Experts explain what to know about strokes and why every second matters.
A stroke can occur unexpectedly and cause symptoms such as weakness, facial numbness, and confusion. These symptoms can lead to hospitalization or death. In the United States, a stroke occurs every 40 seconds and every 3.5 minutes, someone dies from a stroke. Understanding the warning signs and risk factors for stroke is crucial for preventing and surviving a stroke
Sandra Narayanan, MD, board certified vascular neurologist and neurointerventional surgeon at Pacific Stroke & Neurovascular Center at Pacific Neuroscience Institute in Santa Monica, CA tells us, “Stroke is the fifth leading cause of death and the leading cause of disability in the United States, but is the second leading cause of death in the world. >50% of stroke survivors older than 65 years have reduced mobility, which can lead to lower quality of life. The economic damages of stroke are tremendous (~$53 billion between 2017 and 2018 in the U.S. alone), particularly for younger stroke patients, and encompass the acute and subacute care spectrum, as well as the cost of missed employment.”
A stroke can cause short-term and long-term disabilities such as paralysis or problems controlling movement, sensory disturbances like losing the ability to feel touch, loss of bladder control, problems using or understanding language, issues with thinking and memory and more. Having a stroke can potentially affect daily life in a significant way, but there are ways to help lower the risk and prevent one. Read on to learn more about strokes, the risk factors and how to help avoid one.
What to Know About Strokes
Jason Tarpley, M.D., Ph.D., stroke neurologist and director of the Stroke and Neurovascular Center for Pacific Neuroscience Institute in Santa Monica, Calif. tells us, “Ischemic stroke, or blockage of a brain artery, has many different causes depending on the patient population. Ischemic stroke is more common in older age, and older patients’ strokes are often caused by an underlying heart rhythm called atrial fibrillation, cholesterol plaque in the carotid arteries, or disease in the brain’s small arteries. Risk factors for small artery strokes are high blood pressure, diabetes, and smoking. Stroke in the young, on the other hand, has different causes. The most common cause of stroke in the young is an arterial dissection resulting from a tear in the inner layer of the arteries feeding the brain.
Strokes can vary from very minor to very serious and of course, they can even be deadly. The most severe types of strokes are caused by large blockages in the brain – so called large vessel occlusion. However, if a patient with stroke from a large vessel occlusion is able to quickly access a comprehensive stroke center to receive a powerful therapy called thrombectomy (surgical removal of the blockage), about 50 to 60% will still have a very good outcome. By a good outcome, I mean that they will become functionally independent after the procedure.”
Difference Between Stroke and Mini Stroke
Reza Bavarsad Shahripour, MD, board certified vascular neurologist and neurosonologist, of Providence Saint John’s Health Center in Santa Monica, CA explains, “Mini stroke is when the patient experiences a temporary period of lack of blood flow to the area of the brain and the symptoms are temporary as well. It can take a few minutes to a few hours, and usually within 24 hours, the patient’s symptoms will resolve. We used to call it TIA or transient ischemic attack, but sometimes we as clinicians prefer to call it as a mini stroke to remind the patient that you are not out of the woods and you did in fact suffer a sort of stroke. So we always have to be careful about your risk factors, medication and your lifestyle.
Regarding the difference between stroke and mini stroke: as I mentioned in the mini stroke or TIA there is a temporary blockage in the blood flow and temporary brain dysfunction lasting for a couple minutes or hours. In terms of symptoms, the patient usually has the same symptoms for couple minutes or hours, but the pathophysiology or mechanism of stroke is the same and the source of his stroke could be from heart (such as heart arrhythmia, heart failure, atrial fibrillation), carotid artery disease, chronic hypertension, and small vessel changes in the brain.”
Mini Stroke is Serious
Dr. Bavarsad emphasizes, “Make no mistake about it, Mini stroke/TIA is an emergency, and patients who suffer one, need to call 911 and come to the hospital as soon as possible to have a complete evaluation by a certified stroke team. There is no difference between a mini stroke and acute stroke in terms of modifying the risk factors and approaching it by patient, family and PCP in its acute phase. Based on the etiology of the mini stroke or TIA, we may start antiplatelet such as aspirin or Plavix, or a blood thinner, but the patient needs to have a comprehensive work-up to accurately diagnose what is the etiology of the mini stroke so we can start a targeted treatment plan based on that.
