With Stroke, "Time Is Brain"

Main Category: Stroke / Neuroprotection
Also Included In: Public Health
Article Date: 04 Oct 2007 - 1:00 PDT

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The sensation hits you abruptly. You have difficulty speaking or comprehending what's going on around you. You lose feeling in an arm or leg. Your head is pounding.

These are some of the telltale symptoms of stroke, but despite the fact that stroke is the third-leading cause of death in the U.S. and affects an estimated 700,000 people each year, many people are unaware of these warning signs and fail to act when they occur, according to Cleveland Clinic's Men's Health Advisor.

In fact, in a study published in August in the journal Stroke, researchers reported that about 18 percent of study participants experienced these warning signs including "whispering strokes" with mild symptoms but were never diagnosed with stroke or transient ischemic attack (TIA, or "mini-strokes"). Those who experienced these symptoms suffered declines in physical and mental functioning, the study authors wrote.

The report followed data from the same group presented earlier this year that showed that more than half of those who experienced stroke symptoms but were never diagnosed did not seek medical attention.

New guidelines issued by the American Stroke Association (ASA) in April stress the importance of receiving immediate medical care if you're suffering a stroke, because your prognosis typically improves the sooner you receive treatment.

"There have been many surveys that suggest that public awareness of stroke warning symptoms is much less than cancer or heart attack," said Anthony Furlan, MD, associate director of Cleveland Clinic's Cerebrovascular Center. "If symptoms happen, don't wait. Time is brain."

RECOGNIZE THE SYMPTOMS

Nearly 88 percent of all strokes are ischemic strokes (infarcts), which occur when a blood clot forms and blocks blood flow to the brain. The rest are hemorrhagic ("bleeding") strokes, caused by ruptured blood vessels on the surface of the brain that bleed between the brain and skull (subarachnoid hemorrhage) or defective arteries in the brain that burst and flood surrounding tissue with blood (intracerebral hemorrhage).

An ischemic stroke or intracerebral hemorrhage can produce sudden numbness or weakness in the face, arm or leg, particularly on one side of the body, as well as difficulty communicating or understanding, vision problems in one or both eyes, confusion, dizziness, trouble walking and loss of coordination. Both types of hemorrhagic stroke also cause a sudden, severe headache and a decline in alertness or consciousness.

Another stroke warning sign is TIA, which causes stroke-like symptoms that typically last only a few minutes and significantly increases your risk of stroke. Go to the nearest hospital emergency room if you experience a TIA.

DON'T DELAY

When stroke symptoms first develop, call 911 immediately, or have someone call for you. Not all symptoms occur in every stroke, so don't ignore any warning signs.

The new ASA guidelines note that ischemic-stroke patients can benefit from medications such as tissue plasminogen activator (tPA), a "clot-busting" drug that helps to reopen a clogged artery and restore blood flow to the brain. However, the drug must be given within three hours of the onset of symptoms.

"Roughly only 20 percent of stroke patients get to the hospital within three hours of onset," said Dr. Furlan, who helped draft the guidelines. "There are patients who have reversible stroke injury after three hours, but the number gets smaller as time goes on."

Likewise, hemorrhagic strokes require prompt treatment, either to stop bleeding or remove clotted blood and ease pressure on the brain.

The guidelines also recommend that, when possible, stroke patients should be transported to the nearest primary stroke center, even if it means bypassing the nearest medical center. These stroke centers more than 300 are in the U.S. are certified by the Joint Commission as having the expertise and resources to provide 24-hour emergency stroke care.

Dr. Furlan advises that you learn where your nearest primary stroke center is located if you're at high risk for stroke (see What You Can Do).

REDUCE YOUR RISK

The ASA estimates that your risk of stroke doubles for each decade after age 55, and men are at greater risk, as are African-Americans, some Hispanics and those with a personal or family history of stroke.

While you can't change your age, gender, race or history, you can control other stroke risk factors, such as high blood pressure, diabetes, high cholesterol, cigarette smoking, alcohol abuse, obesity and physical inactivity. Limit your alcohol consumption to one or two drinks a day, and work with your doctor to quit smoking, shed pounds if you're overweight, and control your blood pressure, blood sugar and cholesterol.

Proper diet and exercise are two of the best ways you can control your risk. Reduce your intake of fatty meats, and choose lean protein sources such as fish and chicken. Eat five to six servings of fruits and vegetables a day, cut back on foods high in calories, carbohydrates, cholesterol, saturated fat and trans fatty acids, and choose low-fat dairy products. Also, get at least 30 minutes of moderate-intensity aerobic exercise each day, but first work with your doctor to develop an exercise plan that's right for you.

Have your doctor assess your stroke risk and treat heart disease and conditions such as atrial fibrillation (a rapid, irregular heart rhythm) that raise your risk. Ask your doctor if you need tests to detect arterial blockages, and discuss treatment options if blockages are found.

What You Can Do

Don't ignore any stroke warning signs. Call 911 immediately, or have someone call for you. Note the time when stroke symptoms first develop, because you'll be asked this question later. Find your nearest primary stroke center by visiting the Joint Commission's Web site http://www.jointcommission.org

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