Stroke

woman in hosptial

Did You Know That…  Sharon Stone had a stroke?  She has been open about the experience and has become an advocate, educating everyone on recognizing a stroke and immediately getting medical care.  In 2017 she chaired the Women’s Brain Health Initiative in Beverly Hills.  She was only 43 when it happened and at that time did not think she had any health concerns.  She had starred in movies that made her famous, like Basic Instinct and Casino.  While she had no obvious medical risk factors, her life was miserably stressful, with a bad marriage and child custody battle.  The stroke hit her in September, 2001.  That fateful afternoon she was in her home in San Francisco.  As she describes it, she had a “lightning bolt” pain in her head so powerful and shocking that she fell to the floor, unconscious on the carpet.  When she came to, she was confused with a throbbing headache.  So confused that she didn’t think to call 911.  She tried to drive and couldn’t.  She did not get to the ER for three days, too long, too late for the scanners to detect the hemorrhage clearly.  Her stroke was not a blockage type stroke, that is, not the better one to treat.  It was a bleed, hemorrhaging from a ruptured vertebral artery.  As you’ll learn below, bleeds are much harder to treat.  Finally the angiogram showed the bleed, the surgeons did their best with an endovascular procedure, but much brain damage and cell death had occurred.  She was in intensive care for nine days.  She found herself in a two-year hellish struggle to talk again, to walk again, to read again.  The rehabilitation toward recovery was torture.  She no longer frets about her age.  These many years later she’s just grateful for the opportunity to grow older.

Articles related to Stroke:

Call 911

Calling 911 is the main take away from this page.  The TV ads showing a snake wrapping around a person’s leg or a woman’s hair on fire are exactly on target in terms of the need for urgency if stroke treatment is going to work.  If you think someone has just had a stroke call 911.  This 911 call needs to be immediate, with no hesitation, no lost time.  The person having a stroke needs to get to the nearest Specialized Stroke Center Emergency Department as quickly as possible.  Those first minutes are unbelievably valuable and can make the difference between saving their brain or having their brain die, between life and death.

Strokes Are Rarely a Surprise

There is a belief that strokes are a surprise to people.  Most people feel that strokes come out of the blue, as in Sharon Stone’s situation above.  You’re fine one day and boom, the next day you’ve had a stroke and you’re medically and neurologically in trouble.  People tend to think it’s just bad luck.  Maybe you’ll be lucky and have a complete recovery, perhaps with some physical therapy help.  Or, sadly, you could be permanently disabled.  Or worse yet, dead.

In 2019 it’s rarely really true that strokes come out of the blue.  At times a stroke is a surprise, but seldom.  Long-term smoldering health problems are usually behind the “sudden” stroke, with 85% of strokes due to high blood pressure, hypertension, that has gone untreated for years.  Have your blood pressure checked and, if high, get it treated, and you’ll dodge 85% of the probability of a stroke.  Same story with cholesterol and other blood fats, smoking, and diabetes.  More on prevention below.

A Story

We at the NeuroSci R&D Consultancy care a lot, maybe even worry a lot, about stroke.  Let us tell you a story.  Stroke is personal for one of our company officers.  Both of his grandfathers died of a stroke at age 73.  His uncle was severely and permanently disabled by a stroke at age 45, and when he died years later he was deaf and blind.  It was an era before medical science knew about the hypertension/stroke link and before doctors could readily diagnose and treat hypertension.  His father started battling, successfully battling, high blood pressure at age 40.  He lived to be 96, a healthy, clear-minded, and happy 96.  Treating hypertension really does make a huge difference.  It works.

