Stroke Recognition and Treatment

Air Date: 4/28/2003

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Only a fraction of stroke patients each year are getting to the hospital in time to receive a treatment that makes the difference between disability and full recovery.

Changing the Perception of Stroke

Stroke Risk Factors

Uncontrollable Stroke Risk Factors Include:

Age

The chances of having a stroke go up with age. Two-thirds of all strokes happen to people over age 65. Stroke risk doubles with each decade past age 55.

Gender

Males have a slightly higher stroke risk than females. But, because women in the United States live longer than men, more stroke survivors over age 65 are women.

Race

African-Americans have a higher stroke risk than most other racial groups.

Family history of stroke or TIA

Risk is higher for people with a family history of stroke or TIA.

Personal history of diabetes

People with diabetes have a higher stroke risk. This may be due to circulation problems that diabetes can cause. In addition, brain damage may be more severe and extensive if blood sugar is high when a stroke happens. Treating diabetes may delay the onset of complications that increase stroke risk. However, even if diabetics are on medication and have blood sugar under control, they may still have an increased stroke risk simply because they have diabetes.

Controllable Stroke Risk Factors

Treatable Medical Disorders that Increase Stroke Risk Include:

High blood pressure

Having high blood pressure, or hypertension, increases stroke risk four to six times. It is the single most important controllable stroke risk factor. High blood pressure is often called "the silent killer" because people can have it a nd not realize it, since it often has no symptoms. Hypertension is a common condition, affecting approximately 50 million Americans, or one-third of the adult population. Blood pressure is high if it is consistently more than 140/90. Between 40 and 90 percent of all stroke patients had high blood pressure before their stroke. Hypertension puts stress on blood vessel walls and can lead to strokes from blood clots or hemorrhage.

Heart Disease

Heart disease such as atrial fibrillation increases stroke risk up to six times. About 15 percent of all people who have a stroke have a heart disease called atrial fibrillation, or AF, which affects more than 1 million Americans. AF is caused when the atria (the two upper chambers of the heart) beat rapidly and unpredictably, producing an irregular heartbeat. AF raises stroke risk because it allows blood to pool in the heart. When blood pools, it tends to form clots which can then be carried to the brain, causing a stroke.

Normally, all four chambers of the heart beat in the same rhythm somewhere between 60 and 100 times every minute. In someone who has AF, the left atrium may beat as many as 400 times a minute. If left untreated, AF can increase stroke risk four to six times. Long-term untreated AF can also weaken the heart, leading to potential heart failure. The prevalence of AF increases with age. AF is found most often in people over age 65 and in people who have heart disease or thyroid disorders. Among people age 50 to 59, AF is linked to 6.7 percent of all strokes. By ages 80-89, AF is responsible for 36.2 percent of all strokes.

Coronary Heart Disease and High Cholesterol

High cholesterol can directly and indirectly increase stroke risk by clogging blood vessels and putting people at greater risk of coronary heart disease, another important stroke risk factor. A cholesterol level of more than 200 is considered "high." Cholesterol is a fatty substance in the blood that our bodies make on their own, but we also get it from fat in the foods we eat. Certain foods (such as egg yolks, liver or foods fried in animal fat or tropical oils) contain cholesterol. High levels of cholesterol in the blood stream can lead to the buildup of plaque on the inside of arteries, which can clog arteries and cause heart or brain attack.

Sleep Disordered Breathing - Sleep Apnea

Sleep apnea is a major cardiovascular and stroke risk factor increasing blood pressure rates which may cause stroke or heart attack. Studies also indicate that people with sleep apnea develop dangerously low levels of oxygen in the blood while carbon dioxide levels rise, possibly causing blood clots or even strokes to occur. Diagnosing sleep apnea early may be an important stroke prevention tool.

