Best of 2024 #2 - Get Smart About Stroke

The most important thing you need to remember is that stroke, like heart attack, is a time-sensitive emergency. Failure to act in time can lead to brain damage and even death, as evidenced by these statistics from the CDC:

• More than 795,000 people in the U.S. have a stroke each year.
• High blood pressure, high cholesterol, smoking, obesity and diabetes are leading causes of stroke – 1 in 3 U.S. adults has at least one of these conditions or habits.
• Non-Hispanic Black adults face almost double the risk of a first stroke compared to White adults, with the highest stroke-related death rates among non-Hispanic Black and Pacific Islander adults.
• About 1 in 7 strokes occur in people aged 15 to 49.
• More importantly – 4 in 5 strokes are preventable.

What Is a Stroke?

A stroke occurs when blood flow to the brain is suddenly interrupted, depriving the brain of oxygen-rich blood. Nerve cells can’t function and start to die within die within minutes. This can cause temporary or permanent brain damage, disability, and even death. There are several different types of strokes:

• Ischemic stroke is caused by a blockage in an artery in the brain, either due to plaque buildup or to a blood clot. 87% of all strokes are ischemic.
  • Thrombotic ischemic strokes are caused by a blood clot that develops in the blood vessels inside the brain. Thrombotic strokes may be preceded by one or more ischemic attacks, also called TIAs or mini strokes.
  • Embolic strokes happen when a blood clot or a piece of plaque debris forms elsewhere in the body and travels up to the brain via the blood stream. This type of stroke is more common in people with atherosclerosis and high cholesterol, or in those with AFib, a type of abnormal heart rhythm. Embolic strokes can also occur in people with heart disease or after heart surgery.
• Hemorrhagic stroke occurs when an artery bursts inside the brain, either due a weakness in the blood vessel wall (aneurysm) or to a tangle of abnormal blood vessels connecting arteries and veins in the brain (an arteriovenous malformation). Damage from hemorrhagic stroke is due to blood pooling inside the brain and putting pressure on brain tissue.
   
• Subarachnoid hemorrhage is a hemorrhagic stroke in which the bleeding is between the brain and the skull.
   
• Transient Ischemic Attack (TIA), sometimes called a mini stroke, is a temporary blockage in blood flow to your brain. Symptoms may last for just a few minutes. However, about 15% of strokes are preceded by one or more TIA’s. Even if symptoms appear to subside, a person experiencing a TIA needs to go to the Emergency Department.

To recognize stroke symptoms, think G.F.A.S.T.

If you think you, or someone else, may be having a stroke, use the G.F.A.S.T. test for recognizing stroke symptoms:
G = Gaze – the person may be looking off only in one direction
F = Face – Ask the person to smile. Does one side of the face droop?
A = Arms – Ask the person to raise both arms. Does one arm drift downward?
S = Speech – Ask the person to repeat a simple sentence. Does the speech sound slurred or strange?
T = Time – If you observe any of these signs, it’s time to call 911.

The sooner a stroke patient can get medical attention, the greater the chance that doctors can limit the damage. Patients who arrive at the emergency room within 3 hours of their first symptoms often have better outcomes than those who received delayed care. If possible, note the time the symptoms started, or the last time the person was known to be well – this is important information for the medical team. If you are the one having stroke symptoms do not drive yourself! Call 911 and unlock your door so the paramedics can let themselves in.

Treating stroke

Treatment for stroke often begins in the ambulance. First responders assess the stroke victim’s airway, breathing and circulation and start oxygen therapy if needed. They perform a simple neurological exam called a stroke screen and check the person’s blood sugar to make sure their symptoms are not due to a hypoglycemic attack. They take a base line electrocardiogram and get an IV started and update the Emergency Department so the stroke team can be ready to treat immediately upon arrival.

Treating ischemic stroke

The standard treatment for ischemic stroke is the use of a protein involved in the breakdown of blood clot, tissue plasminogen activator, or TPA. This must be given within four and a half hours of the stroke’s onset. If a CT scan reveals salvageable tissue around the clot, surgical removal may be attempted.

Treating hemorrhagic stroke

Emergency treatment of hemorrhagic stroke focuses on controlling the bleeding to reduce pressure on the brain. If a person is on a blood thinner, they will be given medication and/or a transfusion of blood products to counteract the effects of the blood thinner. They may also be given drugs to lower blood pressure and intracranial pressure and prevent seizures and blood vessels spasms.

Surgical and minimally invasive procedures to treat stroke

A large clot may sometimes be removed minimally invasively through catheter-based procedure called a thrombectomy. Treatment is different for hemorrhagic stroke because the problem is bleeding. If blood pools in the space between the brain and the skull, it causes swelling a pressure on the brain. If possible, strokes like these are treated surgically through a craniotomy, an open procedure that alleviates pressure on the brain and provides access to the affected blood vessel if it can be surgically repaired.

Reduce your risk of stroke

1. Know your blood pressure and work with your doctor to keep it under control.
2. Cut down on the sodium (salt) and fat in your diet.
3. Find out if you have atrial fibrillation (AF). If you have AF, work with your doctor to manage it.
4. If you smoke, stop. Smoking doubles the risk for stroke.
5. Drink moderately. Remember that alcohol can interact with other drugs you are taking.
6. Know your cholesterol number and work with your doctor to reduce it.
7. If you have diabetes, follow your doctor’s recommendations carefully to control your blood sugar.
8. Exercise regularly. As little as 30 minutes of daily exercise may reduce your risk for stroke.

This article appeared in the May 2024 edition of the HealthPerks newsletter.