May is Stroke Awareness Month, and while many families are affected by this potentially fatal event, few of us know the startling statistics. Every year, nearly 800,000 strokes occur in the United States, killing nearly 130,000 people. Strokes are also a leading cause of long-term disability.
Strokes can happen to anyone regardless of age, race, or sex; however, older adults, African Americans, American Indians/Alaska Natives, and people living in the southeastern United States have higher stroke prevalence, according to the Centers for Disease Control.
A stroke or brain attack, also called cerebrovascular accident, occurs when an artery carrying oxygen-and-nutrient-rich blood to the brain is blocked or bursts and the brain cells begin to die.
There are two types of stroke. The most common, accounting for about 85 percent, is an ischemic stroke, which is caused by a blocked artery due to plaque inside the vessel or blood clots. Hemorrhagic stroke is caused by a leaking or burst blood vessel resulting from pre-existing conditions such as high blood pressure or aneurysms, balloon-like bulges in an artery.
Transient ischemic attacks (TIAs), sometimes called “mini-strokes,” occur if blood flow to a portion of the brain is blocked only for a short time and does not cause permanent damage to brain cells. TIAs may indicate an impending significant stroke.
It is imperative to know the symptoms of stroke because immediate treatment can save lives and prevent serious complications. The acronym FAST can help determine if someone is having a stroke:
• F—Face: Can the person smile? Does one side of the face droop?
• A—Arms: Can the person to raise their arms? Does one drift downward?
• S—Speech: Can the person to repeat a simple phrase? Is their speech slurred?
• T—Time: If any of these symptoms are present, call 9-1-1.
In addition to the FAST symptoms, any signs suggesting brain dysfunction such as confusion, dizziness, poor balance, vision problems, or severe headache may indicate a stroke. Women may experience atypical signs of stroke, some of which mimic heart attack, including face or chest pain, nausea, heart palpitations, or shortness of breath.
There are numerous risk factors for stroke, divided into two categories: controllable and uncontrollable.
• Uncontrollable risks include gender, family history, and age. African Americans and Native Americans, who have a higher rate of high blood pressure and diabetes, are at greater risk for stroke as are those with family history of strokes and heart attacks.
• Controllable risk factors include high blood pressure, diabetes, smoking, high cholesterol, heart disease, obesity, and alcohol or drug abuse. Controlling risks often requires medications but primarily revolves around healthy lifestyle choices such as daily exercise and not smoking. In fact, the incidence of stroke has decreased as more people have become educated about the importance of maintaining healthy blood pressure and cholesterol.
Women who use oral contraceptives, especially those who smoke, are at greater risk. There is also evidence that pregnant women and hormone replacement therapy patients are at greater risk. Women who suffer migraine headaches with visual disturbances are at higher risk of stroke along with women with autoimmune diseases such as lupus.
Treatment depends on the type of stroke. When a patient is brought to the emergency room, the stroke team works quickly to determine the cause with physical examinations and tests including blood work, CT and magnetic resonance imaging scans, echocardiograms, carotid ultrasounds, and cerebral angiograms.
Treatment for ischemic stroke may include injection of blood clot busters such as tissue plasminogen activator (TPA), which only works within several hours of the onset of symptoms. Aspirin may be administered to prevent the formation of other clots. Catheters may be used to remove blood clots.
Hemorrhagic strokes may require surgery to repair blood vessels or endovascular embolization, a procedure in which a surgeon guides a catheter to the trouble spot to stop bleeding.
The severity of a stroke depends on the part of the brain affected. Strokes that occur on the right side of the brain affect movement and feeling on the left side of the body. Left-brain strokes affect the movement on the right side, in addition to speech and language problems.
Rehabilitation and physical therapy for stroke patients is very important. While one part of the brain may not recover from a stroke, the rest of the brain can compensate for the loss. Outcomes are much better for patients who go through a structured rehabilitation program.
Dr. Smaranda Galis is a board-certified neurologist and practices with the Bon Secours Neuroscience Center in Portsmouth. She is a member of the American Academy of Neurology, Virginia Neurological Society, and Tidewater Medical Women’s Association and is a clinical assistant professor in the department of physical medicine and rehabilitation at EVMS. For more information, call 757-215-3565.