Stroke: The Best Treatment Is Prevention

OCTOBER 01, 2002
Dana Singla, PharmD

Did you know that strokes are the third leading cause of death in the United States, behind heart disease and cancer? Stroke can rob individuals of their independence and dignity. Stroke does not discriminate?it can occur in all age groups, in both sexes, and in all races. Here are some startling stroke statistics:

? Someone suffers a stroke every 53 seconds
? About 600,000 Americans undergo strokes every year
? Stroke is the leading cause of long-term disability

What Is a Stroke?
A stroke, also referred to as a ?brain attack,? is a sudden, severe problem that occurs when brain tissue is starved of blood. Brain cells can begin to die in as little as 4 minutes. The loss or change in body function that occurs following this interruption in blood flow to the brain is called a stroke.

Are All Strokes the Same?
There are 2 types of strokes: ischemic and hemorrhagic. Ischemic strokes are most common. They usually result from a blockage when brain tissue is starved of blood and oxygen.  Hemorrhagic strokes occur when an artery in the brain bursts.

What Are the Symptoms of a Stroke?
Strokes have 5 common warning signs:
? Sudden weakness or numbness of the face, arm, or leg,
especially on 1 side of the body
? Sudden confusion, with trouble speaking or understanding
? Sudden trouble seeing with 1 or both eyes
? Sudden trouble walking, dizziness, loss of balance or coordination
? Sudden, severe headache with no known cause (for hemorrhagic stroke)

The key word to remember with each of the warning signs is sudden. If any of them occurs, immediate medical attention should be sought.

Stroke Is Considered a Medical Emergency!
Brain cells usually die within minutes to a few hours after a stroke starts. Without prompt medical treatment, a larger area of cells around them will also die. For the best chance of limiting damage, a stroke should be treated even more urgently than a heart attack.

Is a TIA the Same as a Stroke?
A transient ischemic attack (TIA) may be thought of as a mini-stroke or a warning stroke. Approximately 50% of all major strokes are preceded by 1 or more mini-strokes.  Symptoms of a TIA are similar to those of a stroke except that they last for a short period of time. The warning signs of a TIA should not be ignored, however. A physician should be notified immediately.

What Are the Risk Factors for Stroke?
The American Heart Association has identified several factors that increase the risk of stroke. Some risk factors for stroke are controllable, and some are not. The stroke risk factors that cannot be treated or controlled are as follows:
? Age?the chances of having a stroke go up with age
? Gender?males have a slightly higher stroke risk than females
? Race?African Americans have a higher stroke risk than most other racial groups
? Family history of stroke?this increases risk
? Prior stroke or TIA?after suffering a stroke, men have a 42% chance and women have a 24% chance of having another stroke within 5 years Stroke risk factors that can be controlled and treated through diet, medication, and/or intervention are as follows:
? High blood pressure?considered the single most important risk factor
? Diabetes?should be treated to delay the onset of complications that increase stroke risk
? High cholesterol?causes clogging of blood vessels
? Atrial fibrillation?an irregular heartbeat
? Cigarette smoking?damages blood vessel walls, clogs arteries, raises blood pressure, and makes the heart work harder
? Alcohol?especially in excess, is associated with stroke in some research studies. Recent studies, however, have also suggested that modest alcohol consumption may protect against stroke.
? Obesity?puts a strain on the entire circulatory system

How Can a Stroke Be Prevented?
Stroke is among the most preventable of all life-threatening health problems. Controlling stroke risk factors can prevent stroke. It is important to remember that having an uncontrollable stroke risk factor does not mean that a person doomed to have a stroke. Here are some important steps that patients can take to prevent a stroke:

? Know and control your blood pressure and cholesterol
? Find out if you have atrial fibrillation
? Do not smoke
? Drink alcohol only in moderation
? Treat diabetes if you have it
? Get enough exercise
? Eat a healthy diet
? Know the symptoms of a stroke

Are There Treatments That Can Help?
Because their mechanisms are different, the treatments for the 2 types of stroke are different. Ischemic stroke is treated by removing obstruction and restoring blood flow to the brain. In hemorrhagic stroke, physicians try to prevent vessel rupture and bleeding.

Clot Busters
The most promising treatment for ischemic stroke is the clot-busting drug tissue plasminogen activator. To work best, this treatment must be administered within 3 hours of the onset of symptoms. Generally, only 3% to 5% of those who suffer a stroke reach the hospital in time to receive this treatment, so it is critical to seek medical attention at the first sign of stroke.

Anticoagulants (or blood thinners) interfere with the blood?s ability to clot. Because of their ability to interfere with blood clotting, however, their most common side effects are increased bleeding and bruising.

Blood vessel blockage can be surgically removed from an artery. Surgeons use balloon angioplasty and stents to remedy cholesterol buildup in the vessel. For hemorrhagic stroke, surgical treatment can remove the abnormal vessels or implant a device to prevent rupture.

Advice for Caregivers of Stroke Victims
Stroke caregivers are a vital part of the stroke recovery process. The American Stroke Association suggests that the most important tip for caregivers is to take care of themselves. If caregivers do not take time out for themselves, the family and the stroke survivor will not be getting the care they need.


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