May is Stroke Awareness Month, so we would like to share with you some knowledge about Stroke, how it can be identified, and what immediate steps need to be taken with the onset of warning signs. By the time you finish this article, on average, seven to 10 people will have suffered a stroke in the US alone (about one every 40 seconds). If one happens to you or someone around you, will you know what to do?
There are essentially two types of Stroke. The first occurs when the brain is deprived of oxygen, even if for a few minutes, needed to function due to a clot blocking blood flow in a vein or artery; this is an ischemic stroke (IS). The second type results from a burst vein leading to a part of the brain, or damage to the meninges, which is the membrane around the brain, causing it to become hemorrhaged; this being a hemorrhagic stroke (HS).
Ischemic stroke (IS)
Ischemic stroke is more frequent than the hemorrhagic type with straightforward, easily recognizable symptoms. The most common are:
• Paralysis or numbness of one side of the body, face, or limbs.
• Aphasia; the inability to verbally express oneself as well as understand others.
Testing (F.A.ST.: Face, Arm, Speech, Time):
One mnemonic you should learn to check if someone if having a stroke is FAST. Ask the person you believe may be having a stroke to:
- FACE: Ask them to smile. If one side of the face appears to droop it may be a sign of stroke,
- ARMS: Ask to lift both arms above their head. Strokes will cause weakness or numbness in the limbs making this difficult.
- SPEECH: Ask them to repeat a simple sentence, like: “We had a good day.” Is the speech is slurred, unintelligible or hard for them to get out?
- TIME: Call emergency services. If the person has difficulties completing any of the tasks listed above, call an ambulance (112 in Hungary).
If the person has difficulties completing any of the tasks listed above, call an ambulance (112 in Hungary). If the symptoms subside only to return it may be signs of a transient ischemic attack (TIA). Don’t wait, call an ambulance. There are a few other warnings to watch out for: a sudden severe headache with no cause; sudden trouble walking; dizziness; loss of balance or coordination; Trouble seeing out of either one or both of eyes.
• Lifestyle diseases. Diabetes, obesity, high blood pressure, cholesterol problems, sedentary lifestyle, smoking, unhealthy diet, and excessive alcohol consumption may all contribute to a greater stroke risk.
• Age. Although stroke may occur in all ages it is much higher in advanced ages.
• Gender. Stroke appears 25% more frequently among men than women. Unfortunately this leads many women to not recognizing symptoms of a stroke or unique signs for females.
• Other hereditary risk factors, like acute blood clotting diseases, or multiple family members with known cerebral aneurysms or subarachnoid bleeding issues. Often adults can be screened for some of these risk factors.
The goal of treatment is eliminating the clot from the vein so oxygen carried in the blood can return to the brain ASAP. There are two ways to do it. The first is thrombectomy, during which medical professionals try to remove the clot mechanically with the help of a catheter. Outside of the National Center of Neurosurgery there are few places in Hungary where this can be performed. The other procedure it is called thrombolysis, where attempts are made to dissolve the clot.
Unfortunately thrombolysis can only be performed on adults. While most have about four or five hours to find treatment after first experiencing symptoms, diabetics and those over 80 years have roughly three hours to begin. During this time patients needs to:
• Get to a hospital,
• be diagnosed,
• be given a cranial CT,
• have lab tests analyzed,
• have vital parameters taken,
• check potential contraindications,
• have infusions given.
The earlier the interventions begin the greater area of the brain that can be saved, decreasing the damage caused by bleeding. Stroke victims must get to the hospital as soon as possible to minimize damage to the brain. That’s why it is important to recognize symptoms and know what to do when they are observed.
Hemorrhagic stroke (H.S)
Hemorrhagic stroke is the condition where the brain, or the membrane surrounding the brain, suffer from direct hemorrhage caused by:
• extremely high blood pressure, or
• a perforation of a cerebral aneurysm (vascular protrusion), or
Risk factors (in addition to those listed at IS):
• High blood pressure.
• Aneurism – hereditary.
• Anticoagulant use among the elderly. As they tend to fall and become injured easily, there is a much greater risk of hemorrhage. A potential headache, confusion, slowness following a fall are signs to look out for as well.
In addition to those mentioned for IS, symptoms may include; severe headache; nausea and vomiting; a stiff feeling in the neck; an inability to tolerate light; and loss of consciousness.
Sometimes a hemorrhage can be removed but for some, the extensive or poorly situated ones, they are better left alone to become absorbed into the body.
Prevention of both types of stroke
Some lifestyle tips to help you reduce your risk of stroke.
- Maintain a healthy lifestyle by:
- keeping a Mediterranean diet,
- not smoking,
- moderating consumption of alcohol,
- exercising at least three times a week for a total of 60 minutes per week.
- Stabilize high blood pressure and diabetes.
- Maintain regular medical checkups, especially for those with high risk factors.
There is a lot you can do to help prevent and help recognize the onset of a stroke especially by following the guidelines above. It is advisable for everybody above 40 to partake in regular annual medical checkups. Speaking with a medical professional may help identify risk factors and prepare you if you are at a great risk of stroke. Don’t hesitate, make an appointment today if you have not had your annual checkup yet.
This article first appeared in our May, 2015 Newsletter.