The management of acute stroke has changed over the last several years. There are treatments that can be done early in the course of the event that can prevent permanent brain injury. In order to effectively treat a stroke, the symptoms have to be recognized early so evaluation and treatment can be started as soon as possible.
Stoke is a term that commonly is used to indicate an acute injury to the brain related to blood flow in the brain. The brain cells need oxygen to survive. The brain is only about 2% of the adult body but gets 20% of the blood flow. Lack of blood flow means lack of oxygen which causes brain cell damage.
There are approximately 130,000 deaths per year due to stroke and about 795,000 total strokes. Stroke is the 4th leading cause of death in the United States. Some strokes are due to lack of blood flow to a portion of the brain which is referred to as an ischemic stroke, which accounts for 87% of all strokes. Ischemic strokes occur when a blood vessel closes in the brain or when a clot flows into a blood vessel in the brain causing a blockage. The other type of stroke is due to bleeding into the brain due to a blood vessel leaking. This is known as a hemorrhagic stroke.
Brain tissue does not recover from an injury like some other tissues can. Lack of blood to the brain will cause the tissue to die or infarct. This is similar to what happens in the heart when a blood vessel is blocked causing heart muscle damage. This is why a stroke is sometimes referred to a brain attack.
The goal of acute treatment is to try to restore blood flow to the brain in an ischemic stroke before the tissue is permanently damaged. The treatment goal for hemorrhagic stroke is to limit the bleeding. The best results are associated with treatment that is initiated within three hours of the start of the symptoms. This can be accomplished with clot-busting medication or opening a blood vessel with a catheter. Time is critical since the longer the blood flow is limited the less chance of saving the brain tissue affected.
In order to get immediate help for a possible stroke, the symptoms need to be recognized. Stroke symptoms are a true emergency and would be a reason to call 911 to get to the hospital for help immediately. The mnemonic FAST has been used to help people recognize stroke symptoms. F -stands for facial drooping on one side. A -stands for arm or leg weakness on one side of the body. S -stands for difficulty speaking. T -stands for time to emphasize that time is critical and help should be sought immediately. Headache without other stroke symptoms is generally not a sign of a stroke.
There are risk factors for stroke. The main factors for a blocked blood vessel are the same as for a heart attack. They are smoking, high blood
pressure, diabetes, and high cholesterol. Stroke risk can be decreased by addressing these factors. Heart abnormalities and atrial fibrillation (irregularity of the rhythm) increase the risk of a stroke due to a blood clot traveling to a blood vessel in the brain.
Stroke risk, like heart attack risk, can be reduced by taking an aspirin daily to decrease the chance of a clot. Other blood thinners can be used for people with heart rhythm problems.
To avoid stroke, work to control risk factors and ask your provider if daily aspirin is right for you. If signs of a stroke occur, seek help immediately and stay healthy my friends.
By P. Michael Shattuck, M.D. – Community Health Network Family Physician