Personal history of stroke or TIA

People who have already had a stroke or TIA are at risk for having another. After suffering a stroke, men have a 42 percent chance of recurrent stroke within five years, and women have a 24 percent chance of having another stroke. TIAs are also strong predictors of stroke because 35 percent of those who experience TIAs have a stroke within five years.

Lifestyle Factors that Increase Stroke Risk Include:

Smoking

Smoking doubles stroke risk. Smoking damages blood vessel walls, speeds up the clogging of arteries by deposits, raises blood pressure and makes the heart work harder.

Alcohol

Excessive consumption of alcohol is associated with stroke in a small number of research studies. Its specific role in stroke has not yet been determined or proven. Recent studies have also suggested that modest alcohol consumption (one 4 oz. glass of wine or the alcohol equivalent) may protect against stroke by raising levels of a naturally occurring "clot-buster" in the blood.

Weight

Excess weight puts a strain on the entire circulatory system. It also makes people more likely to have other stroke risk factors such as high cholesterol, high blood pressure and diabetes.

The Five Most Common Stroke Symptoms Include

• Sudden numbness or weakness of face, arm or leg, especially on one side of the body
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause

Call 911 if you see or have any of these symptoms.

Treatment can be more effective if given quickly.

Every minute counts!

Other Important but less Common Stroke Symptoms Include:

• Sudden nausea, fever and vomiting distinguished from a viral illness by the speed of onset (minutes or hours vs. several days)
• Brief loss of consciousness or period of decreased consciousness (fainting, confusion, convulsions or coma)

3-Step Stroke Test

By familiarizing yourself with this one-minute, three-step test, you can recognize the early warning signs and symptoms that are common with a stroke. Then, taking action fast can help improve the treatment and the outcome for stroke victims. This test is so simple that even a child can use it. Teach it to your child--many children do save others by learning life-saving techniques such as CPR.

If you do believe someone is exhibiting the symptoms of a stroke…

Act fast. Dial 911.

Step 1: Ask person to "smile broadly, showing your teeth." (This "smile test" is checking for one-sided facial weakness or paralysis.)

Step 2: Ask person to close their eyes, raise their arms in front of them and hold them out for a count of ten. (Checking for limb weakness or paralysis, dizziness, loss of balance.)

Step 3: Ask person to repeat a simple phrase, such as "Don't cry over spilled milk." (Checking for difficulty speaking or understanding.)

This test was developed by a team of stroke researchers from the University of North Carolina-Chapel Hill School of Medicine and presented during a conference of the American Stroke Association. Accuracy of the test was determined by first teaching it to 100 healthy bystanders, who then performed the test on stroke survivors. There was 97 percent accuracy in detecting arm weakness and 96 percent accuracy in detecting speech deficits. There was accuracy 74 percent of the time when it came to detecting facial weakness, probably because it is hard to assess a stranger's smile.

Recover from the Effects of Stroke

Strokes are caused by the sudden loss of blood flow to the brain (ischemic stroke) or bleeding inside the head (hemorrhagic stroke).  When this blood flow stops, brain cells stop functioning or die. As a result, the activities of the body controlled by dying brain cells can lose their ability to function. A clot-busting drug called t-PA (tissue plasminogen activator) can stop the spread of brain cell death from an ischemic stroke.  It can help patients recover with little disability if patients receive it within three hours of the first onset of symptoms.  Treatment for hemorrhagic strokes is aimed at getting the blood pressure under control and correcting the cause while protecting the brain from further damage.

When stroke occurs, the potential for brain damage increases with the amount of time that passes. The course of care for a stroke patient typically begins in the emergency room, where Dr. Katz’s 24-hour, rapid-response stroke team ensures access to medical expertise and the latest in treatment and technology.

This team provides a new brand of care and peace of mind for our community because remarkable new options are available right here at home. The Washoe Institute for Neurosciences Comprehensive Stroke Center provides the technology and expert care that makes innovative health care a hometown reality.

Additional Resources

450 Edison Way Reno, Nevada 89502 (775)858-5700 Fax (775)858-5720