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Stroke Symptoms
Harold Adams, MD, a professor and neurologist at University of Iowa Hospitals and Clinics, director of the UI Stoke Center, who also led an effort to update the guidelines for caring for patients affected by stroke, talks about stroke:
What is a stroke?
The term stroke is used to define the diseases of the brain that are secondary to blood vessel problems. Basically there are two types of stroke.
Approximately 80 percent of strokes are due to a blood clot closing off an artery to the brain, depriving the brain of blood, similar to what happens in a heart attack.
The other 20 percent are related to bleeding into the brain, sometimes called a brain hemorrhage.
What are the symptoms of stroke?
The symptoms of a stroke are a little more diverse than symptoms of a heart attack. While sudden severe headache is a symptom of stroke, other symptoms include sudden onset of weakness; paralysis; or numbness of one side of the body, such as the arm, hand, leg, or face; slurring of speech; difficulty finding words; difficulty understanding other people; severe spinning; or imbalance. These can occur alone or in combination.
Does everyone have all of the stroke symptoms, or can they just have one of the symptoms you suggested and it could still be a stroke?
There is a spectrum of symptoms that can occur with patients with stroke. Some of these can be relatively mild; some of them may occur in isolation, but more commonly they will occur in some combination, depending on what part of the brain is being affected by the vascular event.
What steps should a person who believes they are having a stroke or someone witnessing someone who they believe is having a stroke do?
A stroke is a life changing and potentially life threatening disease, so we consider this a medical emergency as much as a heart attack. Our attempt is to have the patients get to medical attention as quickly as possible. If appropriate, that includes calling 911 and getting emergency medical services on the scene to get the patient transferred to a medical institution that can provide the care to the patient.
What is considered an "appropriate" hospital to care for stroke patients?
There are interventions for acute stroke, including the clot busting drug tPA, that must be given within a short time of onset of stroke. The time window is three hours, which means things need to move very, very quickly.
We are encouraging patients be taken to institutions that have a stroke care protocol, where they will have the resources to do emergency evaluation, including imaging of the brain with a study called a CT scan and prompt evaluation and consideration for treatment with tPA, because the new guidelines emphasize that tPA is, in effect, the engine that is driving acute stroke care, where our goal is to get as many people as possible treated within this first three-hour window.
With that said, I know that's exactly what my mother requested as she waited in the emergency room before she was shipped up to UI Hospitals and Clinics and she credits that with helping save her life, it really slows you up a little bit, though, doesn't it?
Obviously patients, particularly in rural areas, are going to go to their closest community hospital. Here at Iowa, we are working very hard to develop strong collaboration with our colleagues in other institutions to try to expedite care that sometimes can be given locally, or maybe possibly being transferred to UI Hospitals and Clinics for more aggressive therapy, including some things that we can do that many other institutions in the state cannot in the study of acute stroke
If treated early, how likely is it a person can recover from a stroke?
Actually, it's really quite good. It's impressive how dramatic the responses can be. There was a recent study that showed that if we can treat somebody within 90 minutes of onset of stroke, we have a one in two chance of curing that individual. Those, to me, are spectacular numbers.
If someone has had a stroke and recovered, are they more or less likely to have another stroke?
An individual that has had one stroke is automatically at higher risk for a second. Once somebody has had a stroke, part of overall management will include strategies to try to lower the risk of a second stroke. This will include addressing important factors that predispose the stroke, such as high blood pressure, diabetes, high cholesterol, and smoking.
It may involve medications, depending on what we think is the cause of stroke. This includes medications such as aspirin, or Plavix ® , or Aggrenox, or Coumadin. I'm using the trade names because I think the listeners may have heard of these medications. And it may include surgical procedures, such as surgery on the carotid artery. That will depend on what the presumed cause of stroke is, and what may be the best treatment option for the individual patient.
You've given a lot of information here, if somebody's interest has been peaked or they haven't had a chance to write all of this down, any good research material or what could they do to be able to get more information?
They can go to the UI Stroke Web site where we have information. They can contact the American Stroke Association, the National Stroke Association, the Brain Attack Coalition, or the National Institutes of Health.
I would encourage them to get as much information as possible. It's important not only for their health, but their loved one's health. An important observation which you alluded to is that sometimes the patient may not know that they're having a stroke, but the spouse, the child, the next-door neighbor, or somebody who's a friend may recognize it as a stroke and they need to be the responder, rather than the patient alone. |
