STROKE.
If you think that the only people who suffer from
strokes are in their senior years, guess again. Every year, more than 700,000
Americans suffer a stroke, which can strike individuals in their mid-teenage
years, but the average age is 65 years old. Strokes are the third leading cause
of death and disability in our country, with 20 percent of the victims dying
within the first year, at a cost of $30 billion in health care costs.
What is stroke? A stroke is the reduction of blood flow to
the brain. This may be caused by a blockage in an artery supplying the brain
by a blood clot, decreasing
the blood flow. This is called an ischemic stroke. Another type of stroke may
be due to the rupture of an artery causing bleeding within the brain. This is
called a hemorrhagic stroke.
Both types of stroke cause damage to the architecture of the brain and these
brain cells will die when deprived of oxygen-rich blood flow. This process may
continue for hours. The ischemic stroke may be more aggressively treated initially,
as opposed to the hemorrhagic stroke. It is therefore important to understand
the signs and symptoms, so that emergent treatment will be sought.
What are the signs and symptoms? It is essential to
understand that the signs and symptoms of stroke may be very nonspecific and
vague. Patients may complain
of a headache or confusion. There may be blurred vision or loss of vision. Additionally,
patients may complain of numbness or tingling. There may be difficulty with speech
and swallowing. The arms and legs may be numb, weak or not able to move. Patients
may pass out.
It is easy to see that there are numerous signs and symptoms. Most patients will
have a few of the above signs. The health care provider must be suspicious of
a stroke based on the history of the condition, as well as other risk factors.
What are risks for stroke? Patients that are at risk
for a stroke may have several factors that may contribute to the condition. Age
is a risk factor, and the older
the patient, the greater the chance of stroke. Patients who have high blood pressure,
who are smokers, have diabetes and are overweight, have the highest incidence
of stroke. The role of high cholesterol in stroke is not clear, unlike with coronary
artery disease and heart attack.
In a previous column, atrial fibrillation was discussed. 1.5 million Americans
suffer from atrial fibrillation, a heart beat rhythm disturbance, and this increases
the chance of stroke six-fold! Patients who remain in atrial fibrillation must
have their blood thinned through the use of aspirin or warfarin (Coumadin).
What should I do? It is essential for patients to
modify their risk factors prior to suffering a stroke. This can be accomplished
through the help of your health
care provider. This is the most important step in dealing with this potentially
deadly disease.
In the event that you or a friend experiences the signs of stroke, IMMEDIATE
medical attention is necessary. Call 911 to activate the emergency medical services
system and the ambulance will be summoned with trained medical professionals.
The emergency medical technicians will notify the emergency department of the
impending arrival of the patient. This will allow the staff to prepare medications
and for testing.
What should I expect at the hospital? The diagnosis
of stroke must be made in a very timely fashion. A CT Scan (X-ray) of the brain
will be immediately obtained
to determine the nature of the cause. If the stroke is caused by lack of blood
supply and not bleeding, a clot-busting drug will be given. This will dissolve
the blood clot causing the stroke. This will be done in the emergency department
in consultation with the emergency physician and a Neurologist. The drug is only
effective and safe if given within a three-hour window of the beginning of the
symptoms.
Additional medications may also be given to thin the blood. Also, other studies
such as an EKG, blood work, echocardiogram and carotid dopplers will be obtained
during the hospitalization.
How long is recovery? As with any medical condition,
recovery periods depend on the extent of the damage. Additionally, underlying
causes of the medical condition
and risk factors must be addressed. A period of physical therapy and rehabilitation
may ensue for several months to return the patient to as near to their pre-stroke
condition.
Most importantly, it is important for the patient and family to initially recognize
the signs and symptoms of stroke. Immediate medical attention will shorten the
course of the recovery and decrease the possibility of major disability. It is
always imperative to seek medical attention when you are confronted with questions
surrounding a stroke.
