Recognize Stroke FAST

A stroke also called a brain attack or medically as a Cerebro-vascular accident represents the third leading cause of death in the United States, behind heart attacks and cancer. It occurs when blood flow to the brain is interrupted. If prolonged, it can lead to lack of oxygen supply to the brain tissues which results in irreversible brain damage.

There are 2 ways in which stroke can occur:

  • By blockage in the arteries supplying blood to the brain. This can occur over a period of time from chronic illnesses like high cholesterol, diabetes and high blood pressure. It can also occur when blood clots break free from other blood vessels or the heart and travel and lodge in the blood vessels of the brain (known in medical terms as emboli).
  • By rupture and bleeding of any blood vessel in the brain.

It is hard to identify for sure what kind of stroke the person is having unless they are hospitalized and CT and/or MRI scans are performed. The signs and symptoms of stroke varies based on which part of the brain is affected. Unless recognized quickly and treated, a stroke can cause permanent brain damage. It is very easy for all of us to remember the signs and symptoms commonly seen in stroke by remembering the mnemonic “FAST”.

f1Ask the person to smile, there maybe weakness and drooping of the muscles on one side of the face.

f2 Weakness and numbness in the affected arm. Ask the person to raise both arms, the patient cannot hold the affected arm high enough due to the weakness.

f3 Ask the person to speak a simple sentence, the speech may be slurred or distorted.

f4 The outcome of the stroke is dependent on how quickly the treatment is given from the time of its occurrence. The brain damage can be stopped or reversed if it is treated early enough. Act FAST and call 911 or your local emergency number right away!

A Mini stroke, also known as Transient Ischaemic Attacks (TIA) is an episode of temporary brain dysfunction caused by impaired blood flow to the brain. Symptoms are similar to stroke and include numbness, paralysis or weakness in one side of the body; difficulty understanding speech or distorted speech; headache or sudden loss of vision. The onset of symptoms are very sudden and last less than one hour. Most TIA’s last less than 10 minutes. There is no residual damage to the brain tissues and even if there is, it is less extensive than in stroke. Even though the symptoms are temporary, the person is not out of danger. About one third of the patients with a mini-stroke develop a full blown stroke, some within the next 2 days! TIA’s should be considered an emergency in spite of its transient symptoms and the person should visit the emergency room immediately.

Risk factors in stroke

  • Family history of stroke
  • Age 55 years and older.
  • Prior stroke, mini-stroke or Heart disease – increases the risk of having a stroke manifold than a person who has not had any of these conditions before.

The preventable risks for developing a stroke are:

  • High blood pressure (Hypertension) – It is the leading cause of stroke. High blood pressure causes stiffening of the walls of the blood vessels and leads to damage.Even mildly increased blood pressure can increase your risk of stroke. High blood pressure should be controlled with appropriate medications.
  • Cigarette smoking – The smoke from cigarettes damages blood vessels, raises the blood pressure and makes the blood to clot. People who inhale second hand smoke are at equal risk as the smokers. Smoking along with the use of oral contraceptives increases the risk greatly.
  • Diabetes – The high blood sugar in uncontrolled diabetes causes blood vessel damage again and increases the risk of stroke. Diabetics should maintain normal blood glucose levels by following their physician’s advice and taking appropriate medications.
  • High cholesterol – A value of above 200 mg/dl (milligrams per deci-liter) increases plaque formation (fatty deposits) in the arteries leading to higher incidences of stroke.
  • Obesity – Obese and overweight individuals have a high risk of developing stroke due to the presence of co-morbidities like diabetes and hypertension.

Treatment

Stroke is a serious medical emergency and the outcome depends on how quickly it is recognized and treatment administered. Brain cells begin to die within 4 minutes of having a stroke due to the lack of oxygen supply. In case of stroke caused by a blocked artery, drugs like tissue Plasminogen activator (t-PA) which break down the clot and restore the blood flow again are given. This is effective when given within 3 hours of having the stroke. Anti-hypertensive medications may be prescribed to bring the blood pressure back to normal in patients with high blood pressure. Drugs like Warfarin, Aspirin et cetera which prevent clot formation and hence reduce the recurrence of future strokes may be administered after a complete evaluation of the patient. Strokes caused by haemorrhage (bleeding into the brain) usually require surgical intervention to relieve the pressure inside the skull as a result of the bleeding and to repair any abnormal blood vessel which lead to the rupture and bleeding in the first place.

Prevention

Our risk for developing stroke is greatly reduced when we make healthy lifestyle choices.

  • Regular medical check-ups – If you already suffer from any disease which increases the risk of stroke, get regular medical checkups to see if everything is under control. Get your blood pressure checked regularly and work with your doctor to reduce it with medications and adopting healthy habits. Control your blood sugar levels with the proper medications, diet and exercise. Control heart disease, and high cholesterol.
  • Diet – Choose foods high in fibre like fruits and vegetables and lower intake of foods high in saturated fats and cholesterol. Foods like egg yolk and organ meats contain cholesterol. Saturated fats are found in beef, pork, lamb, and whole milk products. If diet and exercise alone are not able to bring the blood cholesterol levels down, speak to your doctor about cholesterol lowering drugs. Avoid salt and highly processed foods which increase the blood pressure. Eat whole grains which help to maintain healthy blood sugar levels.
  • Exercise – Regular physical activity improves blood circulation.Being active for atleast 30 minutes a day, 5-6 days a week reduces the risk significantly. Exercises which raise the heart rate strengthen the heart muscle.
  • Maintain a healthy weight – Through regular exercise and healthy eating habits. See my article on preventing Obesity for more information
  • Quit smoking
  • Avoid heavy alcohol consumption – Binge and heavy drinking increases the risk for having a stroke.
  • Avoid use of illegal drugs – Street drugs like cocaine and methamphetamine raise stroke risk by increasing the blood pressure and causing the heart to beat rapidly and out of rhythm.

Care and Support for Stroke Victims

When stroke strikes it can affect the individual with a sense of hopelessness and despair. Post stroke depression is common and it is essential for friends and family to be understanding and supportive. Seek the help of a psychiatrist to overcome depression. It is important to slowly get back to doing day to day activities though it takes some time and effort to do so. Physiotherapy helps in exercising the paralyzed/weakened muscles and prevents contractions. Staying connected with your social circle and involving oneself in social activities help to overcome the challenges faced with stroke.