STROKE: BRAIN ATTACK

In the 16th century, medical professionals began calling a stroke “a stroke” because it was attributed to a power out of their control: It was shortened from “a stroke of God’s hand.” It could be explained no other way. Modern medicine has found the causes in most cases, but sometimes its effects are as mysterious as they were 500 years ago.

In order to make it more clear, medical experts have recently begun calling a stroke a “brain attack.” Everyone knows what a heart attack is, so this similar term should be clear: it is the brain stopping its function, just as the heart does. It is to be taken no less seriously.

In order to get the lifesaving information out and clearly and efficiently, the following acronym has been implemented: FAST.
F: Facial weakness – your face feels numb or weak, especially on one side.
A: Arm weakness – especially on one side
S: Speech problems – you can’t speak or understand properly
T: Time – the faster you get treatment, the less damage to your brain.

Besides the sudden numbness in the arm or face, other symptoms include:

  • Sudden leg weakness
  • Sudden confusion
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance or coordination.
  • Sudden, severe headache with no know apparent cause. It has been described by stroke patients as “the worst headache I have ever had.”

According to www.strokeassociation.org:

  • About 795,000 Americans suffer a new or recurrent stroke. Thus, on average, a stroke occurs every 40 seconds.
  • Stoke kills more than 137,000 people each year. That is one of every 18 deaths, ranking it as the #4 cause of death in the U.S.
  • On average, someone dies of a stroke every 4 minutes.
  • Approximately 40% of stroke deaths occur in males, and 50% in females.

There is a drug known as tPA that can dissolve blood clots when administered within about three hours of initial symptoms, so time is of utmost importance in treatment. This drug treats the most common type of stroke, so getting treatment cannot be put off. Call 911 or have someone call for you, even if your symptoms disappear. If you return to normal functioning, you may have had a TIA, or transient ischemic attack, also known as a “mini-stroke.” TIAs precede major strokes in 15% of occurrences.

The medical term for stroke is cerebral vascular accident, or CVA. There are two general types: ischemic and hemorrhagic:

  • The ischemic stroke is a blood clot that blocks brain function, but does not burst. High blood pressure is the most important risk factor for ischemic stroke that you can change. Immediate treatment will keep the damage as minimal as possible.
  • A hemorrhagic stroke bursts and bleeds inside the brain. Thirteen percent of strokes are hemorrhagic. Blood collects in the brain tissue causing the cells to weaken and die. Hemorrhagic strokes are likely to be life-threatening.

There are many risk factors for stroke, and most can be changed or treated:

  • High blood pressure: this is the #1 cause of stroke, and the most important risk factor. Know your blood pressure and have it checked at least once each year. If it is consistently above 140/90, it is considered high. Talk to your doctor about how to manage it.
  • Tobacco use: tobacco use damages blood vessels. Don’t smoke and avoid second-hand smoke. Chewing tobacco increases risk for oral cancer, as well as stroke.
  • Diabetes Mellitus: having diabetes increases risk because it can cause disease of blood vessels in the brain. Work with your doctor to manage your diabetes medically.
  • High blood cholesterol: high blood cholesterol increases the risk of blocked arteries. If an artery leading to the brain is blocked, a stroke can result.
  • Physical inactivity and obesity: lack of physical activity and/or obesity increases your risk of all cardiovascular diseases. It is never too late to begin regular exercise, but be sure to consult your physician before beginning.
  • Artery disease: the carotid arteries in the neck provide most of the blood supply to the brain. A carotid artery damaged by a fatty buildup of plaque inside the artery wall may be blocked by a blood clot, causing a stroke.
  • Transient ischemic attacks—TIAs: recognizing and treating TIAs can reduce the risk of a major stroke. TIAs can precede a major stroke, but have no lasting effects. Know the warning signs of a TIA and seek emergency medical help immediately.
  • Atrial Fibrillation and other heart disease: In atrial fibrillation, the upper chambers of the heart quiver instead of beating evenly and effectively. This causes the blood to pool and clot, thus increasing the risk of a stroke. Other types of heart disease increase the risk of stroke as well.
  • Excessive alcohol intake: women should drink no more than one drink daily on the average, and men no more than two. Increased blood pressure can result. Binge drinking can also raise blood pressure.
  • Illegal drug use: IV drug use carries a high stroke risk, as does cocaine use. Illegal drugs normally cause hemorrhagic strokes.
  • Stress: A certain amount of stress is inevitable, but too much can increase blood pressure. Work related stress, family stress and situational stress can be managed with exercise, adequate sleep, good nutrition, lifestyle changes and changing the stress-causing situation. This is obviously easier said than done, but the rewards are worth the effort.

LIFE IS TOO SHORT, TAKE GOOD CARE OF YOURSELF AND ENJOY LIFE.

