Quick Action is Key to Surviving a Stroke

By Guest Contributor September 15, 2009 11:47

By Dr. Bob Uslander

“Paramedics are bringing us a 73-year-old female who woke up with paralysis of her right side, and she’s unable to speak.” This report, which came near the end of a recent emergency room shift, was disturbing. I knew these symptoms were most likely caused by a stroke, and without knowing when they began, I knew there wasn’t much we’d be able to do for her.

As an emergency physician, my goal is to fix people quickly. That’s what excites me about the job – diagnosing a problem and finding the right solution. But stroke frustrates doctors because the treatment options are limited. Only a small percentage of stroke victims get to an E.R. quickly enough to receive the one treatment that can make a significant difference.

For the vast majority, the only options are aspirin and, on occasion, other blood thinners. Rehabilitation programs, like occupational, physical and speech therapy, often begin once the stroke symptoms have stabilized. While these services are helpful, they are often not enough to allow stroke victims to return to good health. This is why I cringe when I hear about a possible stroke patient on the way to the emergency room.

Strokes are the third leading cause of death among Americans, after heart disease and cancer. More than 750,000 people will suffer strokes this year, and about 160,000 will die.

Strokes can also cause dementia in older adults. “Multi-infarct dementia” is the result of many small strokes occurring over time. Most of these do not cause noticeable symptoms alone, but cumulatively cause this common form of dementia.

A key stroke warning sign is a Transient Ischemic Attack (TIA), or mini-stroke. This is when symptoms of a stroke develop, but disappear within 24 hours. Many people who experience a TIA will have strokes in the future if not treated effectively. So TIA victims should seek immediate medical attention. TIA also stands for: Take Immediate Action!

Most strokes are caused by “ischemia” of the brain, resulting from a blocked or narrowed artery in the brain or neck. “Ischemia” is a fancy word for the lack of oxygen that occurs in cells when their blood supply is interrupted.

When blood flow to the brain is interrupted, the cells begin to die, resulting in loss of the body functions. Depending on the area of the brain affected, the symptoms of a stroke may include sudden arm and/or leg weakness or numbness, loss or changes of vision, dizziness, loss of balance, inability to speak properly, and confusion. Most “ischemic” strokes are painless.

About 80 percent of all strokes are ischemic, while the rest are caused by a hemorrhage (bleeding) into or around the brain. Hemorrhages result from a ruptured aneurysm, from a leaking blood vessel damaged by high blood pressure, diabetes or other inflammatory diseases, trauma, or an arteriovenous malformation – an abnormal collection of small blood vessels that can leak, rupture or clot off.

Hemorrhagic strokes are typically more devastating and life threatening than ischemic strokes, but not always. Hemorrhages are commonly accompanied by a headache, and more frequently cause significant confusion and an altered level of consciousness. Hemorrhagic strokes can sometimes be treated by surgery to remove the blood.

One treatment that has been shown to make a difference in reducing stroke-related death and disability is a “clot busting” medication called Tissue Plasminogen Activator (TPA).  Only patients who have an ischemic stroke confirmed by a thorough exam and a CAT scan within three hours of the symptom onset are eligible to receive this treatment. Later, the risk of giving the medication increases and its effectiveness decreases.

Getting to a hospital very quickly once stroke symptoms develop is crucial. The quicker the stroke is diagnosed, the more options for treatment may be available. Too often, we see patients who have waited at home for several hours, sometimes up to a day, to see if the symptoms disappear. A “wait and see” approach is no way to treat stroke symptoms.

Since the 73-year-old woman I wrote of earlier “woke up” with her symptoms and an accurate time frame could not be established, her treatment options were limited. Most importantly, she was not a candidate for TPA.

For information about stroke prevention, symptoms, and treatment, check these websites: www.stroke.org and www.mayoclinic.com.

Reducing Stroke Risk

  • Just as with heart attack prevention, focus on controlling your blood pressure, cholesterol and triglyceride levels – and your weight.
  • Eat healthfully, and get lots of exercise.
  • Stop smoking. It’s a major risk factor.
  • If you’ve had a previous stroke or TIA, aspirin may help prevent a recurrence. A baby aspirin a day may help prevent strokes, even in people who haven’t had prior symptoms, but check with your doctor before starting this therapy.

Dr. Bob Uslander is an emergency room physician and founder of Seniority Lifecare.

© 2009, Friends and Neighbors Magazine

By Guest Contributor September 15, 2009 11:47
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