Even though strokes are this nation's third leading killer, they are a preventable, not inevitable, part of life.
by Carrie St. Michel
Medicine and myths. Just as thunder follows lightening, misperceptions often similarly shadow medical conditions. Stroke is a prime example. Consider the following statements and see if you can separate myth from fact.
Most strokes can't be prevented.
When a stroke is occurring, there is nothing that can be done medically to stop it.
Strokes only strike the elderly.
The organ most affected by a stroke is the heart.
All of these statements are false. And limiting what we don't know about stroke-such as the fact that fully 80 percent of strokes are preventable-can make a life-or-death difference.
Stroke Specifics
Strokes can be divided into two basic categories: ischemic and hemorrhagic.
Ischemic strokes, which account for 80 percent of all strokes, are set into motion when a blood clot forms in a blood vessel or other internal site, such as the heart. Traveling up the blood vessel, the clot sets up a roadblock of sorts, narrowing or completely obstructing arteries leading to the brain, or within it. The clot prevents blood from flowing to particular portions of the brain and, in domino fashion, oxygen-starved cells start to die.
Hemmorrhagic strokes are caused, not by blood clots, but bleeding in the brain from a ruptured artery - or from an aneurysm, a 'blister' on a weakened portion of a blood vessel wall. Along with bleeding comes the potential for serious brain injury.
The extent of injury, in all types of strokes, is dependent upon which region of the brain is affected and the incident's severity. For example, someone who suffers a small stroke may experience only slight weakness in an arm or leg. By contrast, a large-scale stroke can wreak sweeping destruction, from permanent impairment of motor skills to wholesale loss of the ability to express and process language. Of course, the worst possible outcome is death, and stroke continues to be the nation's third leading killer, claiming nearly 160,000 lives each year.
Grasping a stroke's clinical intricacies is a complex task. For this reason, many experts, including George Teitelbaum, M.D., associate professor of neurological surgery at the Keck School of Medicine of USC, prefers the term "brain attack." Derived from the phrase "heart attack," brain attack better characterizes what a stroke actually is. "People generally understand that a heart attack is caused by a blockage of blood flow to the heart," explains Teitelbaum. "Strokes also are caused by a blockage of blood flow, but the target organ is the brain, not the heart. So the term brain attack is really much more descriptive."
A 911 Situation
Once a stroke occurs, Teitelbaum stresses that the urgency commonly associated with heart attacks should similarly be applied to strokes. "A stroke must be viewed as a medical emergency," he says. "Strokes are progressive, so from the moment they start, there is a three- to six-hour period in which it is critical to obtain emergency medical treatment. During this window, if we're able to restore blood flow to certain parts of the brain, we may be able to reverse much, if not all, of the stroke's damage."
However, according to the National Stroke Association, patients wait an average of 13 hours after the onset of stroke symptoms before seeking treatment, and fully 42 percent delay as long as 24 hours. A survey conducted by the same organization found that only 40 percent of those questioned would call 911 immediately if they were having a stroke, and two-thirds were wholly unaware of the short time frame during which medical intervention can be effective.
Central to the problem is the simple fact that many people do not realize they are experiencing a stroke. Becoming familiar with stroke symptoms is thus crucial. Symptoms include: numbness, weakness or paralysis in the face, arm or leg, especially if this occurs on only one side of the body; blurred or decreased vision; sudden and severe headache; difficulty speaking or understanding simple statements, and dizziness, loss of balance, or loss of coordination, particularly if associated with one or more of the above symptoms.
Compounding the problem of symptom unawareness is "the widespread misperception that strokes can't be treated," observes Teitelbaum. Nothing could be further from the truth. In fact, Teitelbaum notes, "in many cases strokes can be treated extremely effectively."
A person coming to the hospital with stroke symptoms will first undergo a CT scan to determine if there is bleeding in the brain. If bleeding is not detected, the patient may be given a clot-busting medication such as tPA (tissue plasminogen activator). Approved by the Food and Drug Administration in 1996, tPA is administered intravenously and works to dissolve the clot and restore blood flow. This therapy must begin within three hours of a stroke's onset, Teitelbaum notes.
An experimental twist to tPA that is currently being investigated is called intracranial thrombolysis. As Teitelbaum explains, "We can actually place a small tube inside the brain and deliver clot-busting medicines directly to the clot itself, dissolving it, and reversing the stroke's impact."
