Time factor critical in stroke treatmentby Michael BakerPublic Relations With a stroke, time lost is brain lost. The message appears on flyers distributed by the American Stroke Association during Stroke Awareness Month, May 2004, and it serves as a thesis statement for the effects of the third-leading cause of death in the United States. According to Timothy D. Carter, M.D., director of adult neurology, and Mark S. Kindy, Ph.D., director of MUSC’s stroke program, stroke occurs in two main forms: ischemic and hemorrhagic. An ischemic stroke occurs when an artery or blood vessel leading to the brain becomes clogged. Blood flow to that part of the brain ceases, and the affected area shuts down. Sometimes the effects are particularly devastating—a blockage in the carotid artery robs the brain of nearly two-thirds its supply of blood and oxygen. A hemorrhagic stroke occurs when an artery or blood vessel breaks open and bleeds internally, cutting off a portion of the brain’s supply of blood and oxygen. This type of stroke includes intracerebral hemorrhage (bleeding from vessels in the center of the brain) and subarachnoid hemorrhage (usually bleeding from aneurysms at the base of the brain). “One of the main dangers associated with hemorrhagic stroke is edema,” Kindy added. “Blood soaks into the brain tissue, which expands and creates a lot of pressure against the skull.” Extensive brain damage can occur if doctors don’t alleviate the pressure quickly, which usually involves opening the skull. Carter pointed out that this lack of an ideal treatment further underscores the need for stroke prevention. Due to the countless vessels and arteries in which stroke can occur, diagnosis remains difficult. “A stroke can happen anywhere in the brain,” Carter said, “which is why the list of symptoms is so long.” The official list of symptoms as decided by stroke researchers and specialists during an NIH-sponsored meeting includes weakness or numbness on one side of the body, unexplained difficulty with speech, balance, or coordination, unusually severe headaches, and dizziness. Why are the symptoms so important to remember? Because of stroke’s remarkable prominence in South Carolina. The state holds a reputation as the buckle of the nation’s stroke belt, and according to Kindy, the state’s incidence of stroke ranks highest in the nation and probably highest in the world. So why is a South Carolinian more likely to suffer a stroke than someone from, say, Michigan? “The lifestyle has a lot to do with it,” Kindy explained. “There’s the infamous Southern diet: high carbs, high fat, high you-name-it.” Two major South Carolina health issues, obesity and high cholesterol, also represent major risk factors. In addition to controllable lifestyle aspects, there also are a number of independent variables that determine a person’s susceptibility to stroke. The risk of stroke increases with age, stroke-prone family history, and race—blacks experience a higher incidence of stroke than any other ethnicity. And though men are more likely to suffer from stroke, Carter said that women are particularly vulnerable. “Each year stroke kills more women than breast cancer,” he cautioned. The statistics can be startling, but fortunately, it is possible to reduce or eliminate certain risk factors. “Lowering your blood pressure remains the most powerful preventative measure against stroke,” Carter asserted. “If more people controlled their blood pressure levels, we’d no longer rank first in the nation in stroke mortality.” In addition, smoking cessation greatly reduces the risk of stroke, and those who take medication to control high cholesterol levels are less likely to suffer a stroke. Moderating the consumption of alcohol also helps. Sometimes, Kindy said, an excellent method of prevention comes from a precursor to stroke. A transient ischemic attack (TIA), or mini-stroke, often serves as a warning sign of future problems. Similar to a stroke, a TIA occurs when the blood supply to a particular area of the brain is cut off, but unlike its more severe counterpart, a TIA only halts blood flow for a short period of time. These attacks are often characterized symptoms similar to stroke; however, TIA symptoms resolve themselves in a matter of minutes. “If you experience any of those problems under unusual circumstances, it’s a good indication that something bigger may be around the corner,” Kindy said. Any stroke, mini or severe, can have serious consequences, and he recommends immediate physician consultation. But prevention only goes so far. Once a stroke has occurred, a punctual response is crucial. To treat an ischemic stroke, doctors often use a drug called TPA to break the clots that clog arteries and blood vessels. By administering the drug within three hours of a stroke, doctors can minimize or eliminate the chance of permanent damage. A speedy diagnosis remains particularly imperative in the event of a hemorrhagic stroke, for which surgery is the only way to repair the bleeding artery or blood vessel. “Surgery may be helpful for aneurysmal subarachnoid hemorrhage and only some cases of intracerebral hemorrhage,” Carter said. While both types of stroke can be treated with timely diagnoses and quick actions, Carter and Kindy asserted that awareness remains the key to combating stroke. “Stroke is much easier to prevent than it is to treat,” they concluded, “and awareness is still the best method of prevention.” Stroke Risk Screening to be offered
Learn about stroke risk factors that you may need to control. This screening will include a stroke risk questionnaire; cholesterol check with lipid profile (LDL, HDL, triglycerides); and blood glucose, blood pressure, and a carotid artery checks. Presented by the MUSC Neuroscience Institute in conjunction with the
12 Months to a Healthier Heart Program.
Friday, May 7, 2004
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