Stroke symptoms usually develop suddenly and without warning, or they may occur on and off for a day or two.
Stroke victims need to be treated as soon as possible. One of the most important treatments loses effectiveness if not administered within three to four hours of stroke onset. Therefore it's crucial to call 911 immediately if you suspect you or someone else is having a stroke. Although stroke treatment and rates of good outcome have improved dramatically over the past decade, timing is essential.
"Wait-and-see should not be a part of the decision process," says Edward C. Jauch, M.D., of the Medical University of South Carolina. Some stroke victims may not be aware of their symptoms or may be unable to communicate, adds Jauch, lead author of the 2013 American Heart Association Acute Ischemic Stroke Guidelines.
Two kinds of stroke
About 87 percent of all strokes are "ischemic," and occur when a blood clot blocks a blood vessel in the brain or an artery to the brain. If administered in time, a clot-busting treatments and intra-arterial catheter-based therapies using new “stent retrievers” can help reduce the damage from this kind of stroke, so getting treatment quickly is absolutely critical. There are now two strategies to remove the stroke causing clot, says Walter Koroshetz, M.D., Director, National Institute of Neurological Disorders and Stroke. The drug, tPA, is given by injection and has been shown effective in dissolving clots and improving outcome if given within three to four hours after stroke onset. In people with clots blocking the larger brain arteries, a specialist can pass a catheter into the blocked brain artery and remove the clot. This procedure has been shown effective if performed within six hours after stroke in patients who did not respond to tPA.
The second type of stroke is "hemorrhagic," and occurs when a blood vessel in the brain breaks, causing bleeding in the brain. These strokes generally need to be treated in intensive care and may require surgery.
A ministroke, or "transient ischemic attack," is caused when blood to the brain is temporarily disrupted. Symptoms, the same as for major strokes, last for only an hour or so, then vanish.
Recognizing and treating TIAs immediately can reduce your risk of a major stroke. “Call 911 or go immediately to a hospital because it can signal that a full-blown stroke is imminent — maybe just hours away. It’s unpredictable,” says Koroshetz.
Treatment might include blood thinners to combat clotting, surgery to clear a blocked artery or treatment plans for underlying disorders, such as high blood pressure, high cholesterol, heart disease and diabetes.
Strokes are the fifth-leading cause of death in the United States — according to the Centers for Disease Control and Prevention — and a major cause of long-term disability, so knowing the symptoms is important.
Call 911 when one or more of these sudden symptoms occur:
- Numbness or weakness of the limbs or face, especially on one side of the body
- Facial paralysis (one side droops, drooling)
- Trouble speaking or understanding speech
- Mental confusion
- Vision problems
- Dizziness, difficulty walking
- Extremely painful headache
If you think someone is having a stroke:
- Call 911
- Do not give aspirin, which thins the blood. Without knowing which kind of stroke is occurring, taking aspirin could cause more damage, says Larry B. Goldstein, M.D., Chairman of Neurology and Co-Director of the Kentucky Neuroscience Institute at the University of Kentucky.
- Try to get the person to sit or lie down to prevent a fall
- Check that the person's airways are clear
- Do not give water or food — the stroke victim could choke
- Write down when symptoms first appear to help the medical staff assess treatment
Reduce your stroke risk
Prevention does make a difference. There’s been a 40 percent decrease in the number of strokes in adults 65 and older from 1988 to 2008, according to a recent study published in The American Journal of Medicine. Many risk factors for stroke are treatable, says Goldstein. "If you make these lifestyle changes, you reduce your stroke risk by 85 percent."
- Stop smoking
- Lower your cholesterol
- Lower your blood pressure
- Manage diabetes
- Don't abuse alcohol
- Maintain proper weight
- Exercise regularly
- Eat three to five servings of fruit and vegetables daily
- Reduce daily salt consumption to 1,500 mg
- Have your blood pressure checked regularly
You're at higher risk for stroke if you:
- Are African American
- Are male
- Have a close relative who had a stroke before age 65
- Are older: Stroke risk doubles for every decade after age 50
- Have already had a stroke. "You are at 10 times higher risk of having a stroke if you've already had one," says Goldstein.
Beth Levine is a freelance writer who lives in Stamford, Conn.
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