January 30, 2012 -- As
Senator Mark Kirk continues to recover, we take a closer look
at the warning signs of stroke. In Monday morning's Rapid
Round, we're joined by Dr. Melvin Wichter, neurologist with
Advocate Christ Hospital and Medical Center in Oak Lawn.
1) What are the signs you're having a stroke?
No two strokes are alike, thus the expression "we learn
strokes, stroke by stroke". However certain patterns are more
common than others. The most important pattern is best
remembered by the acronym F.A.S.T. Face meaning a drooped or
twisted face, Arm weakness or drifting of the arm, Speech
slurred speech or difficulty finding words, Time reminds us
that "Time is Brain" and the shorter the time to appropriate
therapy the less likely permanent damage will occur.
2) What Types of strokes are there?
85% of total strokes are due to blocked arteries which prevent
blood from getting to particular parts of the brain.
Overwhelmingly these kinds of stroke are related to the
clotting of blood in the heart or the blockage of blood vessels
in the neck or within the brain. These are often called "bland"
or ischemic strokes they are directly or indirectly related to
hardening of the arteries due to cholesterol plaque buildup.
15% of strokes are due to
leaking blood vessels that cause bleeding in the brain. This type
of stroke is strongly age dependant . These causes include
abnormal connections of blood vessels called AVM's (arteriovenous
,malformation) age 20-40, aneurysms age 40-60, and high blood
pressure ages greater than 60. Under certain circumstances bland
strokes can themselves turn into bleeding stroke or what is known
as hemorrhagic transformation. Strokes that bleed though less
common are more damaging and more fatal than bland strokes.
3) Treatment options?
Treatment can be divided into 2 categories. Immediate therapy
is designed to open blood vessels and protect further brain
damage. Immediate therapies include allowing blood pressure to
rise for the 1st 24-48hrs, preventing extreme blood sugar
shifts and the judicious use of medications designed to
dissolve clots that have blocked arteries. These must be given
within a tight time frame of 3-4 ½ hrs and can have bleeding as
a serious side effect. Experimental drugs will hopefully extend
this window well beyond this time frame. More novel approaches
include the direct mechanical removal of clots from the
arteries in the brain by a specially trained radiologists or
neurosurgeons.
These therapies are used when other therapies have failed or
the patient is beyond the time frame described above. Brain
bleeds are treated according to their cause, vascular
malformations can be surgically removed or clotted. Coils can
be placed in aneurysms or can be clipped surgically. Blood
clots can be removed by direct surgical intervention as well.
4) Prevention tips?
Prevention of stroke involves reducing risk factors. The most
importantly among these include: blood pressure control,
cholesterol management by way of exercise and diet, cessation
of smoking, reduction of alcohol intake, control of diabetes
and treatment of underlying cardiac abnormalities. Opening up
blocked arteries by way of surgery or stenting and use of blood
thinning medication are also important tools. The single
greatest risk for stroke is signs or symptoms of a prior stroke
and therefore those patients need to be monitored most closely.
Young patients who have had a stroke are a separate group
deserving of special attention. Important causes of stroke in
young healthy adults would include tears or injuries to blood
vessels supplying the brain (dissection), heart disease and
clotting disorders. A family history of frequent strokes in
younger family members might be an adequate reason for
screening for these kinds of abnormalities.
National Stroke Association
http://www.stroke.org
(800) 787-6537
National Institute of neurological disorders and stroke
http://www.ninds.nih.gov
The Internet Stroke Center
http://www.strokecenter.org
American Heart Association
http://www.americanheart.org
(800) 242-8721
SSEEO Stroke Survivors Empowering Each Other
http://www.sseeo.org
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Original post:
Rapid Round: What is a Stroke?