progressive narrowing or occlusions of the arteries that feed the brain, most commonly, the carotid arteries.

A transient ischemic attack (TIA), otherwise known as a mini stroke, is an event in which the stroke symptoms last less than 24 hours. By definition, the symptoms of a TIA will be temporary.

Characteristically, TIA symptoms tend to last only for several minutes then completely resolve. If any of the neurologic symptoms or deficits persists beyond 24 hours, this constitutes a stroke.

TIAs may precede an actual stroke as much as 30% of the time.

TIAs should be considered a warning sign of an impending stroke and demand immediate attention.

In patients presenting with neurologic deficits, one must also consider that those symptoms could be related to other conditions such as seizure, brain tumors, abscess, migraine headaches, or subdural hematoma.

CT scans or MRI scans of the brain are helpful in identifying many of these causes and can often times identify the stroke itself.

In some cases, early small strokes may not be identified on the imaging studies.

Ultrasound examinations of the carotid arteries are also helpful in identifying the degree of narrowing present within these vessels and the likelihood of carotid artery disease causing or contributing to the neurologic event.

Most strokes affect the brain territory fed by the carotid artery while a small percentage are related to the vertebrobasilar system feeding the back of the brain.

Classic symptoms of TIA and stroke (carotid territory) include weakness, numbness, or tingling of the face, arm, and leg (alone or in combination) affecting one side of the body; or blindness in one eye described as a black curtain coming down through the field of vision.

When strokes or TIAs are related to carotid artery disease, visual changes are usually on the same side as the diseased carotid artery while the face, arm, and leg symptoms are on the side opposite the affected carotid.

Left brain events can also affect the patient's speech.

Strokes or TIAs affecting the vertebrobasilar circulation can cause symptoms of ataxia (staggering gait), double vision, vertigo, and weakness or paralysis that can affect all the extremities.

There are several risk factors commonly associated with stroke:

  • Hypertension (systolic and diastolic) increases one's risk for stroke. Reducing systolic hypertension (systolic BP >170 mmHg) by 11mmHg has been shown to reduce the risk of stroke by 35% while reducing diastolic hypertension by 6mmHg is associated with a 40% stroke risk reduction (Collins et al, Lancet 335:827-38, 1990).
  • Diabetes has been shown to increase the risk of stroke by 2.5-3.5 times over non-diabetics as well as increasing the risk of carotid atherosclerosis.
  • Smoking and hyperlipidemia are associated with a 2 times increase in stroke risk, primarily related to their affect on atherosclerosis. Aspirin is an effective antiplatelet agent for stroke prevention in patients with peripheral vascular disease, angina, and symptomatic atherosclerotic vascular disease.

In patients with symptoms of TIA or stroke who have more than 50% narrowing of their carotid artery, or in patients with more than 70% narrowing and no symptoms, the preferred treatment is to eliminate the carotid artery obstruction by either a carotid endarterectomy (surgical removal) or a stent.

The purpose of treatment is to prevent additional symptoms of TIA or stroke.

Strokes can occur with either types of treatment in up to 4% of patients.

At EvergreenHealth Heart & Vascular Care, we are regionally recognized leaders in the treatment of carotid artery disease. Our stroke rates are over four times less than the national average.

We also are the only practitioners on the eastside qualified to place carotid stents and are part of the SAPHIRRE carotid artery stent registry sponsored by Cordis.

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