Kinds of Strokes

Broadly, there are 2 kinds of strokes.  At least for right now let’s stay with the 2 main kinds.  One kind is blood vessel blockage, a clot, called a thrombus or embolus (see further explanation below).  A blood vessel somewhere in the brain becomes blocked and the blood can’t flow.  The other kind is a bleed, a hemorrhage, like Sharon Stone suffered.  A blood vessel bursts and bleeds inside the brain, into the brain.  Blood flows out of the vessel into the brain tissue, and the oxygen the blood was carrying does not make it to the brain areas where it was supposed to go, where it was needed.  With either a blockage or a hemorrhage a part of the brain becomes oxygen-starved.  All brain areas and circuits need oxygen minute-by-minute continuously to stay alive.  Just few minutes without oxygen kills brain cells, brain tissue.

Well, Actually, A Couple More Types of Strokes

The strokes caused by a thrombus or embolus can be further divided into two types.  One type is a blockage where the blood clotted right in the vessel where it was flowing, a thrombus.  The other type of blockage occurs when the blood clot occurs at a more distant, more peripheral, part of the body.  A piece of this peripheral clot breaks off and travels through the blood vessel until it lodges in a vessel in the brain, an embolus. 

In addition, there are two types of hemorrhagic strokes, but for now we’ll stop adding types of strokes.  It can get confusing.

Why the Signs of a Stroke Appear the Way They Do

Each specific area of the brain is connected to several specific parts of the body.  One small area in your brain (the left motor cortex) makes your right leg move.  Another little part lets your left hand feel sensations.  And so on.  Every part of your body is electrically connected by nerves into some area of your brain.  So, what a stroke looks like or feels like depends on which small (or large) areas of the brain are dying.  You might feel a sudden weakness or paralysis of your arm and leg on one side of the body, or just an arm or just a leg, or part of the face.  Your speaking, your words, might become hard to say or make no sense.  Or, the people around the person having a stroke might see that the person having the stoke looks confused.  Or that they cannot understand the conversation.  Their vision might go bad or they might be suddenly blind in one eye, or both eyes.

Strokes Are Common

Strokes are common.  In fact, they are too common.  There’s nothing unusual or rare about a stroke.  In every country around the world stroke is a major cause of disability.  And a major cause of death.  Of the millions of people worldwide who have a stroke, a 1 out of 3 die and another 1 out of 3 are left permanently disabled.

What Causes Strokes and How to Prevent Them

Preventing strokes is by far the better way to go.  In stroke medicine, an ounce of prevention is worth many pounds of cure.  This is true because strokes are hard to treat, and some just can’t be treated.  Once they occur the damage is done, brain damage, disability damage, death damage.  Those that can be treated must be treated immediately.  And with treating strokes, luck does becomes involved.  How far away is the nearest Specialized Stroke Center Emergency Department?  How quickly can Emergency Medical Services get to the stroke victim?  How quickly can the EMS personnel get the stroke victim to the correct emergency department?  How soon after the stroke event did someone call 911 to get this cascade of help started?  As the saying goes, “It’s complicated!”

Getting stroke treated involves an element of luck.  Preventing stroke is much more of a sure thing, more within your ability to control.

Beating Hypertension

High blood pressure causes 85% of strokes.  So, see your health care professional and have your blood pressure checked.  You can use the blood pressure machine in your grocery or drug store, but don’t rely on just these public machines.  Often these store machines are rarely calibrated and are not accurate.  See your health care provider.  If she/he says your blood pressure is high, get a prescription from her for the medication to treat it.  And then take the medication.  We mean, really, take it.  It’s amazing how many people get the hypertension medication and then don’t take it.  Don’t think you don’t need the medication because you feel fine.  You don’t feel high blood pressure.  It’s called a silent killer.  There are no symptoms.  What usually happens is that the person feels fine then suddenly has a stroke.  No warning.  And about one-third of them die.

