Henrylito D. Tacio
FORTY-EIGHT year old Ronald was not unduly worried about his health. As personal driver of the provincial governor in one of the provinces in southern Philippines, he worked irregular hours and found little time for regular exercise, but he had not needed a day’s sick leave in ten years.
Then, one morning, as he entered the governor’s office to answer the telephone, he noticed a twinge of pain his left leg. By the time he picked up the receiver, he couldn’t utter a word. It was good that the janitor was there when it happened. He was brought to the hospital and the doctor found out that Ronald had suffered a transient ischemic attack (TIA).
According to medical science, TIAs are brief episodes in which a clot or an embolus blocks blood flow temporarily, then dissolves without lasting damage. Though a TIA can last up to 24 hours, almost two-thirds end within five minutes. Thus, the victim often ignores or misinterprets the ominous message. This is unfortunate, because one TIA victim in ten will have a major stroke within a year; three in ten within five years.
In Asia, stroke is the third-leading cause of death – after cancer and heart disease. It is also one of leading causes of adult disability. “Don’t confuse a stroke with a heart attack,” writes Dr. Isadore Rosenfeld in his book, “The Best Treatment.” “A stroke is what happens when the blood supply to a portion of the brain is interrupted; a heart attack is what you suffer when the blockage is in an artery within the heart.”
Strokes come in two major varieties: ischemic strokes and hemorrhagic strokes. In an ischemic stroke, a blocked artery prevents blood carrying oxygen and other nutrients from reaching a portion of the brain, leading to dysfunction and death of that brain tissue. What happens during an ischemic stroke is in many ways similar to what happens in a heart attack in which there is a blockage of blood flow to the heart.
Hemorrhagic strokes, on the other hand, occur when blood from a ruptured blood vessel compresses and damages normal functioning brain tissue. This rupture may occur because of underlying damage to the blood vessel from years of high blood pressure or from an underlying abnormality in a blood vessel, such as an aneurysm (abnormal bulging of a blood vessel).
About 80 percent of strokes are ischemic; the remaining 25 percent are hemorrhagic. Studies have shown that fifty percent of hemorrhagic strokes patients die compared with 20 percent of ischemic stroke patients.
General recovery guidelines for stroke show: 10 percent of stroke survivors recover almost completely, 25 percent recover with minor impairments, 40 percent experience moderate to severe impairments requiring special care, 10 percent require care in a nursing home or other long-term care facility, and 15 percent die shortly after a stroke.
Up to 80 percent of strokes may be preventable through lifestyle changes or drugs. (Some risk factors, like age and family history of the disease, cannot be changed, however.) You can do something about these crucial risk factors:
High blood pressure
People with high blood pressure are eight times more likely to suffer strokes than people with normal blood pressure. Several studies have shown that all forms of hypertension are associated with an increased risk of stroke, whether the elevation is in the upper number of the blood pressure (the systolic) or the lower number (the diastolic).
“If you have high blood pressure,” says Dr. Ralph L. Sacco, associate chair of neurology at the Columbia University College of Physicians and Surgeons in New York City, “you can often lower it by simply modifying your diet: Losing weight, reducing fat intake, reducing overall calories. Reducing salt intake is important for some people. These dietary changes, along with a little exercise, can really help to reduce high blood pressure.”
Of course, sometimes you do need medicine to lower your blood pressure. “It is not uncommon to need more than one medicine. If you do need to take medicine, take it every day and follow the prescribing directions. These medicines are extremely important in lowering your blood pressure and your risk of stroke,” Dr. Sacco points out.
Diabetics, especially women, have up to three times the risk of stroke as nondiabetics. One possible reason for this is that diabetics develop diseases arteries earlier, and the damage is generally more severe. Dr. Arthur Pancioli, a neurologist with University of Cincinnati, found in his study that only 13 percent of diabetics realize they are at risk of stroke.
Recent studies suggest that control of blood sugar in diabetes can reduce the risk. Certain medications may also reduce the risks of stroke. For people who develop noninsulin dependent diabetes, a key to reducing stroke risk is weight loss.
Elevated levels of HDL, the good cholesterol, can reduce your risk of heart attack and stroke. The other type of cholesterol, LDL, is the kind that increases the risk of heart attack and stroke by building-up of fatty deposits called plaque inside arteries. Partially blocked carotid arteries – some of the main suppliers of oxygenated blood from the heart to the brain – in the neck may cause roughly 25 percent of strokes.
Studies have shown that controlling the level of cholesterol, especially with a family of medications called statins, may reduce the risk of strokes in people with high cholesterol or heart disease. “But whether it makes sense to treat people with strokes and normal cholesterol levels to produce an even lower cholesterol level remains unanswered,” says Dr. Mitchell Elkind, an assistant attending neurologist on the stroke service at the New York Presbyterian Hospital.