Surgical Intervention
Steven Giannotta, M.D., professor of neurological surgery at the Keck School of Medicine of USC, urges, "People really need to be proactive when it comes to strokes. If a problem is uncovered during a screening, chances are very good that we can surgically intervene."
For example, he explains, "If blood flow is partially blocked in a neck artery, we can perform a carotid endarterectomy." In this procedure, an incision is made in the blood vessel wall. Plaque or fatty deposits are then surgically removed, allowing for the return of normal blood flow. "Numerous studies have confirmed that carotid endarterectomy is a stroke-preventing technique," notes Giannotta
Giannotta adds, "Another approach with which we have had significant success is called carotid angioplasty and stenting." In this case, a plastic tube or catheter equipped with a balloon tip is advanced over a guide wire to the site where the carotid artery is blocked. The balloon is then inflated, dispersing the obstructive plaque. A tube constructed of metal mesh work, called a stent, is permanently placed in the affected artery to prevent a recurrence of blocked blood flow.
Reducing Your Risk
Despite the fact that someone in the United States suffers a stroke every minute, strokes are highly preventable. Heading off a stroke before it starts requires reducing your risk factors. Each risk factor you possess increases your odds of becoming a stroke victim. Risk factors include high blood pressure; elevated blood cholesterol levels; diabetes; smoking; a prior history of stroke and/or heart attack, and atrial fibrillation (irregular heartbeat).
The risk of stroke also increases with age. According to the National Stroke Association, for each decade after age 55, the risk of stroke doubles. For adults over age 65, the risk of a fatal stroke is seven times that of the general population.
Stroke also brings with it distinct gender and racial biases. While women account for 43 percent of strokes suffered annually, they are much more likely to be fatally impacted, as they represent 62 percent of annual stroke deaths. In fact, stroke kills more than twice as many American females per year as does breast cancer. Stroke inequality similarly extends to race, as stroke incidence and mortality rates among African-Americans is almost double that of Caucasians.
Teitelbaum observes, "Strokes are not inevitable; to a significant extent, they are preventable." The keys to prevention include:
- controlling your blood pressure,
- finding out if you have heart disease, an abnormal heart rhythm, or diabetes and, if so, following your
- doctor's advice for treatment,
- lowering your cholesterol level,
- stop smoking,
- limiting alcohol consumption,
- exercising regularly and managing your weight, and
- eating a low-fat, low-sodium diet.
Another prevention tool is ultrasound imaging, the same technology that is used to visualize the fetus in the womb. Ultrasound can be used to detect blood-vessel blockages that carry with them the potential for stroke. It is a screening that takes only about an hour and may literally save your life.
At USC University Hospital, specially trained technicians use advanced Doppler ultrasound equipment to view a patient's carotid artery, located in the neck, and the abdominal aortic artery. The resulting images are analyzed to determine the presence of plaque, the degree of obstruction, if any, the thickness of the artery wall and flow of blood in the carotid artery.
This screening is especially crucial for those ages 55 or over, people with high blood pressure, individuals with a family history of stroke, or those who have previously suffered a stroke or heart attack.
Bill Grundy, a 76-year-old real estate broker, is absolutely sold on the life-saving potential of stroke screenings. Grundy had such a screening six years ago at USC University Hospital. Trim and tall at 6-feet-3-inches and 185 pounds, Grundy-an avid tennis player who had always led a health-conscious lifestyle-was confident he would easily pass the test. Grundy was, in a word, wrong.
The screening showed that 70 percent of his left carotid artery was blocked. "They told me I was a walking time-bomb at risk for suffering a stroke," recalls Grundy. "It really shocked me. I never would have guessed I had a problem." A week later Giannotta performed a carotid endarterectomy on Grundy and alleviated the blockage. He now goes in for biannual screenings; all of which shows his artery remains blockage-free. To say that Grundy is grateful would decidedly be an understatement. In fact, he has become such a staunch supporter of stroke screenings that he personally printed up brochures advocating the procedure. "I've probably given out at least 1,000," he says with a smile.
Be Stroke Smart
Teitelbaum emphasizes that most strokes are preventable: "Take steps to reduce your risk factors. Schedule a screening. Know the warning signs of a stroke. And, if you suffer a stroke, seek medical treatment immediately. Think brain attack." n
For a screening appointment, or to receive a free video "Brain Attack: New Approaches to the Treatment of Stroke "call 1-800-USC-CARE (1-800-872-2273). You can also get a free video by visiting: http://www.usc.edu/health/uscp/preventstroke.html