Several years ago, I had the unfortunate experience of seeing my father suffer a stroke. Dad’s stroke was relatively mild, but he was already suffering from Alzheimer’s disease, and the stroke seemed to only increase the effects of the Alzheimer’s. I am thankful that he fully recovered from some of the strokes affects, such as slurred speech and difficulty swallowing. But sadly, his memory never returned. Strokes can be devastating to both its victims and their families. Let’s see if we can understand this all too common ailment a little better.
What is a Stroke?
Stroke is a term used to describe a condition that involves interruption of or severe reduction of the blood supply to the brain. This deprives the brain of oxygen and nutrients, and can cause tissue death within minutes. Depending on which part of the brain is affected, the result may be paralysis, speech impairment, memory loss, cognitive problems, coma, or death. Strokes are sometimes referred to as “brain attacks.”
Stroke is a public health crisis in America. It kills about 150,000 Americans each year. More than 500,000 strokes occur here annually, and almost a third of them are fatal. Stroke is the third leading cause of death in the US. Heart disease and cancer are the only two illnesses that cause more deaths than stroke.
The socioeconomic effects of stroke are staggering. Three million Americans are permanently disabled from stroke. It is the number one cause of adult disability. The direct and indirect cost of stroke is estimated at $30 billion per year.
There is some good news though. The rate of incidence for strokes in the US has been declining over the last several decades. This is probably because of the reduction of major risk factors such as smoking, high blood pressure, poor diet, and lack of exercise. We have a long way to go towards good health in this country, but apparently some folks are listening. We’ll take any improvements we can get!
What Are the Signs and Symptoms of a Stroke?
It is critically important to know and understand the symptoms of a stroke. Stroke is an emergency that needs immediate medical attention. If you are able to recognize a stroke in yourself or a loved one, precious minutes may be saved. The sooner a stroke victim receives treatment, the greater the chance of survival and the less chance of permanent brain damage. The death of brain cells releases toxic chemicals that can quickly begin to damage other nearby healthy cells. Time is of the essence, so let’s take a look at some of the tell tale signs of stroke:
- Sudden numbness, weakness, or paralysis, most often on one side of your body. It usually occurs in the face, arm, or leg.
- Sudden difficulty speaking (aphasia)
- Sudden difficulty understanding speech (aphasia)
- Sudden vision problems, such as blurring, double, or decreased vision in one or both eyes.
- Sudden severe headache, sometimes described as “the worst headache of my life.”
- Headache may be accompanied by a stiff neck, facial pain, or pain between your eyes.
- Confusion or sensory problems such as distorted spatial or orientation perceptions.
- Memory loss
- Dizziness and loss of balance
- Loss of coordination
Most of the time, stroke strikes without warning. However, there is one exception. A “transient ischemic attack” (TIA) is a temporary disruption of the blood supply to the brain that may last for several minutes or up to 24 hours. The symptoms are similar to those of a stroke, but they do not last, and it does not cause any permanent side effects. Some folks may experience multiple TIAs. But even one should be considered a red flag. If you have a TIA, your risk for a true stroke is greatly increased.
What Are the Risk Factors of Stroke?
As with any illness, there are certain risk factors that can increase your chances of being a victim of a stroke. Some of these can be changed, and some cannot. Knowledge of these can help us avoid the ones we can control. These factors include:
- Age: The older you get, the greater the risk for a stroke. About 66% of all strokes are found in folks over the age of 65.
- Race: African-Americans have a significantly higher number of strokes than Caucasians. This is due in part because they also have a higher rate of hypertension, itself a major risk for stroke. Asians and Hispanics have a slightly higher risk than Caucasians.
- Family history: The risk for stroke is increased if you have a first- degree relative, such as a parent or sibling, who has a history of stroke.
- Hypertension: High blood pressure can weaken the blood vessels in and around the brain, and make you more susceptible to a stroke.
- Smoking: Smoking dramatically increases your risk for a stroke. The reasons are many. Smoking clogs up your arteries with plaque. Smoking gives off carbon monoxide, which replaces the oxygen in your blood and causes the arteries and cells in your body, including your brain, to receive less oxygen and nutrients. They are in a weakened state due to smoking, and will be damaged more easily in the event of a stroke. Smoking also increases your heart rate, puts more pressure on your blood vessels, and causes them to weaken.
