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Stroke Awareness and Prevention -- April 19, 2010 -- Dr. Michael Kaminski

STROKE AWARENESS & PREVENTION
April 19, 2010
Michael Kaminski, MD, neurologist
Saint Thomas Neurology

What is a stroke?

A stroke occurs when a blood vessel in the brain is blocked or bursts. Without blood and the oxygen it carries, part of the brain starts to die. The part of the body controlled by the damaged area of the brain can't work properly.

Brain damage can begin within minutes, so it is important to know the symptoms of stroke and act fast. Quick treatment can help limit damage to the brain and increase the chance of a full recovery.

SYMPTOMS

Symptoms of a stroke happen quickly. A stroke may cause sudden:

• Numbness, weakness, or paralysis of the face, arm, or leg, especially on one side of the body.
• Trouble seeing in one or both eyes. You may have double vision, or things may look dim or blurry.
• Confusion or trouble understanding.
• Slurred or garbled speech.
• Trouble walking. You may feel unsteady, dizzy, or clumsy.
• Severe headache.

If you have any of these symptoms, call911or other emergency services right away.

See your doctor if you have symptoms that seem like a stroke, even if they go away quickly. You may have had a transient ischemic attack (TIA), sometimes called a mini-stroke. A TIA is a warning that a stroke may happen soon. Getting early treatment for a TIA can help prevent a stroke.

CAUSES

There are two types of stroke:

• An ischemic stroke develops when a blood clot blocks a blood vessel in the brain. The clot may form in the blood vessel or travel from somewhere else in the blood system. About 8 out of 10 strokes are ischemic (say "iss-KEE-mick") strokes. They are the most common type of stroke in older adults.
• A hemorrhagic stroke develops when an artery in the brain leaks or bursts. This causes bleeding inside the brain or near the surface of the brain. Hemorrhagic (say "heh-muh-RAH-jick") strokes are less common but more deadly than ischemic strokes.

How is a stroke diagnosed?

Seeing a doctor right away is very important. If a stroke is diagnosed quickly-within the first 3 hours of when symptoms start-doctors may be able to use medicines that can lead to a better recovery.

The first thing the doctor needs to find out is what kind of stroke it is: ischemic or hemorrhagic. This is important because the medicine given to treat a stroke caused by a blood clot could be deadly if used for a stroke caused by bleeding in the brain.

To find out what kind of stroke it is, the doctor will do a type of X-ray called a CT scan of the brain, which can show if there is bleeding. The doctor may order other tests to find the location of the clot or bleeding, check for the amount of brain damage, and check for other conditions that can cause symptoms similar to a stroke.

TREATMENTS

For an ischemic stroke, treatment focuses on restoring blood flow to the brain. If less than 3 hours have passed since your symptoms began, doctors may use a medicine that dissolves blood clots. Research shows that this medicine can improve recovery from a stroke, especially if given within 90 minutes of the first symptoms.1 Other medicines may be given to prevent blood clots and control symptoms.

A hemorrhagic stroke can be hard to treat. Doctors may do surgery or other treatments to stop bleeding or reduce pressure on the brain. Medicines may be used to control blood pressure, brain swelling, and other problems.

After your condition is stable, treatment shifts to preventing other problems and future strokes. You may need to take a number of medicines to control conditions that put you at risk for stroke, such as high blood pressure, high cholesterol, and diabetes. Some people need to have a surgery to remove plaque buildup from the blood vessels that supply the brain (carotid arteries).

The best way to get better after a stroke is to start stroke rehab. The goal of stroke rehab is to help you regain skills you lost or to make the most of your remaining abilities. Stroke rehab can also help you take steps to prevent future strokes. You have the greatest chance of regaining abilities during the first few months after a stroke. So it is important to start rehab soon after a stroke and do a little every day.

PREVENTION

After you have had a stroke, you are at risk for having another one. You can make some important lifestyle changes that can reduce your risk of stroke and improve your overall health.

• Don't smoke. Smoking can more than double your risk of stroke.2 Avoid secondhand smoke too.
• Eat a heart-healthy diet that includes plenty of fish, fruits, vegetables, beans, high-fiber grains and breads, and olive oil. Eat less salt too.
• Get exercise on most, preferably all, days of the week. Your doctor can suggest a safe level of exercise for you.
• Stay at a healthy weight.
• Control your cholesterol and blood pressure.
• If you have diabetes, keep your blood sugar as close to normal as possible.
• Limit alcohol. Having more than 2 drinks a day increases the risk of stroke.
• Take a daily aspirin or other medicines if your doctor advises it.
• Avoid getting sick from the flu. Get a flu shot every year.

Work closely with your doctor. Go to all your appointments, and take your medicines just the way your doctor says to.  You can help prevent a stroke if you control risk factors and treat other medical conditions that can lead to a stroke.

And if you have already had a stroke or a transient ischemic attack (TIA), you can prevent another stroke in the same way, by controlling risk factors and treating medical conditions that can lead to stroke.

A transient ischemic attack (TIA) is a warning sign that a stroke may soon occur. Prompt medical attention for a TIA may help prevent a stroke.

Seek emergency medical help immediately if you have symptoms of a TIA, which are similar to those of a stroke. Symptoms include problems with vision, speech, behavior, and thought processes. A TIA may cause loss of consciousness, seizure, dizziness (vertigo), and weakness or numbness on one side of the body. Symptoms of a TIA, however, are temporary and usually disappear after 10 to 20 minutes, although they may last longer.

Treating other medical conditions can help prevent a stroke.

• Hardened arteries. If you have been told that you have hardening of the arteries (atherosclerosis), check with your doctor about whether you should take an aspirin each day and/or a medicine to lower your cholesterol. Taking an aspirin daily can also reduce the risk of stroke in a person who has already had an ischemic stroke, a TIA, or carotid endarterectomy surgery.
• Blocked carotid artery. If your doctor hears a swishing sound-a bruit (say "broo-E")-when listening to blood flow through the large blood vessels in your neck (carotid arteries), ask whether you need further testing (usually carotid ultrasound). Aspirin or surgery to reopen a blocked carotid artery may be appropriate. For more information on this surgery, see:

LOWER YOUR RISK of STROKE

• Taking aspirin if you have had a heart attack.2 For more information, see:

Should I take daily aspirin to prevent a heart attack or a stroke?

• Taking anticoagulants, as prescribed by your doctor, if you have atrial fibrillation or have had a heart attack with other complications.2
• Eating a nutritious, balanced diet that is low in cholesterol, saturated fats, and salt. Foods high in saturated fat and cholesterol can make hardening of the arteries worse. Eat more fruits and vegetables to increase your intake of potassium and vitamins B, C, E, and riboflavin. Add whole grains to your diet: one study showed whole grains reduced the risk of ischemic stroke in women.11 Eating fish one or more times a month may also reduce your risk of stroke.12 Limit the amount of salt you eat too. For more information, see:

Heart disease: Eating a heart-healthy diet.

• Avoiding illegal drugs (such as a stimulant, like cocaine). Cocaine can increase blood pressure and cause the heart to beat more rapidly, thereby increasing your risk of stroke.
• Avoiding birth control pills if you have other risk factors. If you smoke or have high cholesterol or a history of blood clots, taking birth control pills increases your risk of having a stroke.
• Avoiding hormone replacement therapy. In women who have gone through menopause, hormone replacement therapy has been shown to slightly increase the risk of stroke.7
• Avoid getting sick from the flu. Get a flu shot every year.