By Dr. W. Gifford Jones
July 2, 2002
Why did one person die from a stroke while stroke destined another to spend the rest of life disabled? And why did still another return to a normal life following a life-threatening stroke. The reason is that some people are "stroke smart". They know that speed can often mean the difference between a return to walking, or being confined to a wheelchair for life.
Stroke is the third leading cause of death in Canada and the U.S. But it's the # one cause of adult disability. Dying is not a good thing, but being severely disabled from stroke may be a worse disaster. Unfortunately, only three percent of stroke victims are treated within the first crucial three hours of attack.
There are two kinds of stroke. "Blockage strokes" are most common in which a blood clot forms in an artery and prevents oxygenated blood from reaching the brain. The other type happens when an artery, like a flat tire, has a blow-out and destroys brain tissue.
Whether or not a stroke occurs usually depends on the condition of the arteries. Sir William Osler, one of the world's most famous doctors, said patients were lucky if they were born with "good rubber". He meant it was good to have soft, pliable, arteries rather than ones hardened by atherosclerosis, a cause of hypertension.
So how do you become "stroke smart?" Dark threatening clouds often appear before a major storm and we know it's wise to seek cover to avoid getting soaked or struck with lightning. Fortunately, some patients see a red light, a transient ischemic attack (TIA), that warns of impending trouble before a major stroke strikes.
Patients who suffer one of more TIAs complain of a loss of vision or numbness that lasts for only a few seconds. These symptoms are due to decreased blood supply. So never take the attitude, "I'll wait and see if it happens again." These symptoms provide an opportunity to obtain rapid treatment to prevent the threatened attack.
But some stroke victims are not that fortunate and without warning a major stroke occurs. This is when you or a family member must act with the speed of lightning. Brain cells die quickly whether it's due to a blockage or hemorrhage.
How a stroke affects patients depends on where the stroke occurs in the brain and how much the brain is injured. Diagnosis is obvious when a large stroke causes immediate paralysis on one side of the body or when the patient is suddenly unable to speak. In these instances most do not delay a call to 911.
But smaller strokes are less noticeable and precious moments may be lost in getting medical attention. Patients may experience minor symptoms such as slight weakness of an arm or leg. They ignore it, sadly, but it still demands speedy attention.
I recall many years ago picking up my Father at the airport on his return from a business trip. He was a proud Scot who never liked to bother anyone and said he felt good. But I could see there was a problem. A corner of his mouth was sagging. He had had a small stroke and needed treatment.
Today a speedy diagnosis of stroke is even more vital as unlike former years much can be done to prevent permanent brain damage. But 97 percent do not receive this prompt treatment for various reasons.
Some patients ignore the symptoms and arrive at the hospital too late. Or doctors may delay treatment as they're not sure whether the paralysis is due to blockage or hemorrhage. It's an important distinction.
Patients who have a blocked artery need to receive quickly a drug called TPA which helps to dissolve the clot. But administering TPA to a patient who has a ruptured artery will cause more brain damage. And some hospitals do not have the staff or equipment to make this speedy diagnosis. Unfortunately, where you live and what hospital is involved may determine the outcome.
Patients who have TIAs can often avoid the big stroke by surgery that removes a partial blockage of the carotid arteries that supply blood to the brain.
The big message. Being stroke smart increases the chance of walking again.
W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com
My book, �90 + How I Got There� can be obtained by sending $19.95 to:
Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1
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