We all know what a heart attack is: the disruption of blood flow to the heart muscle. But when it comes to understanding stroke, people tend to be a little fuzzy. Stroke is the disruption of blood flow to the brain. Also not widely known: Stroke is a leading cause of disabilities and the most common cause of death in the U.S. after heart disease and cancer.
[improve your odds]
Many risk factors are controllable
>> Nearly 14 % of those over 80 will have a stroke
>> 1 in 200 people ages 20- 39 will have a stroke according to the National Center for Health Statistics Prevention is the only cure, dr. frasat chaudry stresses. “Once a stroke has occurred, the damage is done.”
[risk factors] … According to the U.S. Centers for Disease Control and Prevention
>> More than 795,000 Americans suffer strokes each year; about 130,000 of them will die from complications.
>> High blood pressure is the leading risk factor, with others being atrial fibrillation, diabetes, family history, obesity, high cholesterol, smoking and race
(African-Americans are almost twice as much at risk.)
[brain attack]
It’s scary to think we’re just one, small, blood vessel irregularity away from death. However, interrupted blood flow can happen at any time, without warning, the experts explain. “Colloquially, we call stroke a ‘brain attack,’” says Dr. Frasat Chaudry, a neurologist at St. Luke’s Hospital. Millions of brain cells die during each minute blood flow is interrupted. “Brain tissues are deprived of oxygen and nutrients,” she says, which means that stroke can result in loss of function in sight, sleep, bladder or bowel control, body movement, memory and more depending on which part of the brain has been affected, according to the National Stroke Association (NSA). A stroke on the left side of the brain impacts the right side of the body, and vice versa.
“Strokes can occur at the time of birth,” says Dr. Michael A. Twyman of Des Peres Hospital and Premier Medical Specialists, although they’re more common in the elderly, when the blood vessels are hardened. “But nobody is too young to have a stroke,” he points out.”
two types
The majority of strokes (about 87 percent) are ischemic, which occur when the blood supply is interrupted or reduced by a blood clot that either forms in an artery in the brain or travels from another part of the body. Ischemic stroke can be treated with the medication tPa (tissue plasminogen activator) if the patient reaches the hospital quickly enough and the stroke is determined to be caused by a clot, Twyman says.
“The other type, hemorrhagic, is the bleeding stroke,” Chaudry says. “This occurs when a blood vessel ruptures and the blood supply to a part of the brain is interrupted.” We’ve all heard of an aneurysm, and that can be the culprit in bleeding strokes. “An aneurysm is an abnormal dilatation of a blood vessel that can be described as a bulge in the wall of a blood vessel. If an aneurysm ruptures in the brain, it can cause bleeding there,” Chaudry explains.
“Hemorrhagic stroke may require emergent neurosurgery, where a hole is drilled in the skull to relieve pressure,” adds Twyman.
when is it a stroke?
“One of the keys is a sudden change, like the sudden loss of strength on one side of the body, a sudden onset of numbness on one side of the body, a facial droop or double vision,” Chaudry describes. “Some people feel a sudden loss of balance or the ability to walk straight.” Another telltale symptom is “the worst headache of your life,” she says. “It is called the ‘thunderclap headache’ because one second you are OK, the next you are not.”
“The moment any of these symptoms come on, call 911,” Twyman cautions:
The FAST test >>
Face: Ask the person to smile to see if one side of the face droops.
Arms: Ask the person to raise both arms to see if arm drifts downward.
Speech: Ask the person to repeat a sentence to see if it is slurred or strange.
Time: If you suspect stroke, call 911 immediately.
[time is brain]
Doctors say you can’t overestimate the importance of immediate treatment for stroke. That’s why they’ve coined the phrase, ‘time is brain.’ Treatment is measured in seconds and minutes, not hours, with quality of life in the balance.
the good news
Fatalities and disabilities resulting from stroke have decreased dramatically in recent years. “Stroke, by definition, cuts off the blood supply to the brain, causing cells to undergo death—quickly,” says Dr. Amer Alshekhlee, an interventional neurologist with the SSM Neurosciences Institute at SSM DePaul Health Center. “The brain is very frail, very friable tissue, not like muscle. Delaying the opening of a blockage can lead to more cell death—and more debilitating and deadly strokes.”
stat!
Utilizing new imaging techniques, researchers determined the brain loses 1.9 million of its 130 billion neurons each minute blood supply is disrupted during a stroke. Each minute of acute ischemic stroke produces the same effects as 3.1 weeks of ‘accelerated aging.’ “The medical response comes from one angle—getting the patient as quickly as possible to the emergency room to treat that blockage,” Alshekhlee says. “Our institution, and the majority of others, rely on CAT scan imaging to localize the clot inside the brain and tell us exactly what we can do for it.”
When a stroke is caused by a blood clot blocking an artery, “the most common treatment has been clot-busting medicine,” he says. This approach is typically used with patients whose stroke happened within four and a half hours.
new alternatives
Patients who reach a hospital too late for the clot-dissolving medication may benefit from a relatively new technique similar to cardiac catheterization, a minimally invasive procedure used to diagnose and treat other cardiovascular issues. Performed with a needle and fine flexible tubing threaded through the blood vessels, interventional neurology has become a common treatment for strokes in the last three or four years, Alshekhlee says.
CAT images “tell us whether we can safely say this person is a candidate for catheter treatment,” he says. “The most common site for introducing the catheter is the groin; then we pass it up the carotid or vertebral artery to the brain. Then we pass a very small microcatheter through the larger catheter and localize the clot, which we remove.”
local abundance
There are 14 hospitals in the St. Louis metropolitan area recognized as primary stroke centers by The Joint Commission, which accredits health care organizations and programs. An additional two centers, SSM DePaul Health Center and Barnes- Jewish Hospital, are accredited as comprehensive stroke centers capable of treating patients with “the most complex strokes.” Saint Louis University Hospital is the only one in Missouri to receive the Gold Award for stroke from the American Heart Association.
brain saved
“Blood clots in the brain used to have a very high mortality. Using the new technologies, the percentage of deaths has dropped from 60 or 70 percent down to 20 or 25 percent or less,” Alshekhlee says. Educational efforts are ongoing to make more people across the country—patients, emergency medical service providers and medical professionals—aware of the need to respond quickly, he adds. “Strokes often are painless, unlike a heart attack. So people don’t report them as soon as they start having symptoms.”
[stroke secret]
First we were bombarded by the news that women actually suffer more heart attac ks than men. Now we learn they are also at greater risk for stroke later in life. Let’s see why.
Throughout much of life, women and men have similar stroke risk rates. But in the later years, women suffer about 55,000 more strokes a year than men, according to the American Heart Association. “It appears that women are mostly protected until they enter menopause,” says Dr. Michael J. Lim, director of the division of cardiology and co-director of the Center for Comprehensive Cardiovascular Care at Saint Louis University School of Medicine. “The natural estrogen that women have tends to protect them against cardiovascular disease.”
In fact, the incidence of strokes increases greatly for both genders as they age. About 2.4 percent of women aged 40 to 59 will have a stroke, according to the National Center for Health Statistics. The portion increases to 8.2 percent for women 60 to 79 and 14.8 percent for women 80 and older. As if the figures weren’t bad enough, strokes also tend to be more dangerous in the later years. “When you are older you have less ability to make it through the acute problem and recover from it,” Lim says. “It is not necessarily that the event is more severe, but tissues don’t regenerate as quickly so healing doesn’t happen as quickly.”
