October 10, 2006 > Preventing and Treating Strokes
Preventing and Treating Strokes
by Washington Hospital
Each year, at least 700,000 people in the United States suffer a stroke, according to the American Stroke Association. One in four people will die as a result of suffering a first stroke, and many more will face a lifetime of devastating disability. Fortunately, most strokes are preventable, and for people who do suffer a stroke, improved treatments have made it easier to preserve brain function.
“Administering treatment as soon as possible after a stroke is crucial,” says cardiologist Dr. Ash Jain, medical director of the Stroke Program at Washington Hospital. “The sooner we can treat a patient who has suffered a stroke, the better the results are likely to be. There are a lot of exciting new developments in the treatment of strokes, and the treatment available through our program at Washington Hospital is as good as it gets.”
To expand community awareness of stroke prevention and treatment advances, Jain and Stroke Program Coordinator Douglas Van Houten, R.N., will present a free Health & Wellness Seminar on Monday, October 16 from 1 to 3 p.m. The seminar will be held in the Conrad E. Anderson, M.D. Auditorium, Rooms A & B, in the Washington West Building located at 2500 Mowry Avenue in Fremont. For more information about the seminar, or to register to attend, please call (800) 963-7070.
“There are two broad categories of strokes,” Van Houten explains. “Hemorrhagic strokes, which account for only 10 to 15 percent of all strokes, are caused by ruptured blood vessels bleeding into the brain or the spaces around the brain. Ischemic strokes – by far the vast majority of all strokes – are caused by decreased blood flow to the brain due to a blocked blood vessel.”
Van Houten notes that there is a big difference in the symptoms of a hemorrhagic stroke as opposed to an ischemic stroke. “A hemorrhagic stroke happens quickly and causes intense pain,” he says. “People who suffer this type of stroke often will say, ‘I’ve got the worst headache I’ve ever had in my life!’ Because of the intensity of the pain, these people usually go to the hospital as soon as possible.”
Ischemic strokes, on the other hand, often don’t produce pain, and they come on slowly, he adds. “Someone suffering an ischemic stroke might say, ‘I’m having some trouble with dizziness, and I’m dragging my foot. I’m tired and I’m going to bed.’ They don’t recognize they are experiencing a stroke. That can create grave problems if they don’t get to the hospital early enough to receive treatment.”
The symptoms of a stroke fall into five main categories, Van Houten says:
- Sudden numbness or weakness, almost always on one side of the body.
- Sudden confusion or difficulty in speaking or understanding language.
- Sudden trouble with seeing, such as double vision, blind spots, or a “hole” in the field of vision.
- Sudden trouble with walking, dizziness, loss of balance or coordination.
- Severe, sudden headache with no known cause.
“The symptoms you experience during a stroke depend on the area of the brain that is affected,” Van Houten explains. “You won’t necessarily have all of the symptoms, although that is a possibility.”
People who experience stroke symptoms that go away fairly quickly may have suffered a transient ischemic attack (TIA). “With TIAs, the symptoms do resolve themselves, but they can be the precursor to a major stroke,” Van Houten says. “Having a TIA means you are at a much, much higher risk of suffering a major stroke, and you need to be evaluated right away to determine effective preventive measures and lower your risk factors for a stroke.”
The risk factors for stroke are very similar to the risks for cardiovascular disease, including high blood pressure, high cholesterol levels, smoking, excessive alcohol consumption, physical inactivity and obesity. The risk of stroke increases after age 45 and is highest for people in their 70s and 80s. In general, men are more likely to suffer strokes than women, but the incidence of strokes in women increases after menopause. Some additional risk factors for stroke include cardiovascular disease, diabetes, a family history of strokes and atrial fibrillation (irregular heartbeat).
“Recent studies have suggested other risk factors for stroke,” says Jain. “One is a high level of the amino acid homocysteine in the blood. Homocysteine interferes with the metabolism of cholesterol, and changes the good cholesterol (HDL) into bad cholesterol (LDL). Another one is a high level of CRPhs, or high-sensitivity C-reactive protein, in the blood. This protein is a ‘marker’ that indicates inflammation in the lining of the arteries, which is linked to coronary and cerebrovascular problems.”
Controlling your risk factors is key to stroke prevention. “Obviously you can’t control factors such as age, but most risk factors can be controlled with a healthy diet and exercise,” Jain says. “Your physician may prescribe medications to help control blood pressure, cholesterol or diabetes, or to help with quitting smoking. We also can conduct various screenings such as MRIs and carotid artery Doppler sonograms to detect blockages. When blockages are discovered, various procedures can be performed to remove them.”
Treatment options for stroke victims now include the use of the clot-busting medications. If administered soon enough, these drugs can dissolve many blood clots that cause strokes.
“Patients who come in within three hours of suffering a stroke may be candidates for intravenous administration of clot-dissolving medications,” Jain says. “If the patient comes in within three to six hours, we could administer the medications via the arteries. That procedure, however, is more invasive and must be done using a catheter.
“After six hours, the patient is no longer a candidate for clot-dissolving medications, although we can perform procedures to go into the brain and open up the blockage,” he adds. “After eight hours, most of the damage to the brain has been done, and it’s primarily a matter of rehabilitation, rather than interventional treatment.”
Jain emphasizes that people need to be aware of the symptoms of stroke and to seek treatment as soon as possible. “It is even more important to deal with your risk factors for stroke,” he says. “Preventing a stroke is always preferable to treating one.”
To learn more about the Stroke Program at Washington Hospital, or to schedule an evaluation, please call (510) 745-6525.
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