According to the National Stroke Association, strokes are still the leading cause of disability in America and third in cause of death. Here is a startling fact: as many as 80 percent of all strokes can be prevented. Harold Adams, MD, director of the UI Stroke Center, located in UI Hospitals and Clinics, talks about stroke and prevention:
What is a stroke?
The term stroke covers a variety of diseases that affect the brain and spinal chord. The types of stroke are basically two:
- The rupture of a blood vessel that causes bleeding into or around the brain—called a cerebral hemorrhage
- A blood clot forming in an artery that deprives part of the brain of adequate blood supply—called a cerebral infarction
Who typically suffers a stroke?
Stroke can occur in all age groups, but typically we think the highest risk group of people is those people over the age of 60. People who have heart disease, high blood pressure, diabetes, people who smoke—all have a higher risk of stroke.
Can children or adolescents have a stroke?
Yes, stroke is an illness that does occur in children, young adults, and adolescents. Now the causes of stroke in these groups of people are different than we talked about in older people. In older people we're talking about diseases such as hardening of the arteries, also called atherosclerosis, or heart diseases. In children and young adults, it may be disorders of blood clotting, it may be other diseases of blood vessels, and it may be diseases such as congenital heart disease that predisposes to the stroke.
What are the symptoms of stroke?
Depending on the type of stroke, the symptoms can vary by the area of the brain that is injured. Among the symptoms are:
- Paralysis
- Weakness or clumsiness of part of the body
- Numbness on one side of the face or body
- Slurred speech or speech that does not make sense
- Person suddenly cannot understand what other people are saying
- Sudden onset of severe sense of imbalance or spinning
- Unusually severe headache
- Loss of consciousness
Does the person having symptoms of stroke recognize them in themselves?
This is a very difficult issue because the brain itself is being affected by the event, the person may not be fully aware of what is happening to them. It's important for family members, neighbors, friends, coworkers to be aware of the signs and symptoms of stroke, because in some cases the patient may not know what is happening to them.
If a person witnesses someone having a stroke, what should he do?
Stroke is an emergency. This is as big an emergency as a heart attack, and sometimes you'll see stroke now described as a brain attack. The response should be to seek medical attention immediately.
We should not hope that the symptoms go away. The best response is to call 9-1-1 so rescue crews can bring the patient to a stroke center such as The University of Iowa where we have therapies that can be given. Time is a very important, a critical variable. We need to treat people as rapidly as possible.
How is stroke treated?
The treatment involves a number of interventions. The most important is a clot-busting drug called t-PA. This drug is also used for treatment of patients with acute heart attack. This agent has to be given within three hours of onset of stroke. The sooner we can give it, the greater the success. What this drug does is open up the artery that has been occluded by a blood clot. This is an approved therapy and has been around for 10 to 12 years. We need to treat more people with this and we can if people respond quickly to the symptoms of stroke.
How can strokes be prevented from occurring?
I can't say we can make the risk of stroke zero. There are basically three lines of interventions we can use to lower the risk of stroke:
- Identify the conditions that predispose to stroke including high blood pressure, diabetes, high blood cholesterol, smoking, and heart disease; and treat those conditions as effectively as possible. That may mean changes in lifestyle changes and /or with medications.
- Administer medications to prevent blood clots from forming. These are in two classes:
- Anticoagulants are given to patients with atrial fibrillation, an irregular heartbeat. Patients are usually treated with a medicine called Warfarin or trade name Coumadin
- Anti-platelet agents are used with patients with artery problems. We have three choices—aspirin; Clopidogrel sometimes called Plavix; or a Aggrenox.
- Surgical procedures include carotid endarterectomy which removes the area of narrowing of the artery going to the brain; angioplasty, and stenting.
Depending on the cause of the stroke symptoms and their severity, most patients with risk factors will be treated with one of the anti-clotting medications and the may or may not have a local intervention, such as surgery.
Is the University of Iowa Stroke Center currently involved in any research with regard to stroke?
We are looking at various interventions to try to prevent and treat stroke. We are looking at medications in patients who may not be diabetic but are becoming close to diabetic—something called pre-diabetes or insulin resistance—and looking at early treatment of those patients that lower the risk of stroke. We are waiting for results of a study comparing the two medicines I mentioned earlier—Aggrenox and Plavix—to see which of these medicines is better. We have some studies underway looking at acute treatments, looking at various interventions that may be able to be given in addition to t-PA or in patients who cannot get t-PA in the first few hours after onset of stroke. |
