The phrase “time is brain” is often used by health experts to emphasize the need to act immediately when a stroke is suspected. That is because with each tick of the clock chances of severe and potentially permanent brain damage increase and so does the risk of death. According to the American Stroke Association, every 40 seconds someone in the United States has a stroke.
What you do and don’t do impacts survival and the degree of recovery.
A stroke inhibits normal blood flow to the brain. If blood flow is interrupted for more than a few seconds, neurons (brain cells) begin to malfunction. If flow is not restored quickly, neurons begin to die.
“The brain depends on a continuous supply of blood. It delivers oxygen, nutrients, and glucose, and carries waste products away from the brain,” explains Jeffrey Saver, MD, director of the UCLA Comprehensive Stroke Center in a recent UCLA video. “If something goes wrong with this circulation system, the brain will be injured.”
Knowing what caused the disruption in blood flow is critical in properly treating this medical emergency.
Stroke Types
The two main categories of stroke are ischemic and hemorrhagic. The former is a blocked artery problem, while the latter results from bleeding in the brain, usually caused by a ruptured blood vessel. The vast majority of strokes (about 87 percent) are ischemic. These are typically caused when an artery leading to the brain has been blocked. Sometimes ischemic strokes can happen from a severe drop in blood pressure, but that’s rare.
It’s also worth being aware of what’s called a transient ischemic attack (TIA). This event is sometimes called a mini stroke and occurs when a blood clot briefly blocks an artery. The American Stroke Association says the key difference between a stroke and a TIA is that with a TIA the blockage is temporary. TIA symptoms occur rapidly and last a relatively short time. Unlike a stroke, when a TIA is over, there’s no permanent injury to the brain. But a TIA raises the risk for a stroke occurring within the next 90 days. There’s no way to tell in the moment if stroke symptoms are due to a TIA or a major stroke.
Stroke Symptoms
“Stroke can cause many different symptoms because whatever the brain does can go wrong in stroke,” explains Dr. Saver. “But there are three common symptoms to be aware of. They are drooping of the face on one side, arm weakness on one side, and speech difficulty, including trouble speaking, slurred speech, or incorrect speech.”
Upon recognizing symptoms, it might be tempting to call a doctor to first verify that it is indeed a stroke, or to just drive yourself or someone else to the emergency department. Don’t do either. Remember, time lost is brain lost. Emergency personnel are trained to recognize a stroke and can begin interventions while en route to the hospital. Arriving to the hospital via ambulance also bypasses the ER check-in required if you walk in, which saves even more precious time. Remember, speed is of the essence and may make the difference between a lasting disability and a partial or perhaps complete recovery.
Life-Changing Disabilities
It’s estimated that one in six people will have a stroke in his or her lifetime. Though anyone can experience a stroke, even babies, older age increases the risk for both men and women. Stroke treatments have improved survival rates, but unfortunately many survivors are disabled and require care in nursing homes or long-term care facilities. Stroke reduces mobility in more than half of stroke survivors ages 65 and over. And only 10 percent of stroke survivors recover completely. The more encouraging news is that the most common type of stroke, ischemic, can in large part be prevented.
Preventing Strokes
Steps to improve heart health also improve brain health and lower the risk of stroke. About 90 percent of people who have had a stroke have one or more of the following risk factors: Hypertension (high blood pressure) is the most common risk factor, followed by high cholesterol and/or high triglyceride levels, and diabetes. Smoking, obesity, and sedentary lifestyles also are contributing risk factors that you can do something about.
Lowering blood pressure. Hypertension is the single most important modifiable risk factor for stroke prevention. People with a systolic (top number) of 160 millimeters of mercury (mmHg) or greater and a diastolic (bottom number) of 95 mmHg or greater have four times the risk of stroke compared to someone with optimal blood pressure. Optimal blood pressure is 120/80 mmHg, though for some older adults a bit higher readings may be allowable—ask your doctor. To keep your blood pressure at healthy levels, take medications as prescribed, even if you feel fine. Hypertension is called a “silent killer” because you may not feel it as it causes damage. Regular exercise and cutting back on sodium can also help regulate blood levels.
Lowering cholesterol. As with hypertension, it’s important to take medications as prescribed. Eating foods low in saturated fats and cholesterol and high in fiber can help prevent high cholesterol, and possibly lower elevated levels.
Managing diabetes. Type 2 diabetes, the most common kind, also can be addressed through lifestyle choices and medications. In some cases, losing weight and becoming more active may eliminate the need for medications.
Losing weight. The battle of the bulge is mainly lost and won through diet. Learning to prepare healthy meals at home is the ideal way to control what you put in your body. The Mediterranean diet emphasizes heart-healthy fruits, vegetables, olive oil, and fish. Oldways (oldwayspt.org) is a nonprofit website offering a wide variety of Mediterranean meal plans.
Being active. Exercise is excellent medicine and helps with all the aforementioned health issues. The type of activity doesn’t matter. What does matter is that you do it, and do it consistently. It’s important to get 30 minutes of cardiovascular (a.k.a. aerobic) exercise most days of the week. It’s any activity that elevates your heart rate. If you’re not used to exercise, get some guidelines from a health professional before you begin. Give any new plan a few weeks for the workout habit to form. Once you get in the groove, you’ll start to feel better—more energy, less stress, and possibly some weight loss are all benefits of regular physical activity.
Finally, some people may wonder what to do while waiting for an ambulance to arrive for a person suspected of having a stroke. For example, should you give someone an aspirin?
“No,” says Dr. Saver. “Though aspirin might help the most common type of stroke, the blockage (ischemic), it could make the less common bleeding stroke (hemorrhagic) worse. Without a CT scan we don’t know which stroke is taking place.”
He recommends having the affected person lie down. Wait with them until help arrives. To view Dr. Saver’s excellent video on stroke prevention and treatment, go to this link https://bit.ly/30A92KR.
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