Considering that simple yet profound advice, there are several factors that cannot be controlled:

  • Increasing age: Stroke can affect any age, but as age increases, so too does stroke risk.
  • Heredity and race: Those with close relatives who have had a stroke have a higher risk of having one themselves. African Americans have a higher risk of death and disability from stroke than whites, because they have a higher incidence of high blood pressure. Hispanic Americans are also at a higher risk than whites.
  • Personal history of stroke: those who have had one stroke are more likely to have another one.
  • Gender: in most age groups, more men than women have strokes, but more women die from strokes.
    There are unique risk factors for women, including:

  • Atrial fibrillation: Women 75 years of age and older should be examined for this irregular heartbeat.
  • Migraine headaches with aura: These headaches combined with smoking boost your risk x 10.
  • Preeclampsia: During pregnancy, this blood pressure disorder doubles the risk of a stroke after childbirth. Women with high blood pressure before pregnancy may need aspirin or other drugs to reduce it. Women with a history of preeclampsia should be watched closely for strokes later in life.
  • Prolonged use of oral contraceptives: talk to your prescribing physician about the potential dangers of long-term use of birth control pills. When other risk factors are present, birth control pills can double the risk of stroke.

Given the profound and mysterious complexity of the human brain, each person who suffers a stroke likely has a set of symptoms that is unique to them. Few people have a stroke that is identical to someone else’s in its effects. Each person is different before the stroke, and each person who suffers a stroke is different from anyone else who has suffered a stroke.

Muscle weakness is common, likely on one side or the other. Some strokes affect both sides equally, but typically it is one-sided. This is due to the fact that the brain is divided into two halves, and a stroke typically happens in one side or the other, instead of at the base of the brain before it divides. The human body is controlled contralaterally, meaning that the right side of the brain controls muscle function on the left side of the body, and the left side of the brain controls the right side of the body. Therefore, if a person has a stroke on the left side of the brain, then the right side of their body—likely the arm and/or leg and perhaps the face—will be weak.

The brain also specializes in certain functions in specific areas on one side of the brain. For example, in a right-handed person, as well as the majority of left-handed people, the language center is housed on the left side of the brain, while the visual/spatial abilities are on the right side of the brain. Concrete brain functions such as mathematics are on the left side, and abstract abilities such as art and music appreciation and creativity are on the right side. A stroke on each side of the brain carries many different possible deficits.

LIFE AFTER STROKE

Some strokes leave little or no residual damage. Most, however, leave at least a small mark. Some people who have had a stroke report that their life is now close to what is was before the stroke, there is occasionally that small remnant of the stroke. Some report occasional speaking difficulty or loss of balance, but it does not affect their lives on a day-to-day basis. Unfortunately, most people live with a daily reminder of the stroke that left them somewhat impaired. Many find themselves living a life of a “new normal.”

There is help available. Therapy to improve physical abilities is offered through physical and occupational therapy, which address walking, transfers, balance and general gross motor strength and coordination. Occupational therapy addresses arm and hand strength, and activities of daily living—ADLs—such as dressing, grooming, cooking and other household chores. Visual-perceptual abilities are sometimes affected, which may be treated by both the occupational therapist and the speech therapist. Speech therapy also addresses speech production, cognitive function and swallowing deficits. These therapies are typically available in the hospital setting, and are initiated soon after the stroke patient has stabilized, in order to begin the rehabilitation process. There are other levels of therapy after dismissal from the acute unit of the hospital, as soon as the patient is physically stabilized:

  • Specialized rehabilitation units are appropriate for those patients who can withstand intensive therapy. These may be stand-alone facilities, or may be part of a larger hospital.
  • Skilled therapy is most appropriate for those who are not able to tolerate intense therapy. This therapy is typically provided within a long-term care setting, with the goal for most patients to return to their home.
  • Home health can be provided for those who are able to return to their homes but need assistance and therapy in order to return to their maximum function. Learning how to manage in what was once a familiar setting may pose new challenges such as negotiating steps and stairways, navigating around the house and transferring from bed to chair, or from car to wheelchair. Completing ADLs can be a new and unfamiliar challenge as well.
  • Outpatient therapy is another option for those who are strong enough to return home and can ambulate well enough to come to a clinic for treatment.

The physical rehabilitation process is one aspect of recovery. Many people find that the emotional and psychological part of recovery is an overwhelming challenge, and require help to find a way to cope with life as they now know it. As difficult as it is to lose physical abilities, the most difficult losses most people face are the loss of independence and sometimes their dignity. Many patients find it necessary to take prescription medications for depression, even if they never have before.

As with any loss, the people who can best understand are those who have experienced stroke themselves. Those who have “been there” are often the best therapists. In some areas, programs exist to match “peer-to-peer” people who have suffered a stroke. A person with a relatively new stroke may benefit from visiting with someone who has been living with the effects of stroke for a prolonged period of time. They can offer the new stroke patient ideas about how to live life with a stroke, and offer support and encouragement that those without a stroke may not have the insight to provide.

Stroke support groups exist in larger towns and cities. Most meet at least monthly, providing support and education for those who continue to live with the effects of stroke. There are many books written about life after stroke, as well as online support. Log on to www.strokeassociation.org for more information.

There is life after stroke. If you think you may be having a stroke, remember to think FAST.