Tia Aryal, M.D., Williamson Medical Center
Although most people will say they have heard of a stroke or are familiar with the term, very few people can cite specifics about stroke warning signs and care. Being board certified in stroke care, it’s my job to lead stroke education for the community and share the latest science behind treatments. Did you know that stroke is the fifth leading cause of death in the United States? It is also the leading cause of disability in adults. Every forty seconds someone has a stroke, but more importantly, up to eighty percent of all strokes are preventable. Let’s go through a few stroke facts, risk factors and warning signs you need to be aware of.
WHAT IS A STROKE?
By definition, a stroke is sudden brain damage caused by an abrupt lack of blood flow to the brain. Essentially, the brain is deprived of oxygen and important nutrients. When there is a lack of blood to the brain, the brain cells start to die. This leaves people with varying levels of disability. There are two main types of stroke, ischemic and hemorrhagic. A blood clot or plaque buildup blocks an artery in an ischemic stroke. An artery bursts causing bleeding in or around the brain in a hemorrhagic stroke. Strokes are not typically painful, so people often ignore the symptoms and delay seeking care. I tell people to think of a stroke like a “brain attack.”
When I tell people that up to eighty percent of strokes could have been prevented, the first thing I am asked is how? My response is simple; make good lifestyle choices so your modifiable risk factors are controlled.
It is important to know your blood pressure and have it checked at least annually. If it is elevated, work with your doctor to get it under control. If you have an irregular heartbeat, inform your doctor so they can determine if you have atrial fibrillation. If you smoke, you must stop. Consuming alcohol is fine in moderation. Drinking more than the recommended one standard drink for women or two standard drinks for men per day can have adverse health effects. Cholesterol and diabetes both need to be controlled with the help of a physician. And with many health issues, it’s important to exercise and eat a healthy diet. Your goal should be 150 minutes of moderate exercise per week. It does not have to be too strenuous, but should raise your heart rate. For diet, consider a Mediterranean diet. This includes fruits, vegetables, fish and other un-processed foods.
Strokes happen suddenly. If any of the following symptoms occur suddenly, they could be the symptoms of a stroke.
• Sudden numbness or weakness of the face, arm or leg, especially on one side.
• Sudden confusion, trouble speaking or understanding.
• Sudden trouble seeing in one or both eyes.
• Sudden trouble walking, dizziness or loss of balance.
• Sudden severe headache with no cause.
There is only one medication available to treat stroke called tPA. This powerful blood thinner works by dissolving clots that are blocking arteries, but it is only effective if given within four-and-a-half hours after the onset of stroke symptoms. Arriving to the hospital via ambulance allows people to be recognized as a stroke sooner. Emergency medical service (EMS) providers can pre-notify the emergency department that a possible stroke patient is on the way. This results in faster brain imaging, faster evaluation by the doctor and a higher likelihood of being treated with tPA. Our EMS in Williamson County has established a pre-notification system for stroke patients so we can activate our stroke protocol before you even arrive at the hospital.
There is now a second option for acute stroke treatment after tPA is considered. If there is a blockage in a large blood vessel in the brain, you may be a candidate for endovascular stroke treatment. For this procedure, doctors thread a special catheter through an artery in the groin up to the blocked blood vessel in the brain to remove the clot. Just like tPA this is a very time sensitive treatment. It is only recommended if it can be started within six hours after the onset of stroke symptoms.
There is still a lot we don’t know about the brain’s ability to repair itself from the damage caused by a stroke. Some brain cells may only be temporarily damaged and can resume function. In some cases, the brain can re-learn what was lost. Roughly 10 percent of stroke survivors recover almost completely and 25 percent recover with only minor disabilities. The remaining are left with significant disability or even death. Early rehab is beneficial in stroke recovery. A stroke is a life changing event. Stroke survivors and their families must face these changes with patience, creativity, and tenacity.
Tia Aryal, M.D. is board certified in neurology and vascular neurology. She is part of Williamson Medical Group and sees patients at Williamson Medical Center.