|
Warning, stroke is an emergency!
|
|
|
It used to be that once you had a stroke, it was too late, the damage was done. But today, urgent rehabilitation can lead to recovery
By Larissa Hachinski and Vladimir Hachinski, M.D., D.Sc.
In a matter of seconds, stroke can attack without warning and change a life forever. The leading cause of adult disability in Canada, strokes afflict about 50,000 people every year. Some die from it, some survive and recover completely, some remain disabled from its ravages — about 200,000 Canadians, according to the Heart and Stroke Foundation of Canada. Stroke not only affects the sufferer, but the whole community: family, friends, employers and taxpayers. Educate yourself about the warning symptoms and effects. It’s the first step towards prevention.
Stroke used to be considered an affliction of the old or a condition only a threat to men. Neither is true. Stroke makes no distinction between young or old, man or woman. While it is true that risk increases with age, it’s never too early to take preventive steps.
In an ischemic stroke, which accounts for about 80 percent of cases, an artery to the brain becomes blocked so that part of the brain no longer receives the oxygen and glucose it needs to function. The usual cause of blockages are blood clots, which generally originate in the heart, the aorta — the body’s main artery — or neck arteries, and then travel to the brain.
Hemorrhagic strokes signify bleeding in or around the brain. This bleeding can be caused by high blood pressure or a burst aneurysm. An aneurysm is a little pouch protruding from a weakened artery wall. When it bursts it causes severe bleeding around the brain. Stroke caused by an aneurysm typically produces a very sudden and excruciatingly painful headache in the back of the head, like being hit by a baseball bat.
The effects of stroke depend mainly on two factors: how much of the brain and what part of it the stroke affected. The left hemisphere of the brain is usually associated with verbal and written language, number skills, scientific functions and reasoning, whereas the right hemisphere is considered responsible for musicality, artistic ability, spatial orientation, creativity and insight. Each hemisphere is highly specialized; each controls the opposite side of the body. If your right hemisphere is damaged by stroke, for instance, you might be paralyzed on the left side of the body and have trouble with spatial orientation. Sometimes stroke survivors paralyzed on the left side don’t recognize their left hand as their own.
Not only can stroke alter one’s physical abilities, but it can also change the personality, depending on what part of the brain is involved. An afflicted person may become more prone to mood swings, and might prove less caring where once conscientious.
Stroke requires urgent medical attention. At the hospital, a stroke victim should be seen by a neurologist or another physician expert in stroke, who will perform a physical and neurological exam and may order tests. The most common tests used to diagnose strokes are computed tomography, or a sometimes three-dimensional CT scan of the brain, which is useful for determining cause; magnetic resonance imaging (MRI), which produces a 3-D image of the brain that shows the area damaged by the stroke; and ultrasound or angiogram, providing information about arteries and blood flow.
Medication may also be administered to either dissolve a blood clot or to try to protect the brain. A number of drugs are being tested in clinical trials with patients. In select patients, tissue plasminogen activator (tPA) has been demonstrated as effective treatment to dissolve clots, if given within three hours of the onset of symptoms. Conversely, it may also cause bleeding into the brain and hasn’t been approved yet in Canada. Other drugs, like aspirin and warfarin, are used according to the specific condition.
The news about stroke isn’t all bad. Much progress has been made in its treatment in the last 20 years. Units offering comprehensive and complete care for stroke patients are being set up across the country, and the days are gone when you had to accept your fate after stroke struck. The sooner it’s treated, the greater the chance for recovery. The extent of recovery and the rate of recovery varies, depending on how much of the brain was affected and where the stroke hit.
The determination of the survivor and family directly influences rehabilitation. Stroke survivors with a strong external support system tend to recover better. Start rehab as soon as possible. The Heart and Stroke Foundation of Canada provides literature and videos on how to live with the effects of stroke, as well as information about groups and services that provide assistance and support. Preventing a stroke is the best treatment. Primary prevention is when someone has no symptoms but does have risk factors for stroke, whereas people practicing secondary prevention have already had a stroke or warnings of stroke and are taking action to prevent a second one.
The first preventative step is to get a medical assessment to determine if you’re at risk, what factors need to be modified and how. Of the many recognized risk factors for stroke, some you just can’t do anything about. You cannot change your age, sex, ethnicity or family history. In general, the older you are the greater the risk. Men and women are at equal risk, particularly after age 60. African-Americans and Asians tend to have a higher incidence than Caucasians. History of stroke plays a role, as does history of heart disease, since the consequences of hardening of the arteries, otherwise known as atherosclerosis, is one of the most common causes of stroke.
Other risk factors are treatable. They include high blood pressure, smoking, homocystenemia, high cholesterol, diabetes, obesity, heart disease, prior strokes and transient ischemic attacks where warning symptoms last only minutes. The brain is the body’s most complex organ and the one ultimately responsible for all that makes us human. Research is still discovering and demystifying how the brain works. In today’s emergency wards, stroke, or a “brain attack,” is treated with the same urgency as a heart attack. You can do a lot to minimize the effects of stroke — know the warning symptoms, recognize your risk, take preventive steps against it and support medical research, the only guarantee of further progress.
Symptoms of stroke
Symptoms of stroke include sudden blurring or loss of vision in one or both eyes, loss of speech, vertigo or imbalance, weakness or numbness of the face, arm or leg, or a very sudden and unusual headache. If you experience any one or more of these symptoms, call 911 and get to the hospital.
Larissa Hachinski is a writer based in Calgary; Vladimir Hachinski is the Richard and Beryl Ivey Professor and Chair, Department of Clinical Neurological Sciences, University of Western Ontario. They coauthored the book Brain Attack!
|
|
|
|
