May is National Stroke Awareness month. Responsible for one out of six deaths in the U.S. in 2018, the signs of stroke are worth being aware. On average, according to the CDC, a stroke happens nationally once every forty seconds, and there is a death every four minutes, totaling almost 800,000 cases per year. Stroke is responsible for more long-term disability than any other disease in the U.S.
A stroke occurs when there is a compromise of circulation to the brain. There are common health problems that increase the risk of developing a stroke. High blood pressure, elevated cholesterol, diabetes, smoking, and obesity are the major contributory health risks. About one in three Americans have at least one of these health concerns, and one out of every four patients have already had a stroke previously. Although the likelihood of stroke increases with age, the CDC notes that about one third of hospitalized patients are under sixty-five. Stroke risk doubles every decade after the age of fifty-five.
Most strokes are ischemic, caused by blocked circulation. A cerebral thrombosis is a clot that develops in a blood vessel in the brain and clogs circulation at that area of the brain. A cerebral embolism is a clot that forms in a remote part of the body, commonly in the heart or upper body. As it follows the circulation to the brain, it then lodges in a vessel in the brain, stopping further circulation. A common heart problem that causes this is known as atrial fibrillation, as clots repeatedly develop in the heart due to this rhythm irregularity.
Less common but equally devastating is a hemorrhagic stroke. Rather than a blockage, this stroke is caused by bleeding in the brain. Examples would be from a leaking blood vessel or one that has burst or ruptured. A brain aneurysm has potential to break and bleed, as it can be a naturally occurring weak spot.
Time is of the essence in treating stroke. Those patients who have been treated within the first three hours of the development of symptoms often have less disability at three months after the stroke.
F.A.S.T is an easy mnemonic to spot the development of a stroke.
F: face drooping. Ask the person to smile and look for drooping on one side of the face.
A: arm weakness. Have the person raise both arms and look for one side to drift downward.
S: speech difficulty. Slurred or difficult speech, have the person repeat a short sentence correctly.
T: time to call 911. Even if symptoms may resolve, early intervention is critical.
In addition to FAST, there are other symptoms of stroke that should be considered. This includes a sudden numbness or weakness of the leg; sudden trouble with understanding or confusion; sudden difficulty seeing with one or both eyes; acute trouble with balance, walking, incoordination, or loss of balance; and sudden severe headache with no known cause.
A transient ischemic attack, or TIA, has all the features of a stroke except for the duration and damage. The same mechanism of stroke occurs, but spontaneously clears in a short period of time without any neurologic compromise. Nonetheless, there is medical evaluation that needs to be done. Should you experience a TIA, seek medical care urgently as one in three will evolve into a full-blown stroke within a year.
Bradford Croft, DO
East Flagstaff Family Medicine