Prevent Disability by Learning Stroke Symptoms

Saira Purewal, National Center for Health Research

Strokes are the 5th leading cause of death in the United States and the #1 cause of long-term disability. Having one stroke increases the risk for having another stroke in the next year. Recognizing the early signs of stroke can save lives, prevent long-term disability, and improve quality of life. Unfortunately, only 38% of Americans are aware of the warning signs and symptoms.[1]

A stroke occurs when there is a sudden lack of blood supply to an area of the brain. Blood carries oxygen to the brain. Without oxygen, brain cells begin to die immediately.

The most common type of stroke is an ischemic stroke. This is when a blood clot blocks blood flow to a specific part of the brain. For example, if there is a stroke in the part of the brain that controls vision (the occipital lobe), the person will have sudden problematic changes in vision.

A hemorrhagic stroke occurs when a blood vessel ruptures and blood spills into or around the brain. Hemorrhagic strokes are less common than ischemic strokes, but they cause 2 out of 5 deaths due to stroke.

Once blood flow is cut off to an area of the brain, the cells begin to die in seconds. Treatment is needed immediately to restore blood flow and prevent more cells from dying. Here’s what you need to know to prevent serious damage:

What are the signs and symptoms?

The four most common stroke symptoms include:

  1. Sudden loss of vision.
  2. Sudden loss of the ability to speak or communicate.
  3. Sudden loss of feeling in a part of the body.
  4. Sudden inability to walk.

The American Stroke Association suggests the acronym F.A.S.T. to remember the signs and symptoms.[2]

F: face drooping

A: arm weakness

S: Speech difficulty

T: time to call 911 (Remember, stroke is a medical emergency!)

If you or a loved one experiences the sudden loss of any of these functions, call 911 immediately because every minute counts!

You should call 911 and take an ambulance to the hospital rather than driving with a loved one. Taking an ambulance provides many advantages. Ambulances reach hospitals faster than the average car. Paramedics are trained to track symptoms, record vital signs, and determine the type of stroke, all of which can be very helpful to making sure the patient gets the best care. An ambulance also will alert the hospital so the medical team can put a stroke plan into action even before the patient comes through the door. Every second counts, and time is brain.

Treatment

tPA

Treatment options depend on the type of stroke. tPA (tissue plasminogen activator) is a “clot-busting” drug that is administered in the Emergency Room intravenously (through a vein in the arm).[3]

tPA must be given to stroke patients within 4 hours of the onset of the stroke. Unfortunately, fewer than 5% of stroke victims get to the hospital in time to receive tPA.[4] If tPA is given after 4 hours, it can be harmful or even fatal.

Many patients don’t recognize the warning symptoms of a stroke, and will try to “sleep it off. This is a dangerous strategy! By the time a person realizes something is really wrong, they can no longer receive tPA.

For patients that don’t qualify for tPA, aspirin and other “anti-platelet” blood thinners such as warfarin can be effective.

Medical Procedures

In addition to tPA, there are newer more invasive treatment options. For example, Merci Retriever is a clot removing device that can be used by specially trained doctors. It threads through the carotid artery (in the neck) into the brain where it can mechanically remove the dangerous clot. The device was approved by the FDA in 2004 and is most effective with larger clots that tPA cannot break down.[5]

Ninety days after the procedure, patients who had their clot removed with the Merci Retriever and survived had 20 times more recovery of functions such as speech and walking, and a 70% decreased risk of dying. Even if the procedure is successful at removing the clot, it is still risky.  Approximately 8 out of 10 patients will suffer from bleeding in the brain and 34% to 44% will die. If the procedure is not successful at removing the clot, the chance of dying is even higher.[6]

We have learned from clinical trials and registries of patients that underwent the procedure that those who do better with Merci Retriever are younger, have fewer severe neurological problems before the procedure (such as unresponsiveness, vision loss, or profound weakness), had the clot successfully removed, and did not require breathing support during the procedure.

