Strokes are the No. 5 cause of death in the U.S., according to the American Stroke Association — and about 80 percent of them are preventable. Here, two area professionals explain strokes, their symptoms, treatments, and offer some advice for prevention.
About Strokes
There are two different types of strokes, explains ProHealth Care neurology nurse practitioner Barbara Hughes, APNP — hemorrhagic and ischemic. “Hemorrhagic is the medical term for bleeding, and ‘ischemic’ means no blood is getting to your brain,” she says.
• Ischemic strokes are usually caused by hypertension, high cholesterol and diabetes.
• Hemorrhagic strokes can be caused by hypertension or some other vascular anomaly that may have ruptured a blood vessel, resulting in a bleed in the brain. “Hypertension can cause a bleed in the brain, blood pressure gets too high, and the little tiny hoses in your brain break,” Hughes says.
Dr. Marc Lazzaro, medical director of the Froedtert & the Medical College of Wisconsin health network comprehensive stroke program, notes that the its main hospital sees more than 900 stroke patients a year. About 80 percent of stroke patients, he adds, are ischemic.
Genetics very rarely have an impact on strokes, Dr. Lazzaro notes. Though age may play a role, strokes are typically a result of “mostly modifiable vascular risk factors” such as high blood pressure, high cholesterol, elevated blood sugars like with diabetes, smoking and heavy alcohol use, he says.
“The other offender is something called AFib, and a lot of people don’t know they have it,” Hughes says. “It occurs very infrequently, but it is a contributor to stroke.”
Symptoms
Since “time is brain,” Hughes and Dr. Lazzaro both note the importance of knowing the signs and symptoms of a stroke to get treatment as soon as possible. One effective tool to detect strokes is the BE FAST acronym: B —balance, E — eyes, F — face, A — arm, S — speech, and T — time.
“If somebody experienced sudden change in balance or with their vision, that’s what the ‘E’ stands for,” Dr. Lazzaro says. “Other symptoms are facial weakness, drooping of one side of the face, or arm weakness. Slurred speech can be a sign of a stroke. The T is for time, which is a reminder that it’s important to call 9-1-1 because that urgent or emergent evaluation can be very important to treat stroke.”
Though the amount of symptoms of BE FAST may vary between patients — Dr. Lazzaro notes it could be anywhere from one symptom or all — it’s important to be aware of all of them.
“If other risk factors had been identified and addressed early, perhaps we could do something to avoid the stroke in the first place,” Hughes says.
Treatment
Both physicians urge the importance of noting the time when someone’s stroke symptoms become obvious.
“Once that patient gets to the emergency room, the first thing that they’re going to do is perform a CT scan to make sure the stroke isn’t because of a bleed,” Hughes says. “The CT that can tell us that can be done quickly, and doctors can assess if it’s a bleed, something blocking the artery, or something that can quickly be treated.”
“Treatments are offered and best used in the very early period —usually within minutes to hours,” Dr. Lazzaro adds.
Once it’s been determined which type of stroke a patient is having, a plan is put into place. For ischemic strokes, treatments include a clot-busting medicine, or a thrombolytic to break up the clot and restore normal blood flow. Another procedure, endovascular therapy or mechanical thrombectomy, uses a catheter to physically remove the clot to open the blood vessel, Dr. Lazzaro explains.
“If we can do that within minutes or hours of the onset of the stroke, it can have a dramatic effect in improving outcome for patients and substantially changing the course of their stroke,” Dr. Lazzaro explains.
For patients with hemorrhagic strokes, treatment options can be medications for those who might be on blood thinners, or interventional treatments to close a blood vessel that may have bleeding (as with an aneurysm), Dr. Lazzaro says.
Advice
Hughs and Dr. Lazzaro both note the importance of living a healthy lifestyle to prevent strokes.
“Not only do lifestyle changes help prevent a stroke, but you can diet and exercise yourself out of multiple medications for hypertension,” Hughes says. “Something as simple as watching your diet, really exercising for 30 minutes, five days a week, can help prevent catastrophic illnesses.”
Along with living healthier lifestyles, Dr. Lazzaro and Hughes note that educating the public on ways to both recognize and prevent strokes is an important factor.
“We need to educate people before they have a stroke, not after,” Hughes says. MKE