Smoking

Don’t smoke.  It really is that simple.  Smoking cigarettes, cigars, or a pipe damages blood vessels.  The plumbing goes from nice, solid, like-new pipes to rusty, corroded pipes ready to burst at any time.  (The proverbial “jury is still out” on vaping.  It certainly does much less damage than any kind of combustible smoking.  But, is the inhaled nicotine itself, or other components of the vaping solution, a risk factor?)  Smoking, in addition to aging your plumbing, also gives a person high blood pressure.  The trouble is, the nicotine from smoking feels like it treats a down mood.  And, nicotine is addictive.  If your mood is too down without smoking ask your health care provider for a medication for depression.  If you’re not depressed and can’t stop smoking, you’re addicted to nicotine.  Find a safer source for nicotine.  Smoking is the most dangerous way to get nicotine.  Stop smoking and use nicotine patches.  Or, stop smoking and chew nicotine gum.  Or, stop smoking and start vaping (electronic “cigarettes”).  Do whatever, but stop smoking.  It might not feel like the best answer to you, but you’ve got to stop smoking.

When our CEO was treating patients at Scripps Clinic, an elder gentleman from Montana came to see him.  He said that it was so obvious that smoking was shortening the lifespan of his siblings.  His parents and their siblings, his aunts and uncles, all lived into their mid-90s, ranchers in Montana.  None of them smoked.  His siblings and cousins were all smokers.  And they were all, one by one, dying in their early 70s.  Story told and message clear, from his point of view.  He had stopped smoking.

Those Fats in Your Blood

LDL Cholesterol, triglycerides, the fats (lipids) floating in your blood.  While your health care provider is checking your blood pressure, have her draw some blood to measure your cholesterol.  High cholesterol causes atherosclerosis, another way to ruin the plumbing of your blood vessels, weaken the walls, and set everything up for a stroke.  If your cholesterol is high, there are now great medications to treat it.  Get a prescription, get the medication, and take it.

The Sugar in Your Blood

Type II diabetes, or high blood sugar.  If lifestyle changes (healthy foods, exercise) aren’t enough to bring your blood sugar down, ask your health care provider for a medication for the diabetes and take it.  And get checked for “pre-diabetes”.  There are now tests and medical history that can provide a likelihood of becoming diabetic in the future.  It’s easier to prevent than to treat.  You might be able to “dodge the bullet” altogether.

Are You Healthy?

If so, great.  If not, do whatever you need to do to become healthier to help prevent strokes.  Eat healthy foods.  Emphasize vegetables and fruits, balance the diet out with whole grain breads and cereals, healthy proteins (fish, chicken), and healthy oils (olive oil, canola oil).

And exercise.  Get yourself moving.  Any exercise, physically getting in gear and getting going, is better than sedentary.  Walk.  When going up two or down three floors in a building, take stairs rather than just hopping on an elevator and pushing a button.  Swim.  Bicycle.  If you can and want to do more, go for it.  But while you’re procrastinating, while you’re thinking about it, about what to do, about how to start, take a walk.

A Bit if Medical History – 4000 Years of Stroke

Physicians in ancient times recorded episodes of people having strokes as long as 4000 years ago.  These reports were in the geographic areas with curiosity and advanced knowledge about medicine, Persia and the various countries that comprise Mesopotamia.  The Greek physician Hippocrates, who seemed to be the first great Western civilization physician, recorded the sudden paralysis caused by stroke about 2400 years ago.  The term he used was apoplexy, meaning struck down with violence.  The word “stroke” was first used about 300 years ago.

Helpful links:

National Institutes of Health, National Institute on Aging

https://www.nia.nih.gov/health/stroke

National Institutes of Health, National Institute of Neurological Disease and Stroke

https://www.ninds.nih.gov/Disorders/All-Disorders/Stroke-Information-Page

National Institutes of Health, National Heart, Lung, and Blood Institute

https://www.nhlbi.nih.gov/health-topics/stroke

National Library of Medicine (United States), Medline Plus

https://medlineplus.gov/ency/article/000726.htm

Center for Disease Control and Prevention (CDC)

https://www.cdc.gov/stroke/index.htm

National Stroke Association

http://www.stroke.org/

The Mayo Clinic

https://www.mayoclinic.org/diseases-conditions/stroke/symptoms-causes/syc-20350113