Mini stroke or TIA usually have a good recovery in the first 24 hours and the patient does not have any more symptoms or deficit, but the patient is not out of the woods. In the first couple of weeks and months after suffering the mini stroke, they are at an increased risk of having an acute stroke and that is the reason they need to have close monitoring by their vascular neurologist, primary care physician and family at home.”
80 Percent of Strokes Can Be Prevented
Dr. Narayanan explains, “There are many strategies to prevent a first-time cerebrovascular event or to reduce the risk of recurrent stroke or TIA. Up to 80% of strokes can be prevented with these lifestyle changes:
- Quit smoking.
- Keep a blood pressure (BP) machine at home if you have high blood pressure and take measurements daily. Write these down and bring the log to your doctor’s appointments. Goal BP is <140/90 mm Hg (or <130/80 mm Hg for patients with diabetes mellitus).
- Eat a Mediterranean-style diet rich in fruits, vegetables, whole grains, fish, and nuts.
- Exercise – in any form, even if it’s just 10 minutes a day at first.
- Know your cholesterol. If you’ve already had a stroke or TIA, aim for low-density lipoprotein (LDL of <70 mg/dL. Knowing your numbers and partnering with the appropriate healthcare providers (PCP, neurologist, cardiologist) for routine follow-up, medication adjustment, and lab work is critical.
- Consistency is key to maintaining healthy lifestyle interventions. Start early. 10-15% of strokes occur in adults <50 years of age.”
According to Dr. Bavarsad, “Controlling the risk factors and changing the lifestyle and diet significantly decreases the risk of recurrence of strokes and mini strokes/TIA in the first 1-5 years after stroke. People with high blood pressure/high cholesterol/uncontrolled diabetes/obesity/SLEEP apnea, history of stroke, history of carotid disease or coronary artery disease, or who have history of mini stroke or TIA, and/or other cardiovascular risk factors such as atrial fibrillation or heart arrhythmia, they are at risk of having TIA or mini stroke.
Dr. Bavarsad says, “If the patient experiences symptoms like weakness, numbness, double vision, balance issues at acute onset, no matter the duration of time they are experienced, you need to call 911 or have someone safely transport you to the ER for evaluation. You will then undergo a brain CT scan and CT angiography of the head and neck to be sure there is no narrowing or blockages of the carotid arteries. Heart monitoring will continue for at least 24 hours during hospitalization and sometimes the patient will need intervention if they have any critical narrowing in the vessels. The patient needs to have a brain MRI to rule out acute stroke or any other reasons for his symptoms.”
Dr. Tarpley says, “The classic and common signs of a stroke have an acronym to help us remember them. FAST – Facial drooping, Arm weakness, or Speech difficulties means that it is Time to call 911. However, these are only the most common signs of stroke and are typically seen when the front of the brain is affected by stroke. Stroke in the back of the brain can cause sudden onset of vision loss, abnormal eye movements, balance difficulty, dizziness, loss of consciousness or even headache. While stroke symptoms commonly fluctuate, their onset is almost always sudden.”
Sanjiv Patel, MD, interventional cardiologist at MemorialCare Heart & Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA adds,
1.” Sudden onset of nausea or vomiting- this can happen due to a large stroke from a blocked artery in the brain or bleeding in the brain.
- Sudden severe headache- this can occur as a result from bleeding in the brain.
- Sudden loss of vision in one or both eyes either partially or completely – this can be as a result from either an ischemic stroke or hemorrhagic stroke.
- Sudden confusion. Again, this is a symptom caused by loss of brain function due to a stroke.”
Every Second Matters with Stroke
Dr. Tarpley says, “The American Stroke Association has a useful acronym for identifying signs and symptoms of a stroke. Any of these symptoms should prompt emergent evaluation for possible stroke as we have powerful brain saving treatments for patients with stroke. The acronym is BE FAST.
- B for balance problems
- E for eye problem such as sudden vision loss
- F for facial drooping on one side
- A for arm weakness
- S for speech difficulty
- T time is brain or time to call 911″
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