Cigarette smoking increases the risk of stroke, and the more one smokes, the bigger the risk. Cigarette smoking also increases the chances of so-called subarachnoid hemorrhage, the kind of bleeding stroke that occurs from a burst aneurysm.
“Smoking is an important risk factor for stroke,” says Dr. Sacco. “It increases one’s risk almost twofold.” Just to put things in perspective: in the United States, the number of people who die annually due to smoking-related causes is approximately equal to the number of deaths that would result if three jumbo jets crashed every single day for a year.
The encouraging news is though, that there is a lot of good scientific data that shows that those who can quit smoking can reduce the risk of stroke. It is reassuring to know that the risk of stroke is reduced to that of a nonsmoker within two to five years after quitting.
There are two things about alcohol: good and bad. The good thing is that if you drink a little bit–mild to moderate drinking–you can actually reduce your risk of stroke. A study conducted by Dr. Sacco and his colleagues showed that “moderate alcohol use is associated with a significantly decreased risk of ischemic stroke.”
The bad thing is that heavy alcohol use increases the risk of stroke. The more you drink, the worse the risk of stroke. Listen to the explanation of Dr. Sacco: “However, heavy drinkers who cut back to no more than two drinks a day can reduce this risk. Of course, these studies are not implying that physicians should recommend to their patients to have two drinks a day in order to reduce their risk of stroke. No study has shown a benefit in recommending alcohol use to people who don’t drink. What the studies are suggesting is that among those people who are moderate drinkers, continued consumption might provide a reduction of ischemic stroke risk. However, they may have other medical conditions that need to be considered which may be aggravated by alcohol. Therefore, every patient’s situation is different and the risk and benefits of alcohol must be balanced.”
This refers to a certain kind of irregular heart rhythm, which leads to blood clots forming in the heart. These blood clots can then be released from the heart and travel to the brain, causing what doctors referred to as an embolic stroke. Blood thinners, such as warfarin, are routinely used to reduce the chances of stroke in people with this kind of problem.
“Atrial fibrillation is very common in elderly people (approximately 10 percent), but may occur in younger people too,” says Dr. Elkind. “In young people who have atrial fibrillation but no other risk factors for heart disease or stroke, the chances of having a stroke are so remote that blood thinners are often not used.”
Many other heart conditions can also cause strokes, including valvular heart disease, rheumatic heart disease, and congestive heart failure. “Some of these may also need to be treated with blood thinners in certain circumstances,” says Dr. Elkind.
Transient ischemic attacks
TIAs are often called “mini-strokes.” Oftentimes, a TIA is so fleeting that it is dismissed. Besides lapses in sight or speech, symptoms include dizziness, tingling and numbness, limb weakness, inability to comprehend or use the correct word when speaking. Many TIAs are dismissed because symptoms are not dramatic or well known – unlike the crushing chest pain common in heart attacks.
“The difference between a TIA and a stroke is that, with TIA, the blood clot dissolves on its own and blood flow is restored before permanent damage to the brain can occur,” explains Dr. Elkind.
Antithrombotics such as aspirin, which interfere with blood clotting, are the standard therapy. But taking aspirin is not enough. The patient needs to know what causes the attack. About 10 to 15 percent of strokes are preceded by TIAs, which can happen days, weeks, or even months before a major stroke
Migraine sufferers may be twice as likely to have a stroke as those who do not have the debilitating headaches, according to a Harvard University study. It looked at information from more than 20,000 male doctors, gathered as part of the Physicians’ Health Study. The researchers found that the doctors who suffered from migraine headaches were 80 percent more likely to have a stroke, and were twice as likely to have a type known as ischemic stroke. There was no increased risk of stroke for those who suffered from ordinary, non-migraine headaches.
Migraine headaches usually cause severe pain on one side of the head, and can be accompanied by symptoms such as sensitivity to light, nausea, vomiting or ringing in the ears. It has been hypothesized that it is the abnormal constriction of brain blood vessels during migraine that increases the risk of stroke.
Some studies have suggested that people who experience an aura, such as a change in vision or loss of strength or sensation, prior to their migraine may have an especially increased risk of stroke, though it is unclear why. People with migraines who have suffered strokes should probably avoid medications that constrict blood vessels.
A stroke is always serious. Cells in the brain that become damaged cannot be repaired or regenerated. But other areas of the brain may take over the work of the damaged portion. Most people know they should seek emergency medical help immediately if they are having symptoms of a heart attack. But the average stroke patient waits more than 12 hours before going to a hospital emergency department, losing precious time that could be critical to treatment.
Stroke was first recognized more than 2,400 years ago by Hippocrates, the father of medicine, who described a condition marked by the sudden onset of paralysis. There are steps you can take to help prevent a stroke. Know what your risk factors are. Do what you can to modify your lifestyle. Think of the good things that can be done, that can be enjoyable, and that you can adopt into your day-to-day routines. If you need medications, don’t forget to take them as prescribed. Remember that even small changes can make big differences. – ***