What is a stroke or CVA?
Dr. Jim Mumper: A stroke or cerebrovascular accident (CVA) occurs when brain cells die due to a sudden lack of oxygen from interrupted blood flow or the rupture of an artery supplying oxygen-rich blood to the brain. Also known as a "brain attack," a stroke is basically the same in principle as the other most common effect of heart disease, a heart attack – it simply affects a different part of the body. During a heart attack, a coronary artery in the heart is blocked causing the heart muscle to starve and die from a lack of oxygen-rich blood. Similarly, during a brain attack, an artery is blocked, or ruptures, causing the affected part of the brain to starve and die from a lack of oxygen-rich blood.
There are two different kinds of stroke, both with the same end-result. The first and most prevalent type is called an ischemic stroke. This is where a clot forms in the artery supplying blood to the brain, or forms in another part of the body and floats to one of the brain-supplying arteries. Approximately 83 percent of all cases of stroke are ischemic. The second, less common form of stroke is called hemorrhagic. This stroke occurs when a blood vessel in the brain ruptures or leaks. The result is not only a lack of oxygen-rich blood to an area of the brain, but also pressure forced on the brain from the bleeding. While hemorrhagic stroke is more difficult to treat than ischemic stroke, they are both best approached when discovered early. Upon immediate identification of any warning signs or symptoms, 9-1-1 should be called and the individual should be taken directly to the emergency department that can best treat their particular condition.
Currently, three local hospitals are considered Primary Stroke Centers by The Joint Commission. These are Bon Secours-St. Mary's Hospital, CJW Medical Center and Henrico Doctors' Hospital. However, the desire to be taken to a Primary Stroke Center versus another emergency department should not be allowed to unduly delay emergency care. The best course of action in any case is to call 9-1-1.
What are some of the warning signs of stroke?
Dr. Virginia Kladder: The symptoms of stroke can come on quite suddenly. Knowing the symptoms and taking immediate action via the emergency response system (dialing 9-1-1) can help save precious brain function and increase the chances for a full and complete recovery. The most common warning signs are as follows: 1) Sudden numbness or weakness of the face, arms or legs most often occurring on just one side. Many times, victims experience a "facial droop" on one side and are unable to raise both sides of the mouth when trying to smile; 2) Sudden confusion or trouble speaking or thinking. Victims often want to talk, but are unable or can't seem to find appropriate words; 3) Sudden vision difficulty, or blurred vision in one or both eyes; 4) Sudden trouble balancing, walking or standing. An unexplained dizziness and lack of coordination; and 5) A sudden, severe headache that cannot be explained.
While the above are the most common warning signs, they may occur singularly or in varying degrees. It is best to err on the side of caution when experiencing any signs or symptoms of a medical problem and seek immediate assistance. It is also important to note that certain populations are at a greater risk for stroke than others. Blacks have almost twice the risk of whites for having a stroke. Smokers also have a twice the amount of risk for stroke as do non-smokers.
What can I do to lessen my risk for stroke?
Dr. Stuart Solan: According to the American Heart Association, every 40 seconds someone in the United States has a stroke. And 780,000 people experience a stroke every year. While stroke can happen to anyone at anytime, there are certain conditions or lifestyle choices that increase one's risk. Both high blood pressure and smoking are two correctable risk factors for stroke. Hypertension, or high blood pressure, is the most important risk factor for having a stroke. Left untreated, high blood pressure can result in a more than 50 percent increased in the lifetime risk for stroke.
Similarly, smoking can cause a person to have two-times the stroke risk as a non-smoker. Atrial fibrillation, a heart rhythm disorder, is also a leading, and often treatable, risk factor for stroke. Other medical risk factors include diabetes mellitus, high blood cholesterol, sickle cell disease and other types of cardiovascular disease. Some non-medical risk factors include poor diet, physical inactivity and obesity. Some risk factors which we cannot control are age, gender and ethnicity. The risk for stroke increases as we age. And men are more likely to experience stroke at younger ages than women. However, as women age, their risk increases to the point where they are at a greater risk than men. Blacks, especially males, are also at a much higher risk for stroke. According to the American Heart Association, the incidence rate of stroke among blacks age 45-64 is 6.6 for every 1,000. The same incidence for white males is 3.6 per 1,000.
Overall, the best way to reduce your risk is to monitor and control your blood pressure, don't smoke and generally take good care of yourself through frequent and routine visits with your physician. There are also tests available to help diagnose your stroke risk early. The most popular and widely available exam is a carotid artery scan. Using harmless ultrasound, a technologist analyzes the carotid arteries (arteries on both sides of your neck which supply all of the blood to your face, head and brain) for early signs of blockages. Speak with your physician to determine if this test would be appropriate for you.
What might happen after I have a stroke?
Dr. Leon Spiers: As with most medical emergencies, treatment of stroke can best be accomplished if the attack is recognized early and treatment is started immediately. Regarding a heart attack, lost time is considered lost muscle. With a stroke, the more time elapses without restoring blood flow, the more brain tissue and function is lost. Immediately after the warning signs of stroke are recognized, the emergency response system should be activated by calling 9-1-1. Immediate transport to an appropriate facility can begin the accurate diagnosis and treatment. If a diagnosis of an ischemic stroke is made within approximately 3-4 hours of the onset of symptoms, certain "clot-busting" medicines can be administered to help eliminate the blockage and restore crucial blood flow to the affected area. Unfortunately, the majority of people do not act quickly enough, or the symptoms are not recognized in enough time, for this option to be utilized. For hemorrhagic strokes, surgical intervention is sometimes recommended to stop or correct the rupture or leak.