To treat patients with a hemorrhagic stroke, surgical procedures might be done to place a medical clip at the base of the rupture to stop the bleeding.[7]

Bottom line: It is imperative to recognize a stroke at its earliest so that the patient arrives within the window for intervention with better studied interventions, such as IV-tPA.

How to Lower Your Risk of Stroke

The American Stroke Association lists 7 tips on how to lower your chances of getting a stroke.[8]

  1. Prevent or control high blood pressure
  2. Be physically active
  3. Control blood sugar
  4. Eat healthy
  5. Lose weight
  6. Manage cholesterol
  7.  Quit smoking

Women are more likely to have a stroke than men are. Women who use hormonal birth control are also more likely to suffer a stroke because hormones can increase risk of blood clots.[9] Because there are many different forms of birth control available, it is important to avoid the types that are most likely to cause blood clots, such as Yaz, Saftral, and other birth control pills containing drosperinone.[10] In addition, women who are pregnant are more likely to have a stroke than non-pregnant women of the same age.

Strokes occur more frequently in African American men than White men. This is because African Americans are more likely to have high blood pressure, which is the leading risk factor for stroke. Sickle cell anemia, a genetic disorder among African Americans, can also cause blood clots than can cause strokes.[11]

The Bottom Line

Strokes are among the leading causes of deaths in the United States and the leading cause of adult disability. Immediately recognizing the symptoms can help you or a loved one get to the hospital in time to receive life-saving treatment. Just as important, talk to your doctor about how you can practice healthy habits to lower your risk for stroke.

All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.

References

  1. Centers for Disease Control and Prevention. (2017). Stroke Facts. Retrieved from https://www.cdc.gov/stroke/facts.htm. Accessed on October 2, 2017.
  2. American Stroke Association. (2017). Warning Signs. Retrieved from http://www.strokeassociation.org/STROKEORG/WarningSigns/Stroke-Warning-Signs-and-Symptoms_UCM_308528_SubHomePage.jsp. Accessed on October 2, 2017.
  3. National Heart, Lung, and Blood Institute. (2017). How is a Stroke Treated. Retrieved from https://www.nhlbi.nih.gov/health/health-topics/topics/stroke/treatment. Accessed on October 2, 2017
  4. Roth, JM. Recombinant tissue plasminogen activator for the treatment of acute ischemic stroke. Proceedings (Baylor University Medical Center). 2011;24(3): 257-259.
  5. Katz, JM; Gobin, YP. Merci retriever in acute stroke treatment. Expert Review of Medical Devices. 2014;3(3): 273-280.
  6. American Academy of Neurology. (2012). Merci mechanical thrombectomy retriever for acute ischemic stroke therapy. Retrieved from http://www.neurology.org/content/79/13_Supplement_1/S126.full.pdf. Accessed on November, 8, 2017.
  7. American Stroke Association. (2013). Stroke Treatments. Retrieved from http://www.strokeassociation.org/STROKEORG/AboutStroke/BLS/Stroke-Treatments_UCM_310892_Article.jsp#.WdKxwWhSzIV. Accessed on October 2, 2017.
  8. American Stroke Association. (2017). Brain Health. Retrieved from https://brainhealth.strokeassociation.org/ . Accessed on October 2, 2017.
  9. Roach RE, Helmerhorst FM, Lijfering WM, Stijnen T, Algra A, Dekkers OM. Combined oral contraceptives: the risk of myocardial infarction and ischemic stroke. Cochrane Database of Systematic Reviews 2015, Issue 8. Art. No.: CD011054. DOI: 10.1002/14651858.CD011054.pub2.
  10. Welch, Ashley. Newer birth control pills have higher risk of blood clots. (2015). https://www.cbsnews.com/news/newer-birth-control-pills-higher-risk-of-blood-clots/ Accessed October 20, 2017.
  11. Centers for Disease Control and Prevention. (2017). African-American Men and Stroke. Retrieved from https://www.cdc.gov/stroke/docs/aa_men_stroke_factsheet.pdf. Accessed on October 2, 2017.