Managing Risk Factors and Early Intervention Can Lessen Stroke Impact

When it comes to effective stroke care, time is truly of the essence, says Harold Adams, MD, director of the Stroke Clinic at UI Hospitals and Clinics and professor of neurology in the University of Iowa Roy J. and Lucille A. Carver College of Medicine.

"The longer without intervention the stroke goes, the more brain injury there is and the greater likelihood of severe residuals and an unhappy outcome," Adams says. "Time-to-treatment is critical. Don't wait for the symptoms to go away, call 911 and get to the hospital."

Adams also stresses that this is a message for everyone. Not only will about 750,000 Americans have a stroke this year--stroke is the third-leading cause of death and a leading cause of disability--but the condition also has an enormous impact on the lives of family members of people who have strokes both in terms of emotional and economic demands.

"There is nothing like a stroke to change the life of the person who has it and to change the lives of the family of a person who has a stroke," Adams says.

Early treatment starts with someone recognizing the stroke symptoms and getting the person having a stroke to the emergency room as quickly as possible. However, stroke affects the brain and often the person having the stroke is not thinking well and does not recognize that there is a problem. Ensuring that a person having a stroke receives the rapid medical intervention that might minimize the damage often falls to people around that individual--family or co-workers--who need to understand what is going on and get the individual to the emergency room.

Symptoms

The usual symptoms of strokes include:

  • Sudden onset of some sort of neurological problem
  • Transient loss of vision in one eye
  • An episode where part of the body becomes numb, heavy or clumsy
  • Paralysis or sagging of one side of the face
  • Slurred speech or speech that doesnt make sense
  • Weakness and numbness is usually confined to one side of the body
  • In the first few hours following a stroke, the goal is to treat the stroke such that the patient largely recovers, thus lowering the risk of complications, eliminating the need for rehabilitation and providing an opportunity to start treatments that help lower the risk of recurrent stroke.
  • About 80 percent of strokes are associated with a blood clot blocking an artery and depriving part of the brain of an adequate blood supply. This type of stroke is called ischemic stroke or infarction.

For patients who have an acute ischemic stroke, the opportunity to limit the neurological damage is very time sensitive. In particular, if a clot-busting drug, which has been available for about eight years, can be given to the patient within three hours of the stroke onset this can limit the extent of brain damage and can lead to good recovery.

Although a devastating ischemic stroke can happen without warning, some patients will have a warning sign in the form of a transient ischemic attack (TIA). The difference between a TIA, sometimes known as a mini-stroke, and a full-blown stroke is that TIAs generally resolve themselves without causing substantial or permanent brain damage. However, a TIA is a warning of an impending stroke and intervention needs to be moved forward rapidly.

Interventions

Interventions that can help to prevent ischemic stroke in people who have warning signs include blood-thinning medications such as aspirin and warfarin and surgical procedures like carotid endarterectomy (removing a narrow portion of the artery) and angioplasty (stenting).

Around 20 percent of strokes are due to a ruptured blood vessel causing bleeding into or around the brain, so-called intracerebral or subarachnoid hemorrhages. These types of stroke require different treatment and generally have a poorer outcome than ischemic stroke.

In general, the causes and symptoms of stroke are the same in men and women. Although stroke affects both genders, men are generally more likely to have a stroke than women. However, because women have a longer life expectancy than men, the majority of strokes and stroke deaths occur in women. In the United States, two women die of stroke for every woman who dies of breast cancer.

"Advanced age is one of a number of factors that increases a person's risk of having a stroke. The older you are, the higher your risk," Adams says.

Adams adds that the number of older people who are more likely to have a stroke will increase substantially over the next 25 to 30 years and as this at-risk population grows, the number of strokes also will grow. This means that stroke represents a growing and significant public health problem especially in states like Iowa, which have a high proportion of older residents.

In addition to advanced age, the risk factors that predispose people to stroke are the same as those for heart disease: hypertension (high blood pressure), diabetes, cholesterol problems and smoking. Among these risk factors, hypertension is the most important, and improvements in the management of high blood pressure are behind the decline in stroke incidence seen over the latter part of the 20th century.

Adams notes that an increasingly important part of stroke management will be identifying people at risk for stroke and treating or controlling their risk factors.

"That is why there is such an important public health component to managing stroke," Adams says. "Getting blood pressure under control, losing weight, controlling diabetes, controlling cholesterol via cholesterol-lowering medications and stopping smoking all lower the risk of stroke as well as heart attack."

Although it is not possible to guarantee a good outcome for all patients, Adams believes that advances in understanding and treating the underlying causes of stroke and the availability of newer drugs to treat acute strokes, and improvements in stroke rehabilitation protocols means that a stroke need not be the devastating event that it has long been considered.

University of Iowa Health Science Relations and
Harold Adams, MD
Professor of Neurology