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| Written by Tyrone M. Reyes, M.D. |
| In the first minute of a stroke, your brain loses an estimated 1.9 million brain cells — what you’d lose in three weeks of normal aging. But the loss continues every minute the stroke is left untreated. If a stroke runs its usual 10-hour course, it can kill 1.2 billion nerve cells — what a normal brain loses over a course of 36 years. That doesn’t have to happen. “Stroke is a highly treatable disease, but unfortunately, the time in which physicians can effectively reverse a stroke is short,” says UCLA neurologist Jeffrey Saver. “Precious tissue is lost every second,” he explains. “Patients need to get to the hospital at the first sign a stroke is occurring.” If they get there within three hours, doctors can use a clot-busting drug like tPA (tissue plasminogen activator) to curb the damage. But many victims wait, hoping the symptoms will disappear. “Don’t try to tough it out, and don’t waste time trying to get in touch with your primary physician or neurologist,” says Dr. Saver, who calculated the brain cell losses. “You need emergency help.” Unfortunately, many people wait too long to call for help. An analysis of 48 reports done in the US showed that the median time from stroke onset to arrival in an emergency room (ER) is between three and six hours. Some people even dismiss or ignore symptoms. The result, quite often, is that the stroke produces significant impairment and disability. In the US, stroke is the third leading cause of death, right behind heart attack and cancer. In the Philippines, it is the number one cause of major, long-term disability in adults. The good news is, there are still many modifiable risk factors you can control today. Easy measures are available to help you gauge your risk — and doing so now can give you time to make some long-overdue lifestyle changes that may tip the stroke odds in your favor. A Brain Attack A stroke occurs when a blood vessel carrying oxygen and nutrients to the brain is either blocked by a clot (ischemic stroke, which accounts for about 83 percent of all strokes) or ruptures (hemorrhagic stroke, which comprises the remaining 17 percent of cases). As a result, the affected part of the brain does not receive the blood and oxygen it needs and begins to die (see diagram on Page E-1). A study presented last year at the annual meeting of the American Stroke Association (ASA) in San Francisco, revealed that during a stroke — just as with heart attacks — people do not always have classic symptoms. This study, conducted by Michigan State University, looked at symptoms displayed by 1,724 patients treated for stroke in more than a dozen emergency rooms across the state. Many did not present with the five classic ASA warning signs: 1) sudden numbness or weakness of the face, arm, or legs; 2) confusion, trouble walking, speaking, or understanding words; 3) sudden loss of vision in one or both eyes; 4) dizziness, loss of balance or coordination; and 5) sudden severe headache with no known cause. Women were 33 percent less likely than men to have these signs, and more alarming, 15 percent of the women and 10 percent of the men reported none of the classic warning stroke signs. Some patients instead complained of having fainted, developed trouble breathing, had fallen, experienced pain, or developed seizures. If a person’s symptoms seen in the ER don’t match classic stroke symptoms, it may be less likely that brain imaging, such as a CT scan or an MRI, will be done to confirm a stroke and miss the three-hour window of opportunity for clot-busting treatments. Further studies are needed to confirm the difference in symptoms and the possible reasons behind them. Two Kinds Of Risk Some risk factors are out of your control such as age and family history. Every 10 years after age 55, stroke risk doubles with two-thirds of all strokes occurring after age 65. Your risk also doubles if someone in your immediate family had a stroke. However, there are risk factors that you can change. The most important is smoking, which may predispose people to develop ruptured cerebral aneurysm, especially in women. “Both smoking and obesity are big risk factors,” notes Tobias Kurth, MD of Brigham and Women’s Hospital in Boston, and lead author of a stroke and lifestyle change study in 2006. “The risk associated with obesity is underestimated. Preventing obesity leads to a substantial reduction of ischemic stroke.” High blood pressure is another significant risk factor that’s within your control. People with normal blood pressure (less than 120/80 mm Hg) have half the risk of those with hypertension (pressure above 140/90 mm Hg). Atrial fibrillation (AF), an abnormal heart rhythm, can lead to blood pooling and clotting, and increases risk about five-fold. Treating AF with heart rhythm drugs and blood thinners can halve the risk. Other factors are carotid or other artery disease, diabetes, high blood cholesterol, physical inactivity, hormone replacement therapy, and a history of transient ischemic attacks (TIAs) or mini-strokes. About 30 percent of strokes are preceded by TIAs. A TIA may present as an abrupt but fleeting focal deficit (a problem in nerve function that affects specific location or a specific function), such as suddenly losing your sight, being unable to talk, or unforeseen paralysis of an arm or leg. A TIA usually clears up in a few minutes, leaving its victims puzzled over what took place and what to do about it. However, the treatment you receive immediately following a TIA can be critical to reducing your chances of suffering a major stroke. In many cases, TIA patients must undergo carotid endarterectomy, in which doctors surgically clean out the carotid artery and restore normal blood flow, sharply reducing — but not eliminating — the likelihood of a subsequent stroke. 8 Steps To Reduce Your Risk The study led by Dr. Kurth, published July 10, 2006 in the Archives of Internal Medicine, defined eight healthy behaviors that can help prevent stroke: 1. Abstinence from smoking. 2. Moderate alcohol consumption, between four and 10.5 drinks a week. 3. Regular exercise (30 minutes a day, four or more times a week). 4. Maintaining a healthy body mass index, if possible less than 22. 5. Eating a healthy diet high in cereal fiber, folate (vitamin B-9 found in green leafy vegetables, beans, and legumes). 6. Consumption of omega-3 fatty acids (found in salmon, tuna, and other oily fish) with a high ratio of polyunsaturated to saturated fat. 7. Avoidance of trans fat. 8. Eating more foods with a low glycemic load (complex carbohydrates that do not raise blood glucose suddenly). You can also reduce your stroke risk by getting blood pressure and cholesterol levels under control. A new study by Dr. Kurth in the February 20, 2007 issue of Neurology found that otherwise healthy people with high cholesterol levels were at increased risk of a stroke. Prevention and Compliance Despite the abundance of modifiable risk factors, people are seldom motivated to take the steps necessary to reduce their stroke risks, says Anthony Furlan, MD, head of the Stroke and Neurologic Intensive Care at the Cleveland Clinic. “Often it takes an event. People tend to respond to a crisis. You have to have a stroke or a TIA. You literally get scared into lifestyle modification,” he explains. “Patients are often unaware of risk factors, are given medication, but don’t take it. For blood pressure control, compliance is often less than 50 percent because we’re treating patients who don’t feel sick, so it’s so easy to slack off.” Blood thinners such as aspirin, as well as clopidogrel (Plavix) and aspirin plus extended-release dipyridamole (Aggrenox; not available in RP), are often prescribed, as in warfarin (Coumadin), an anticoagulant prescribed for AF, one of the most common causes of stroke. Statin drugs, which reduce LDL cholesterol, also play a key role in stroke prevention. The most commonly prescribed statin is atorvastatin (Lipitor). “We’re using statins more aggressively, with higher dose,” Dr. Furlan says, noting two recent studies that utilize 80 mg of Lipitor, a dose far higher than had been commonly prescribed. The bottom line is assessing your stroke risk isn’t difficult. Your birth certificate provides the first clue. An honest look at your lifestyle, a few introspective minutes in front of a mirror, and measures such as your blood pressure, cholesterol, and abdominal girth, will clarify what you have to do to avoid a debilitating or even fatal cerebrovascular event!source: Philippine Star http://philstar.com/index.php?Health%20And%20Family&p=49&type=2&sec=41&aid=2008080488 |
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