- Blood cholesterol: Cholesterol has been the favorite villain of stroke and heart disease for many years. Generally, we have been told to do everything we can to get rid of the “bad” cholesterol (LDL), and build up the “good” cholesterol (HDL). High levels of a blood fat called “triglyceride” is also considered a risk factor. Officially, high cholesterol is considered a risk factor for stroke. But watch this research carefully. There are many people who are starting to take another look at the role of cholesterol, and some believe it has been misunderstood and may not be as nefarious as once believed. The jury is still out on this one.
- Obesity: There is no doubt about this one. Being overweight is clearly a risk factor for stroke. It is also a factor in hypertension, heart disease, and diabetes as well, and all of these conditions increase your risk for stroke.
- Cardiovascular disease: Virtually any kind of heart problem leads to an increased risk for stroke. These include: a previous heart attack, congestive heart failure, atrial fibrillation (a type of abnormal heart rhythm), various valve disorders of the heart, or valve replacement surgery. One of the greatest reasons heart disease increases risk for stroke, is because if you have arteriosclerosis (hardening of the arteries, which is responsible for most heart disease) around the heart, it is a pretty safe to assume that the arteries around your brain are not very healthy either. The diet and lifestyle choices that most often lead to heart problems are the same ones that set you up for a possible stroke.
- Diabetes: When you have diabetes, your body cannot process fats properly. This increases the risk of hypertension and arteriosclerosis. Diabetes also interferes with the body’s ability to dissolve blood clots. All of these factors contribute to a greater risk for stroke if you are diabetic.
- Use of birth control pills and hormone therapy: Birth control pills significantly increase the risk of stroke in women who use them. This risk is even greater if you smoke and use birth control pills. Hormone replacement therapy (HRT) for menopausal women also increases the risk for stroke.
- Homocysteine levels: Elevated levels of this amino acid, which is found naturally in the blood, can damage your heart and blood vessels, and result in a greater risk for stroke.
- Previous stroke or TIA: Once you have had a stroke or TIA, your risk is higher than that of the general population that you will have another stroke.
- Other risk factors include prolonged abuse of alcohol and drugs such as cocaine. Even isolated binges of heavy drinking have been shown to increase the risk of stroke. Ongoing, unmanaged stress has also been implicated as a factor.
What Causes a Stroke?
There are two main types of strokes, and they both have different causes:
- Ischemic stroke: This is the most common type of stroke, compromising about 80% of all strokes. These occur when a blood clot or other foreign object obstructs the arteries to your brain and causes the blood flow to be stopped or greatly reduced. Starved of oxygen and nutrients, the brain cells begin to die, and brain function is affected almost immediately.
- Hemorrhagic stroke: Ischemic strokes are the result of too little blood to the brain. Hemorrhagic strokes are caused by the opposite condition: too much blood to the brain. When a blood vessel in the brain ruptures (called an aneurism), it can also cause the death of brain cells and result in brain damage. Hypertension is the most common cause for a hemorrhagic stroke.
What Treatments Are Available for Stroke?
As I stated earlier, it is of critical importance to get a stroke victim into emergency care as soon as possible. Therapy with clot-busting drugs must be administered within 3 hours in order for them to be most effective. The sooner this is accomplished, the better the chance for full recovery and minimal damage.
However, these drugs are not appropriate for all patients, and they are only effective on ischemic strokes. In fact, if used to treat a hemorrhagic stroke, they can worsen the situation rather than help it.
If drug therapy cannot be used, there are quite a few emergency surgeries that can be done to stabilize the patient. I will spare you all the technical jargon. Suffice it to say that there are many to choose from, and hopefully the doctors in the ER will be able to pick the one most appropriate for you.
The most exciting part of stroke recovery is the rehabilitation phase. It can be sad and discouraging if the damage is so extensive that little improvement can be made. Unfortunately, this is the case for many stroke patients. But there are also many joyous stories of folks who make dramatic comebacks. The recovery process may take months and years of hard work with a lot of help from others, including physical therapists, speech therapists, occupational therapists, ministers, social workers, counselors, support groups, and perhaps most importantly, loving and supporting family members and friends.