On average, someone in the U.S. has a stroke every 40 seconds, and every four minutes someone dies from one. That striking fact is reinforced every year during the month of May, which is when National Stroke Awareness is observed.
But everyone needs to know the basics of a stroke every day, including the telltale warning signs to recognize in yourself, a loved one or even a stranger who may be experiencing symptoms. You’ve probably familiar with recognizing common stroke symptoms. But did you know that it just takes one of those symptoms — not necessarily a combination of them — to signal that you or someone you’re with is stricken. And getting medical help quickly is vital to avoid a stroke’s potential debilitating effects.
Stroke is the No. 5 cause of death and a leading cause of disability in the United States.
“Many times, we’re able to help, but you want to prevent it in the first place as much as possible,” explains Felipe De Los Rios, M.D., medical director of the Stroke Program at Baptist Health’s Miami Neuroscience Institute. “And the good news is that stroke has been found to be about 80 percent preventable.”
During a Resource LIVE panel discussion this month — Stroke Awareness: Why Every Minute Counts — Dr. De Los Rios was joined by Brian Snelling, M.D., chief of Cerebral Vascular and Endovascular Neurosurgery, and director of the Stroke Program at the Marcus Neuroscience Institute; and Leo N. Huynh, D.O., chief of Emergency Medicine at Baptist Hospital. The panel’s host was Jonathan Fialkow, M.D., deputy medical director and chief of cardiology at Baptist Health’s Miami Cardiac & Vascular Institute.
Here are Q&A highlights from the expert panel’s discussion on stroke:
Stroke: Symptoms, Causes and Prevention
Dr. Fialkow: Tell us what is a stroke and the different types of strokes?
“Quite simply, a stroke is a disruption of blood flow to the brain, and that disruption of blood flow deprives the brain cells themselves of oxygen — which can lead to the death of the cells over time. And with regards to the different types of stroke, there are really two main types of stroke. There’s ischemic stroke, where there’s a blockage of blood vessels that deliver blood to the brain. And then the other side of that, there’s what we call hemorrhagic stroke. And those are bleeds that can occur in and around the brain. Ischemic stroke is overwhelmingly more common. It makes up around five out of six types of strokes. So, out of six people that come to the hospital with a stroke, about five of them will have what’s called an ischemic stroke.”
Dr. Fialkow: What would be the warning signs of a stroke — because we want to recognize and treat as quickly as possible. What would be the more definitive signs of a stroke?
“We see stroke presenting in the old very, very often. And early detection is key, obviously. So, sometimes the symptoms are very obvious. It’s either numbness or weakness on one side of the body. It could be visual loss, either one eye or both eyes – that’s important. Speech problems, trouble speaking or slurred speech. And, also, there could be more vague symptoms. Something like dizziness or sudden onset of confusion, trouble walking — things as such. And those are for both the ischemic and hemorrhagic stroke. The slight difference in hemorrhagic stroke is that many times it’s accompanied by a headache. A lot of times, there were preceding headaches and then neurological deficits, and headache during the onset of symptoms. So, it’s a wide range of symptoms. I think the key is a sudden change. If you see a sudden change, we all have to pay attention.
Dr. Fialkow: What are the risk factors or things that may make someone more likely to be at risk for stroke? And more importantly, what can we do to decrease the risk for stroke as a population?
Dr. De Los Rios:
“Prevention is key. Repairing the brain is not easy. And many times, we’re able to help, but you want to prevent it in the first place as much as possible. And the good news is that stroke has been found to be about 80 percent preventable. So, there’s a lot of things that we can do to prevent a stroke. In the other 20 percent — there’s some genetics involved, environmental factors. There are things that are out of our control. But with most of it, we can help ourselves reduce our own risk of having stroke. And some of these things are common to coronary or cardiac disease. Things like high blood pressure, high cholesterol, lack of exercise, having a healthy weight, checking for and treating diabetes, avoiding tobacco, vaping or otherwise, alcohol, recreational drugs. All those things can help us reduce our risk of having another one.”
Stress and Strokes
Dr. Fialkow: Can you talk a little bit about that interaction between stroke and stress, depression, and anxiety? And, of course, the importance of recognizing and managing those stresses?
“This is sort of a newer category … that is not classically associated with the risk of stroke. But there’s mounting evidence that stress, and certainly that would be like work-related stress, does have some association with developing a stroke in adults. And there are studies that have come out that have shown that association. So, while the evidence may not be as strong as it is for other risk factors that were mentioned, we’re starting to see that association and we know that’s something that can be modified — and that it should be modified.”
COVID-19 and Strokes
Dr. Fialkow: What have we learned over the past year regarding the interaction between COVID 19 illnesses and strokes?
Dr. De Los Rios:
“Now, we have more data and there are different sources. The AHA, the American Heart Association, has a COVID-19 registry. Some data was presented in the stroke conference this year. And the good news is that — even though it is associated COVID-19 infection the risk for stroke is really small. It seems like about 1.4 percent of patients that have symptomatic COVID-19 would or could experience an acute ischemic stroke. So, the vast majority of people don’t.
“And we do know from other infections, like influenza-like illnesses and even urinary tract infections, that the risk of stroke has increased in general when your body is battling an infection. The risk might be larger with COVID-19, but that’s a little bit uncertain. But the overwhelming majority of people (with COVID-19) do not experience this. And, what we’ve seen is that those that do experience a stroke, not only can it be an ischemic stroke but they can also have bleeding. Normally, an ischemic stroke is about 80 percent of strokes. When we talk about COVID-19, ischemic stroke is about 50 percent and hemorrhage is about 34 to 40 percent. So, there is a possibility of both events. But, again, for most people, stroke is not on the radar if there’s COVID-19.”
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