Every second, a person in the world suffers a devastating stroke. In the U.S. alone, approximately 700,000 people experience a stroke annually.
The good news: There are 5.7 million stroke survivors in this country, due in part to advanced training of doctors and nurses, improvements in medical technology and medication and awareness in the general public of the signs and symptoms of stroke that allow for immediate treatment.
Elaine Siwiec, neurology nurse clinician at Northern Michigan Regional Hospital, offered insight into the causes of stroke, risk factors and treatment options, in a Q&A with the News-Review.
PNR: How does a person know if they are having a stroke?
Siwiec: You need to be familiar with the signs and symptoms of stroke. (They include) sudden onset of numbness or weakness of the face, arm or leg on one side; confusion, trouble speaking or understanding; trouble seeing in one or both eyes; trouble walking, dizziness, loss of balance or coordination; and severe headache with no known cause.
Because this is a lot to remember, we teach the Quick Check for Stroke:
F = Facial droop — have the person smile
A = Arm drift — have the person extend their arms and look for a drift
S = Speech abnormal — have the person say something and listen for slurred speech, not using the right words or not speaking at all
T = Time to call 9-1-1.
It is important to recognize symptoms of stroke quickly since the brain ages 3.6 years each hour without treatment.
PNR: Who is most likely to be affected by stroke?
Siwiec: Stroke is more prevalent in blacks (6.8 percent) than whites (2.9 percent) or other races (3.9 percent).
A higher percentage of females reported having had a stroke than males, 3.8 percent and 3.1 percent, respectively. (Statistics from the Michigan Department of Community Health, 2008 report.)
To not understate the problem, each year about 700,000 people experience a new or recurrent stroke. Every 53 seconds, or about every minute, someone in the United States experiences a stroke, and every 3.3 minutes, someone dies of a stroke.
PNR: What are the top risk factors? Can a healthy person, too, have a stroke?
Siwiec: High blood pressure is the number one risk factor for both types of stroke (hemorrhagic or bleeding type and ischemic or type caused by a blockage in a blood vessel supplying blood and oxygen to the brain). High blood pressure, also known as hypertension, results in hardening of arteries that supply the body’s organs with oxygen and nutrient-rich blood.
More risk factors:
Cigarette smoking;
Physical inactivity;
Too much alcohol;
High blood cholesterol;
Obesity and being overweight.
Although it is much less likely, yes, occasionally healthy people have strokes.
PNR: If you lose an ability after a stroke — paralysis, speech impairment — is it possible to regain through therapy or will there likely always be a limitation?
Siwiec: Yes, it is very possible to regain function after a stroke. We used to think that all recovery occurred within the first three months after a stroke. We now know that is not true and recovery can take weeks to months to even years. Even so, stroke is the number one cause of long-term disability in the United States.
PNR: Is there any way to predict stroke?
Siwiec: There really is no way to know if a stroke is going to occur before the symptoms start. However, even though there are some risk factors that cannot be modified such as age, race, sex and family history, there are a number of things we can do to reduce our risk of stroke:
If you smoke, quit.
If you drink alcohol, do so in moderation — no more than one alcoholic drink a day. Remember alcohol is a drug and as such can interact with other drugs. If you don’t drink alcohol, don’t start.
Include exercise in your daily routine. Even a little bit of exercise — a brisk walk, bicycle ride, swim or yard work — can make a difference. Adults should engage in moderate-intensity physical activities for at least 30 minutes on five or more days each week, according to the Centers for Disease Control. Before you start a vigorous exercise program, be sure to check with your doctor.
If your blood pressure is high, work with your doctor to control it.
PNR: Explain how the clot-busting drug works, the time frame for its administration and why it is critical. Can it “reverse” a stroke and its damage?
Siwiec: In 1996, the FDA approved the drug t-PA that can reverse the effects of a stroke caused by a blocked blood vessel (ischemic). The drug must be given within three hours of onset.
Many people ignore the symptoms and don’t get to an emergency room in time to receive the medication.
TPA works by dissolving the clot which has blocked the artery causing the stroke and hence blood is re-supplied to the brain before nerve cell death has occurred. It can result in miraculous recoveries in many patients, but not necessarily all.
Although the drug can be given up to three hours after onset of symptoms, the sooner you get it the better your chances for improvement. Also, many tests have to be performed before administering the TPA, so showing up at the ER at three hours would actually be too late.
PNR: How is Northern Michigan Regional Hospital a leader in stroke treatment and patient care?
Siwiec: NMRH earned re-certification or the Gold Seal of Approval from The Joint Commission as a Primary Stroke Center. The Joint Commission’s Certificate of Distinction for Primary Stroke Centers recognizes centers that make exceptional efforts to foster better outcomes for stroke care.
Achievement of certification signifies that the services provided have the critical elements to achieve long-term success in improving outcomes.
PNR: Any final thoughts for people to remember about stroke?
Siwiec: Transient ischemic attack, or TIA, is sometimes referred to as a mini-stroke. You experience the symptoms of a stroke, but the symptoms last a few minutes to no longer than 24 hours. It is a warning that you are at high risk for a stroke, so:
T = Take
I = Immediate
A = Action
Don’t ignore your symptoms.
Stroke defined
A stroke is sometimes thought of as a “brain attack.” A stroke occurs when a blood vessel or vessels that carry oxygen and other nutrients to a specific area of the brain become blocked or suddenly burst. This interrupts blood flow to the brain and prevents oxygen from getting to where it’s needed. When the oxygen supply is cut off, brain cells begin to die resulting in change or loss of abilities or functions controlled by those cells in the brain.
There are two types of stroke — ischemic (iz-KEE-mik) and hemorrhagic.
About 87 percent of all strokes are ischemic, caused by too little blood supply because of a blood clot in an artery leading to the brain.
The other 13 percent are hemorrhagic, caused by bleeding in the brain when a blood vessel bursts.
Source: Second Chances Study of stroke survivors, www.secondchancesstudy.com