Stroke Prevention
Symptoms to Look Out For and Solutions to Consider
Reprinted with permission from the National Stroke Association
What is a Stroke/Brain Attack?
A stroke or "brain attack" occurs when a blood clot blocks a blood vessel or artery, or when a blood vessel breaks, interrupting blood flow to an area of the brain. When a stroke occurs, it kills brain cells in the immediate area. Doctors call this area of dead cells an infarct. These cells usually die within minutes or a few hours after the stroke starts.
When brain cells in the infarct die, they release chemicals that set off a chain reaction called the "ischemic cascade." This chain reaction endangers brain cells in a larger, surrounding area of brain tissue for which the blood supply is compromised but not completely cut off. Without prompt medical treatment, this larger area of brain cells, called the penumbra, will also die. Given the rapid pace of the ischemic cascade, the "window of opportunity" for interventional treatment is about six hours. Beyond this window, reestablishment of blood flow and administration of neuroprotective agents may fail to help and can potentially cause further damage.
When brain cells die, the individual loses control of the abilities that area of the brain once controlled. This includes functions such as speech, movement, and memory. The specific abilities lost or affected depend on where in the brain the stroke occurs and on the size of the stroke (i.e., the extent of brain-cell death). Some people recover completely from less serious strokes, while other individuals lose their lives to very severe strokes.
The Cost of Stroke to All Americans
- Stroke is our nation's third leading cause of death, killing 150,000 Americans every year.
- Over the course of a lifetime, four out of every five American families will be touched by stroke.
- Of the 400,000 Americans who survive a stroke each year, about 10 to 18 percent will have another stroke within one year. The rate of having another stroke is about 10 percent per year thereafter.
- Stroke is the number-one cause of adult disability. Three million Americans are living with the effects of stroke. About one third have mild impairments, another third are moderately impaired, and the remainder are severely impaired.
The Toll on Older Adults
Stroke risk increases with age. For each decade after age 55, the risk of stroke doubles.
For adults over age 65, the risk of dying from stroke is seven times that of the general population.
Two thirds of all strokes occur in people over age 65. The over-50 population is expected to rise by 19 percent from 1994 to 2000, making it the fastest growing U.S. age group. This puts more people at risk for stroke every day.
Recognizing Stroke Symptoms
Stroke is a brain attack, yet most people don't know the symptoms. In a recent Gallup poll, 97 percent of the respondents over age 50 couldn't name a single stroke symptom. Stroke is an emergency! When someone experiences any of these symptoms, there's no way to tell at first if it's a stroke or a transient ischemic attack (TIA is a temporary interruption of the blood supply to an area of the brain. TIAs can appear hours, days, weeks, or months before a full stroke). If it is a stroke, immediate medical treatment can save the person's life and greatly enhance his chances for successful rehabilitation and recovery. If it's a TIA, the doctor will evaluate the underlying causes and begin appropriate preventive measures. Even if these symptoms don't cause pain or they go away quickly-call 911 immediately. (See chart in adjoining column for symptoms).
Uncontrollable Stroke-Risk Factor
Uncontrollable stroke-risk factors include:
- Age: The chances of having a stroke go up with age.
- Gender: Males have a slightly higher stroke risk than females. But because women in the United States live longer than men, most stroke survivors over age 65 are women.
- Race: African Americans have a higher stroke risk than most other racial groups.
- Family history of stroke or TIA: Risk is higher for people with a family history of stroke or TIA.
- Personal history of diabetes: This may be due to circulation problems that diabetes can cause. In addition, brain damage may be more severe and extensive if blood sugar is high when a stroke happens.
Controllable Stroke Risk Factors
Treatable medical disorders that increase stroke risk include:
- High blood pressure (hypertension) increases stroke risk four to six times. It is the single most important controllable stroke-risk factor. Between 40 and 90 percent of all stroke patients had high blood pressure before their stroke. Hypertension puts stress on blood-vessel walls and can lead to strokes from blood clots or hemorrhage.
- High cholesterol can indirectly increase stroke risk by putting people at greater risk of heart disease, another important stroke-risk factor. High levels of cholesterol in the blood stream can lead to the development of plaque buildup on artery walls, which can plug arteries.
- Atrial fibrillation and other heart diseases increase stroke risk up to six times. About 15 percent of all people who have a stroke have a heart disease called atrial fibrillation, or AF, which affects more than 1 million Americans.
- Personal history of stroke or TIA increases risk for having another. After suffering a stroke, men have a 42 percent chance of recurrent stroke within five years, and women have a 24 percent chance of having another stroke. Thirty-five percent of those who experience TIAs have a stroke within five years.
