By Teresa Liccardi, M.D.
Recently a patient called our clinic saying he awoke not feeling well and asked if he could come in for a visit that same morning.
When he arrived, it was immediately evident that the right side of his face was drooping, he was involuntarily gazing to the right and his speech was slurred. He said the symptoms had started at 6 a.m. It was now 9:55 a.m. We immediately called 911 and notified the local emergency room. By the time he was in transport to the hospital it was 10:20 a.m. The patient was beyond the three-hour window of emergent stroke treatment and severe permanent disabilities were likely. The window of opportunity was lost.
What a tragedy for the patient and his family. How crushingly sad for a staff of trained medical personnel to stand by and know that had the patient called 911 and gotten to the emergency room when he first noticed his symptoms, his long-term outcome may have been so different!
What is a stroke?
A stroke is a loss of the blood supply to the brain tissue either because of a hemorrhagic stroke where a burst vessel bleeds uncontrollably in the brain, or because of an ischemic stroke where a blood vessel often narrowed and damaged from hardening of the arteries fills with a clot and blood cannot pass to the tissue. Over 80 percent of strokes are of the ischemic type. Ischemic strokes may be reversed or improved by medication that targets the blood clot to dissolve it.
Many hospitals now have specialty teams of medical staff and doctors trained to rapidly recognize, evaluate and treat stroke patients. If the stroke is ischemic and evaluated within three hours of occurring, a special medicine called tissue plasminogen activator (tPA) may possibly be given and reverse all or some of the symptoms saving the brain tissue.
There is only a small window of time to treat an ischemic stroke patient with tPA before permanent brain damage occurs to the brain; approximately three to four hours. This time frame includes the patient recognizing the symptoms, calling 911, getting to the hospital and having the evaluation to decide if the patient is a candidate for tPA. Time is critical out in the field and home when we the public must understand and recognize what a stroke is and call 911 if we are to save someone’s life!
Stroke is the fourth leading cause of death in the United States. In 2010 strokes killed more than 130,000 people in the United States under the age of 75 years. One in every 18 deaths are attributable to stroke. Over 700,00 people have a new or recurrent stroke annually. Some 20 to 30 percent of these individuals are permanently disabled and 30 percent require at least short-term institutionalization. Though more than 80 percent of strokes are of the ischemic type where tPA may be an option, according to the Center for Disease Control (CDC), in 2005 more than 50 percent of stroke victims never reached the hospital in time to receive this medicine.
Strokes cost the U.S. health-care system more than $86.7 billon annually including health-care services, medications and lost days of work.
The CDC website discusses risk factors for strokes. Medical conditions, behavior and hereditary factors all contribute to stroke disease. High blood pressure, high cholesterol, diabetes, heart disease, being overweight or obese, a prior history of stroke or transient ischemic attack, all increase the risk of stroke in an individual. Tobacco use damages blood vessels and causes hardening of the arteries. Excessive alcohol contributes to high blood pressure and hardening of the arteries as well. Physical inactivity places an individual at risk for high blood pressure, cholesterol, obesity and diabetes.
What are the signs of a stroke?
Found at the Stroke Association website, strokeassociation.org:
Five cardinal signs and symptoms of stroke include:
• Sudden numbness or weakness of the leg
• Sudden confusion or trouble understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause
A simple pneumonic that summarizes the salient points of stroke is:
F acial droop
A rm weakness
S peech difficulty
T ime: 911
Naturally, the best prevention of a stroke beyond early recognition and intervention is prevention. Exercise, diet (maybe the Mediterranean diet in particular), smoking cessation and blood pressure management are key to prevention.
Please, if you think someone is having a stroke act F.A.S.T.
More information may be found at strokeassociation.org or www.cdc.gov/stroke/.
Dr. Teresa Liccardi, who is board certified in internal medicine and nephrology, maintains a clinic for hypertension and chronic kidney disease at the Parker Family Health Center in Red Bank.