Stroke Warning Signs:
- Sudden numbness or weakness of the face, arm, or leg, especially on one side
- Confusion, trouble speaking or understanding
- Partial loss of vision in one or both eyes
- Difficulty in walking, dizziness, loss of balance or coordination
- Sudden, severe headaches
Tom Chivington was sorting some paperwork when he suddenly felt dizzy. A former college tennis coach, he considered himself in excellent health. He and his wife, Georgie, were both sports enthusiasts and avid travelers. Because he had seen a doctor about the same sensations just five days earlier, Chivington knew just what to do: He called 911.
“I had a stroke. The first time was a warning sign. When I felt the same symptoms the second time, I knew to call 911 and get to the hospital right away,” said Chivington, 70, who three years later shows no symptoms of his stroke. Chivington shared his experience at the annual Stroke Awareness and Health Fair in late May, a half-day community education program sponsored by the Stanford Stroke Center. The program included presentations from Stanford stroke specialists on prevention, treatment and rehabilitation.
The message was clear: Stroke can happen to anyone.
Timing is Everything
A stroke occurs when a blood vessel carrying oxygen to the brain suddenly bursts or becomes blocked, explained Anna Finley Caulfield, MD, a clinical assistant professor of neurology. Ischemic stroke, the more common of the two types of stroke, is caused by blockage of an artery in the brain. Hemorrhagic stroke occurs when a blood vessel breaks and leaks blood in or around the brain. Strokes can cause paralysis, language disturbances, coordination or balance difficulties, confusion or sensory loss.
But a rapid response can make all the difference, said JJ Baumann, RN, MS. The symptoms of a stroke manifest suddenly, so it’s crucial to act quickly. “You have about three hours to recognize what’s happening, get to a hospital, get a CT, and get drug treatment,” she said. “That’s a lot to happen in a short time. Most people just don’t get to the hospital fast enough, so it’s important to know the signs and call 911.”
Baumann said that only 50 percent of stroke patients call 911 and arrive at the hospital via ambulance. If patients call 911they are able to see a physician faster because the emergency department is prepared with experts who are trained to recognize the symptoms of stroke. She suggested that family members and coworkers learn to recognize the symptoms and remember the term FAST (face-arm-speech-time).
Every second the brain survives without blood flow, damage is done. The window of opportunity after a stroke is small-treatment is most effective within three hours of the onset of signs and symptoms. But that window is expanding.
“The reality is that not everyone can make it to the emergency room during that ‘golden window,’” said Greg Albers, MD, director of the Stroke Center and the Coyote Foundation professor of neurology.
Albers, an internationally recognized stroke expert, is studying the possibility of using clot-busting medications such as tissue plasminogen activator (tPA) up to six hours after the onset of certain kinds of stroke.
He also described promising breakthroughs in mechanical technologies, including a new clot retriever system called Penumbra, which was approved by the FDA in January 2008. It uses a suction device that can remove a clot in less than 20 seconds. Another corkscrew-like device called the MERCI (mechanical embolus removal in cerebral ischemia) retrieval system, made up of a wire that is threaded up through an artery to the site of the blockage and retrieves the clot. Studies show that about 50 percent of patients benefit from this system up to eight hours after the onset of a stroke
“The technology is improving rapidly, and we have some new, positive options,” said Albers. “But we need to know what’s going on in the brain before we act so we can identify the patients who will have good outcomes after the three-hour window.”
While certain risk factors for stroke-age, gender, race, genetics-cannot be controlled, most people can take active measures to prevent its occurrence, said Neil Schwartz, MD, PhD, a clinical assistant professor of neurology. “There are modifiable factors that play an important part in stroke onset,” he said, “and there are multiple ways to control high blood pressure, cholesterol, smoking, inactivity and obesity.”
Schwartz described several studies that tracked the effects of drugs and behavior modification on preventing stroke. One study showed that stroke patients who used atorvastatin, a drug used to lower cholesterol, were 16 percent less likely to have another stroke; another demonstrated the direct effect of lowering high blood pressure on stroke occurrence. Other trials continue to track the benefits of preventive medication.
“It important that patients get involved in clinical trials to help us learn more about what works and what doesn’t” he said.
Recovery and Rehabilitation
Stroke is the No. 1 cause of disability in the U.S. Regaining and improving function after a stroke is of primary importance to restore independence and to enhance quality of life.
“Rehabilitation is about retraining the person. The patient needs to learn to utilize remaining function in a way that won’t develop into poor movement or behavior,” said Jeffrey Teraoka, MD, a clinical associate professor of orthopedic surgery, who discussed new interventions that range from drug therapy to virtual reality.
Patients often benefit from devices such as a supported gait harness, which helps patients focus on movement mechanics by holding their weight, somewhat like a baby jumper swing. He described animal studies using cognitive stimulants, like adrenaline enhance dopamine, that appear to enhance recovery. Today rehabilitation also includes virtual reality games, which are easy, accessible and safe, and provide positive reinforcement that can reduce the monotony of traditional therapy.
“Rehabilitation is designed to maximize function,” said Teraoka. “Be cautious what you invest in. Your treatment requires diligence, creativity and patience.”
For Tom Chivington, recovery was as much about outlook as action.
“I remember lying there and thinking, ‘Why me?’ and ‘Do I really want to live like this?’ Dr. Albers leaned down and said to me, ‘You know you can recover from this.’ I realized then the importance of attitude. That, and the support of friends.”
About the Stanford Stroke Center
The Stanford Stroke Center was one of the first centers of its kind in the United States and was one of the first to be designated a primary stroke center by The Joint Commission, a not-for-profit organization that accredits more than 15,000 health care organizations in the U.S. Stanford was the 15th hospital and the second academic hospital in the country to be stroke certified, an acknowledgment of its excellence in stroke care.
The Center incorporates a multidisciplinary approach to stroke care. It’s staffed 24 hours a day with neurologists, neurosurgeons, radiologists and rehabilitation experts, who use the latest technology when patients come in with signs or symptoms of stroke. In addition to utilizing cutting-edge technology for emergency stroke care, the Center is involved in studies to improve existing therapies and to develop new techniques for treating, diagnosing and preventing stroke.
- About 700,000 Americans suffer from a stroke each year-that’s someone every 45 seconds.
- Twice as many women die from a stroke than from breast cancer
- The incidence of stroke rises dramatically with age; the risk doubles for each decade after age 55.
- About 5 percent of people over age 65 have had at least one stroke.
- High blood pressure is a factor in 70 percent of all strokes.
For More Information:
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Stanford Stroke Center
American Stroke Association
National Stroke Association
National Institute of Neurological Disorders and Stroke
Peninsula Stroke Association