A stroke can have a devastating effect on a person's life and that of their loved ones. It is one of the leading causes of death and disability in the United States.
But here’s the good news: They are largely preventable.
There are two kinds of stroke:
- An ischemic stroke happens when a blood clot prevents the flow of oxygen-rich nutrients to the brain. It’s by the far the most common type of stroke, occurring in more than 85% of cases.
- In the remaining 15% of cases — intracerebral hemorrhages (ICH), sometimes called a hemorrhagic stroke — a vessel ruptures, sending blood flowing into the brain.
Regardless of the type of stroke, the result is the same: Brain cells begin dying within minutes.
How a stroke affects the body
Typically, a stroke on the right side of the brain affects the left side of the body.
A stroke on the left side of the brain usually impairs the body’s right side and will affect language functions in a majority of people.
“Strokes don’t typically happen in a neat fashion,” says Mohammad Shafie, MD, PhD, a stroke neurologist with the UCI Health Comprehensive Stroke & Cerebrovascular Center.
“I’m always humbled by what I think has happened after examining a patient, then seeing what the imaging shows.”
Quick treatment is essential
Because brain cells are highly susceptible to lack of oxygen and nutrients, the sooner treatment begins, the better the outcome. That is why stroke specialists follow the mantra “time is brain” in their clinical care of patients, says Shafie, who also is an assistant professor of neurology in the UCI School of Medicine.
For ischemic stroke patients who arrive in an emergency department within three to four-and-a-half hours of the onset of symptoms, the standard treatment is a clot-busting medicine known as TPA, which is administered through the vein. In some patients, surgeons may be able to remove a clot in the brain with an endovascular or mechanical thrombectomy.
Until five years ago, this procedure — which is done by inserting a catheter in a groin artery and threading it through the neck to the brain — was performed only as a last resort effort. After several successful research studies, mechanical thrombectomy is now standard treatment for select ischemic stroke patients up to 24 hours after onset.
“These are exciting times for stroke treatment,” Shafie says. “Establishing mechanical thrombectomy as a standard treatment option and expanding the therapeutic time window enables us to offer treatment to more patients with a stroke, even those in whom the exact time of symptom onset is unclear, including for people who wake up with stroke symptoms."
For people with hemorrhagic strokes, which has a higher rate of mortality compared to ischemic stroke, the standard of care is to control blood pressure, reduce increased pressure due to the extra blood in the brain and assist breathing with a mechanical ventilator. Depending on the degree of damage, some patients may require surgery to remove the extra blood from the brain.
Reducing your risk
Much can be done to prevent strokes in the first place. By modifying risk factors, Shafie says 80% of ischemic stroke could be prevented.
Here are some ways to reduce your risk for having a stroke:
- Control your blood pressure. High blood pressure thickens arteries and makes them less elastic. Too often people don’t know they have high blood pressure, so it’s important to get routine checkups.
- Stop smoking. Smoking constricts arteries and also reduces their elasticity.
- Watch your cholesterol levels. High levels of cholesterol, a waxy fat-like substance can clog arteries. When combined with the thickening arterial walls from uncontrolled blood pressure or smoking results, high cholesterol can result in a double-whammy of narrowing your arteries from both sides.
- Don’t do drugs. Cocaine, methamphetamine and other drugs have been shown to constrict blood vessels.
- Eat well, exercise routinely and maintain a healthy BMI (Body Mass Index). Basically, do everything in moderation to promote cardiovascular health.
- Discuss irregular heart beats with your primary care doctor and a cardiologist if recommended. You may need a daily blood thinner medication to prevent a stroke.
- Don’t bother taking an aspirin a day. Research doesn’t support it as a way to prevent a first-ever stroke, except in specific situations, such as in women who have diabetes.
Know the symptoms
The American Stroke Association recommends memorizing the F.A.S.T. symptoms of a stroke to know when to take action:
- Face drooping
- Arm weakness
- Speech difficulty
Time to call 911
Shafie recommends watching for these additional symptoms that may warrant calling 911:
- Numbness or weakness in the face, arm or leg, especially on one side
- Confusion or trouble understanding people
- Vision problems in one or both eyes
- Problems with walking, balance or coordination
- Sudden, unexplained severe headache
Whether people are experiencing an ischemic or hemorrhagic stroke, the faster they get treatment in an appropriate, designated stroke center, the better their outcomes.
"If you or someone you know is experiencing any of these stroke symptoms," says Shafie, "immediately call 9-1-1 to be taken to the nearest stroke center for appropriate treatment."