Certain lifestyle factors increase stroke risk:
- Smoking doubles stroke risk. Smoking damages blood-vessel walls, speeds up the clogging of arteries by deposits, raises blood pressure, and makes the heart work harder.
- Excessive alcohol consumption (more than two drinks a day or binge drinking) is associated with stroke in a small number of research studies. Studies have also suggested that mod-est alcohol consumption may protect against stroke by raising levels of a naturally occurring "clot-buster."
- Excess weight puts a strain on the entire circulatory system and increases likelihood of other stroke factors such as high cholesterol, high blood pressure, and diabetes.
Medical Management of Stroke Risk
In addition to modifying lifestyle factors, stroke risk can be reduced through medical management.
- For high blood pressure, a patient's doctor may prescribe an antihypertensive medication. There are well over 50 prescription antihypertensive drugs on the market from which to choose.
- When cholesterol levels aren't
adequately controlled through diet and exercise, cholesterol-reducing medication will work, as long as it's taken as directed on a regular basis.
- In some patients it makes sense to prevent strokes by preventing clots from forming. There are two primary classes of drugs used for this purpose: anticoagulants and antiplatelet drugs (antithrombotics).
Our notions about stroke and its treatment are being revolutionized. This truly is the "Decade of the Brain" for stroke. For the first time in the history of stroke treatment, today pessimism is being transformed into optimism and nihilists into interventionalists. Our nation's third greatest killer and most prolific disabler may soon be relegated to the status of a petty thief rather than a serial murderer. The new stroke interventionalists (neurologists, neuroradiologists, and emergency medicine physicians) who are dedicated to emergent stroke treatment are leading the insurgency in demonstrating what has now become the National Stroke Association's call to arms, "changing the way stroke is viewed and treated."
The Learning Brain: Hope for Stroke Patients
By Anat Baniel
Two years ago, at age 69, John was in the hospital recovering from open-heart surgery after suffering a torn aorta and a mild stroke. He could barely move; standing and walking were out of the question.
Using the Feldenkrais Method-touching and moving different parts of the body-I worked with John to see whether, despite the trauma, his brain remembered some of what he used to do and was able to learn and form new connections to replace the lost ones. The Feldenkrais Method is based on the understanding that the human brain has the capacity, throughout life, to form new patterns of movement, feeling, thought, and action with great speed and efficiency. No matter what level of skill or degree of limitation one has, the brain can learn to replace limited and disorganized movement patterns with new and better organized ones. This holds true whether the brain has suffered a stroke or not. We do not lose the ability to learn; it just lies dormant.
John demonstrated this when, after just two Feldenkrais sessions, he was able to start walking. Three months later, much of the rigidity John had developed in his chest and spine disappeared. John also learned to roll on the floor like a baby, use his hip joints and lower back more, get a more flexible spine, and breathe better. The process was gentle and gradual and did not require specific skills except the ability to listen, feel, and work. Soon thereafter, John was back to playing golf "better than I did ten years ago," traveling, and leading a full life. Today he doesn't even think of himself as a stroke victim.
About the author: Anat Baniel is the director of Movement Coordination Learning, Inc., 260 Summit Drive, Corte Madera, CA 94925. The corporation provides Professional Training Programs, public seminars, and wellness programs in the Feldenkrais Method. Ms. Baniel is the author of Movement for Life and has movement lessons recorded on video and audio. For information, call 415-927-2211.
Resource Corner
- National Stroke Association (NSA). A national organization dedicated to stroke prevention, treatment, rehabilitation, research, and support for stroke survivors and their families. Call 800-STROKES.
- Stanford Stroke Center. With leading-edge technology and a highly skilled staff, the Center provides stroke patients and those at risk for stroke with a
continuum of innovative services, including screening, diagnosis, treatment, prevention, and rehabilitation of a wide spectrum of circulatory disorders involving the brain and spinal cord. Call 415-723-4448.
- The Cybernetix Institute. Provides state-of-the-art scientific training methods to reduce negative chemical reactions for the prevention and treatment of stroke and cardiac ailments. Call 510-685-4224.
- Stroke Survivors. By W. H. Bergquist, R. McLean, and B. A. Kobylinski. The stories of 75 stroke survivors and caregivers provide an increased awareness of the capacities still present in survivors as well as the limitations imposed by a stroke. It helps survivors, their families, and friends to rebuild and reclaim their sense of self once again. Jossey-Bass Publishers. $25. Available in bookstores or call 800-956-7739.
- After A Stroke. By Geoffrey Donnan, M.D. and Carol Burton. This guide to the causes and consequences of a stroke will help you understand limitations and recovery prognosis, locate movement therapies and body work, and track daily progress with worksheets, charts, and tables. North Atlantic Books. $9.95. Available in bookstores or call 800-337-2665.
