Stroke awareness crucial for prevention
Stroke is the fifth leading cause of death in the U.S., killing more than 133,000 Americans each year. It is also a leading cause of serious long-term disability. Sixty percent of deaths from stroke occur in women, and women tend to have worse functional outcomes from stroke.
Importantly 80 percent of strokes are preventable.
A Brief History
The signs and symptoms of stroke were first recognized over 2,400 year ago. Hippocrates called the condition “apoplexy” which stems from the Greek “struck down by violence,” a nod to the sudden and unexpected onset. Over the centuries, attempted treatments have included enemas and bloodletting (creative, but not useful). In the 1600s the Swiss physician Johann Jakob Wepfer extensively studied the blood vessels supplying blood to the brain. He postulated that in patients suffering from apoplexy there had been a disruption in the blood supply to the brain. He also noted that sometimes this was from a rupture of a blood vessel (with extensive bleeding) and sometimes it was due to a blockage of the blood vessel.
The 1800s ushered in further attempts to treat strokes when surgeons first began operating on the carotid arteries (which supply blood to the brain) in an attempt to remove blockages that could lead to stroke. These were the precursor attempts at carotid endarterectomies that are commonly performed today.
Throughout most of history, treatments for stroke largely revolved around managing the damage done by a stroke. Then, in 1995, tissue plasminogen activator (TPA), a medicine that can treat some types of strokes, was introduced, ushering in an era where there could actually be interventions to lessen the damage caused by certain types of strokes.
Types of Strokes
At this point in our discussion it might be useful to review some basic medicine. Oxygenated blood is carried to the brain by a series of arteries that start as large vessels and branch to smaller and smaller vessels to reach specific areas of the brain. Eighty percent of strokes that occur can be categorized as ischemic strokes. In this type of stroke, the artery becomes blocked either by (a) a clot of cholesterol plaque broken off from a larger artery elsewhere in the body that travels until the “pipe” gets too small and it is stopped (embolus) or (b) a clot or plaque that forms in a vessel and grows to a size to block flow (thrombosis).
The other 20 percent of strokes are hemorrhagic strokes. These occur when an arterial vessel in the brain ruptures, causing bleeding into the brain. Untreated high blood pressure is the most common cause of hemorrhagic stroke. Another cause of this type of stroke is bleeding from a weak spot called an aneurysm.
The effects of stroke depend on the location in the brain. Globally, the left side of the brain controls the right side of the body, as well as the language centers, among other functions. The right side of the brain controls the left side of the body, as well as giving us insight and creativity.
The effects of a stroke are directly related to the place in the brain that suffered damage from the stroke. There are obvious disabilities that can be easily seen such as partial or total paralysis of body parts, but there also may be less obvious effects such as difficulty thinking, memory loss and mood alterations.
Reduce Your Risk
There are several obvious actions you can take to help reduce your risk of stroke. First and foremost, if you have high blood pressure, see your primary care provider and get it under control! Taking your blood pressure medicine religiously is a must (and this is so important that generally blood pressure medications fall on the list of subsidized medications under the Affordable Care Act).
If you have diabetes, closely follow your blood sugars and maintain tight control over this condition. Also monitor your cholesterol and work with your physician to control that, either with diet or medication. Atrial fibrillation (an irregular heart rhythm) is also a significant risk factor for stroke and needs management in order to reduce that risk as much as possible.
Next, there are the lifestyle issues that are so important globally for our health and also can significantly impact stroke risk:
- Decrease your sodium (salt) and fat intake.
- Consume alcohol in moderation.
- Stop smoking.
- Exercise regularly.
I will finally share that I attribute the very fact that I am still here and working to my starting cholesterol and blood pressure medications in my late teens and early 20s, quitting smoking in my late 20s and starting a regular exercise program in my early 30s. I have outlived the prior generation of males on my mother’s side, and am healthier now than many were a decade younger than me.
Get Help FAST
In terms of stroke treatment, it is important to know that “time is brain” and the sooner treatment is begun, the better the outcome can be following a stroke. With every minute after stroke onset, two million brain cells (neurons) die, so it important to seek medical attention immediately. Intravenous tPA can be given up to 4.5 hours to stroke patients from symptom onset, or up to three hours in patients over 80 years old, which can reduce stroke-related disability in some patients. In addition, recent studies have shown additional benefit of a procedure to manually remove the clot from the blocked brain artery causing the stroke which is more effective than giving intravenous tPA alone. This procedure can be performed up to 24 hours of symptoms onset in some stroke patients.
Finally, during this month we need to focus on getting the message on FAST out to friends and family.
FAST is an acronym for:
- Face – is one side of the face drooping?
- Arms – can the person raise both arms? Is one side weak?
- Speech – Is speech slurred or confusing?
- Time – This is critical, call 911! (Remember: Time is important. Note the time when symptoms appeared to let rescue workers and the emergency room physicians know.)
The importance of recognizing signs and symptoms and seeking medical care as soon as possible cannot be over emphasized. Common signs include:
- Numbness or weakness of face, arm or legs.
- Sudden confusion or difficulty speaking or understanding.
- Sudden vision changes.
- Sudden headache (often described as “the worse headache of my life”)