Rapid Round: What is a Stroke?

January 30, 2012 -- As Senator Mark Kirk continues to recover, we take a closer look at the warning signs of stroke. In Monday morning's Rapid Round, we're joined by Dr. Melvin Wichter, neurologist with Advocate Christ Hospital and Medical Center in Oak Lawn.

1) What are the signs you're having a stroke?
No two strokes are alike, thus the expression "we learn strokes, stroke by stroke". However certain patterns are more common than others. The most important pattern is best remembered by the acronym F.A.S.T. Face  meaning a drooped or twisted face, Arm  weakness or drifting of the arm, Speech  slurred speech or difficulty finding words, Time  reminds us that "Time is Brain" and the shorter the time to appropriate therapy the less likely permanent damage will occur.

2) What Types of strokes are there?
85% of total strokes are due to blocked arteries which prevent blood from getting to particular parts of the brain. Overwhelmingly these kinds of stroke are related to the clotting of blood in the heart or the blockage of blood vessels in the neck or within the brain. These are often called "bland" or ischemic strokes they are directly or indirectly related to hardening of the arteries due to cholesterol plaque buildup.

15% of strokes are due to leaking blood vessels that cause bleeding in the brain. This type of stroke is strongly age dependant . These causes include abnormal connections of blood vessels called AVM's (arteriovenous ,malformation) age 20-40, aneurysms age 40-60, and high blood pressure ages greater than 60. Under certain circumstances bland strokes can themselves turn into bleeding stroke or what is known as hemorrhagic transformation. Strokes that bleed though less common are more damaging and more fatal than bland strokes.

3) Treatment options?
Treatment can be divided into 2 categories. Immediate therapy is designed to open blood vessels and protect further brain damage. Immediate therapies include allowing blood pressure to rise for the 1st 24-48hrs, preventing extreme blood sugar shifts and the judicious use of medications designed to dissolve clots that have blocked arteries. These must be given within a tight time frame of 3-4 ½ hrs and can have bleeding as a serious side effect. Experimental drugs will hopefully extend this window well beyond this time frame. More novel approaches include the direct mechanical removal of clots from the arteries in the brain by a specially trained radiologists or neurosurgeons.

These therapies are used when other therapies have failed or the patient is beyond the time frame described above. Brain bleeds are treated according to their cause, vascular malformations can be surgically removed or clotted. Coils can be placed in aneurysms or can be clipped surgically. Blood clots can be removed by direct surgical intervention as well.

4) Prevention tips?
Prevention of stroke involves reducing risk factors. The most importantly among these include: blood pressure control, cholesterol management by way of exercise and diet, cessation of smoking, reduction of alcohol intake, control of diabetes and treatment of underlying cardiac abnormalities. Opening up blocked arteries by way of surgery or stenting and use of blood thinning medication are also important tools. The single greatest risk for stroke is signs or symptoms of a prior stroke and therefore those patients need to be monitored most closely.

Young patients who have had a stroke are a separate group deserving of special attention. Important causes of stroke in young healthy adults would include tears or injuries to blood vessels supplying the brain (dissection), heart disease and clotting disorders. A family history of frequent strokes in younger family members might be an adequate reason for screening for these kinds of abnormalities.

National Stroke Association
www.stroke.org
(800) 787-6537

National Institute of neurological disorders and stroke
www.ninds.nih.gov

The Internet Stroke Center
www.strokecenter.org

American Heart Association
www.americanheart.org
(800) 242-8721

SSEEO Stroke Survivors Empowering Each Other
www.sseeo.org

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