A stroke is a medical emergency that can cause permanent neurological damage, complications, and death. It is the leading cause of adult disability in the United States, and currently the number two cause of death worldwide. Harold Adams, MD, director of the University of Iowa Stroke Center, located in University of Iowa Hospitals and Clinics talks about stroke and the treatment of a stroke:

What is a stroke?

The term stroke covers a number of blood vessel diseases that affect the brain. This includes the rupture of a blood vessel causing bleeding into the brain, or around the brain. The more common cause of stroke is a blood clot that either rises in a blood vessel of the brain, or may arise elsewhere in the body and go to a blood vessel of the brain, which deprives that part of the brain of vital nutrients.

Who is most likely to experience a stroke?

A stroke can occur in any age group. It occurs in children, as well as adults. But generally, the older an individual is, the higher the risk of stroke. In addition, people who have certain identifiable risk factors including high blood pressure, diabetes, high cholesterol, or a history of heart disease are at an increased risk of stroke.

What are the signs or symptoms of a stroke?

The symptoms of stroke reflect the area of the brain that has been affected by the injury. The most common symptoms include:

• Paralysis of one side of the face or body,
• Numbness on one side of the face or body;
• Slurred speech or speech that does not make sense, the words are not correct;
• Intense vertigo or spinning
• Poor balance
• Loss of vision in one or both eyes
• Severe headache
• Loss of consciousness

Why is a stroke similar to a heart attack when it comes to treatment?

The more common type of stroke, called ischemic stroke, which is secondary to a blood clot, can be treated in many ways similar to a heart attack. In fact, the term “brain attack” is now being used for stroke to try to correlate on this important relationship. Both these illnesses are associated with a blood clot, depriving blood supply to a vital organ. Both can be treated successfully with measures including clot-busting drugs or even intra-arterial interventions to restore blood supply to the brain or to the heart and limit the amount of injury.

Are there other options for treating a stroke?

The most important treatment of stroke at present is using the clot-busting drugs that we've talked about. In the past, the treatment window was three hours. That is now being expanded to four and one-half hours. Even though the time window where we can still treat patients successfully is expanding, the key is going to continue to be seen in the emergency room as quickly as possible.

How has treatment for a stroke changed in the past decade?

In the last five to 10 years, there's been advances in the treatment of stroke, including the expansion of the time window. We have new interventions including approval of devices that can be placed in arteries to remove blood clots (this is not widely available but can be done in institutions such as The University of Iowa where we have experts who are able to do these procedures).

If someone has a stroke and recovers, are they more likely to have another stroke?

Yes they are. Once a person has had a stroke, they're at increased risk for a second. Therefore, determining the cause of stroke and coming up with measures to try to limit the chance of another stroke are important.

There are basically three lines of therapies:

• Treat the conditions that predispose to stroke, such as high blood pressure, diabetes, and cholesterol. If a person smokes, we encourage him to stop smoking. We have them try to increase their activity and other lifestyle modifications
• Medications can prevent blood clots from forming. These include aspirin, a medicine called Plavix, another one called Aggrenox, and then the anticoagulant Coumadin
• Surgical procedures may be used. An operation called a carotid endarterectomy or in some other patients, a procedure called angioplasty and stenting, are used to reopen the arteries to the brain.

Is UI Hospitals and Clinics involved in any research with regard to stroke treatment?

We have a number of studies underway where we are testing therapies to prevent stroke; looking at new medications and options of therapy including treatment of those people who are not diabetic but may be prediabetic; we're looking at new antithrombotic agents or anti clotting medications; and we are testing new interventions that can be used to treat a narrowing of blood vessels at the base of the brain.

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Harold Adams, MD