They called my Grandfather, “THE DUKE.” That is because he always dressed liked royalty with a pencil thin mustache, spats and slicked back hair. He loved to dance, drink, smoke and have a good time.  When he walked down the street, people took notice.

Sadly, the only memories that I have of him, occurred after his stroke. His daughters and wife kept him impeccably groomed but he was confined to a chair and could only speak a few slurred words.  He kept his sense of humor as I recall one time we played the game, “I’ve got your nose” and he pretended to not only take my nose but chew it up and spit in the spittoon by his side.  This caused quite an uproar since we only saw glimpses of the larger than life man that he once was.

Stroke is the 3rd leading cause of death in the US stealing life but liveliness as it did to the Duke. Most people with a stroke wait over 24 hours before seeking medical help.  Acting quickly is critical to prevent permanent damage or death. Hopefully I’ll teach you some things so you can keep the Dukes in your life.

What is a stroke?

A stroke is when the brain is not getting enough blood flow. Most strokes are ischemic which means lack of flow from either a clot in the artery, but more often from blockage of the artery as a result of atherosclerosis. There are also hemorrhagic strokes when a blood vessel ruptures and causes bleeding in the brain.

Without blood, the brain tissue will quickly become damaged resulting in symptoms like vision loss, problems talking, walking, headache or confusion.

A TIA or transient ischemic event, also called a mini stroke, occurs when the blood flow is stopped temporarily and symptoms last for a few minutes. The damage is not permanent so people often ignore TIAs.  TIA’s often predict the bigger stroke soon to come so they require emergency care.

People need to act FAST with a stroke.

When the brain is deprived of blood, brain tissue dies and we see permanent deficits.  We can prevent this if a clot buster is given called tPA or tissue plasminogen activator within 3 hours of the first symptoms

What are the warning signs of stroke?

Face

Look at the face.

Does it drop to one side? Have person smile and stick out tongue. Does it point to one side?

Arms

Raise both arms. Does one drift down?

Speech

Repeat a simple sentence. Is it repeated correctly? Is the speech slurred?

Time

If they have ANY of these symptoms or headaches, dizziness or blurry vision then call 911. Time is of the essence. We have to catch it before the brain tissues dies to prevent permanent loss. Ideally they should be seen within 3 hours but most people wait over 24 and the damage is done.

Can you spot a stroke?

Take this quiz

What is the best way to prevent a stroke?

80% of strokes can be prevented. The most important thing is to control blood pressure, which can include a low salt diet.   This alone will decrease your chance of stroke by 40%. Of course the usual things like stopping smoking, exercise, controlling blood sugar, cholesterol, weight and alcohol intake will also prevent stroke.

Take your risk assessment quiz here

Are there any screening tests?

The best test, as I said before, is your blood pressure. High blood pressure certainly increases your risk. Keeping your other numbers low such as cholesterol and blood sugar are also critical.

The best screening test specifically for stroke is an ultrasound of the carotid arteries although it is controversial who should get it base upon the evidence of screening reducing risk of stroke without harmful side effects.

The US Preventative Services Task Force in 2007 did not recommend screening, as they are moderately certain that the potential harms of screening for CAS outweigh the potential benefits.

In 2007, the Society for Vascular Surgery recommended ultrasound screening for individuals age 55 years or older with cardiovascular risk factors, such as a history of hypertension, diabetes mellitus, smoking, hypercholesterolemia, or known cardiovascular disease but not for the general population.

A recent study showed that both in patients that had symptoms of TIA and those that had no symptoms but did have evidence of blockage on based on testing both did well with either carotid endarterectomy (CEA) or carotid artery stenting. (CAS)

CEA is the gold standard where the artery is cleared of blockage by a surgical procedure.  Carotid artery stenting (CAS), a newer and less invasive procedure threads a stent and a small protective device that expands in the artery to widen the blocked area and capture any dislodged plaque.

So, with all this controversy, what do I tell my Dad?

He over 65 years old with controlled hypertension and a strong family history. I will tell him to go ahead and get the ultrasound of his carotid arteries. As my family practice friend, Dr. Terri Zisko said, “Many times the patient, just knowing that there is some blockage, will be motivated to take their medications to control blood pressure and cholesterol, stop smoking, eat better and decrease their risk factors.”  I don’t know that  I would recommend any treatment if he does not have symptoms but at least we could follow the scans if they are abnormal. This latest study shows there are more options to treat the blockage and treatments that are showing less risk so I think it is important information to have.

ACT FAST and don’t hesitate if you or someone you know has any of these symptoms. 50% of those that are going to have a stroke have no symptoms before it happens.

Remember: Time lost is brain lost!

Blessings,

Dr. Deb