Improving the Outcome of Stroke

The majority of strokes occur when a blood clot lodges in a blood vessel, blocking blood flow to a portion of your brain (ischemic stroke). The group of brain cells normally nourished by the oxygen in the affected blood vessels dies almost immediately after blood flow is blocked, while surrounding brain cells experience reduced blood flow.

Although the benefits of early stroke treatment are clear, only a small percentage of people who have a stroke receive optimal treatment. Almost half the 167,000 people who die of stroke each year die before they ever reach a hospital, and a greater percentage of these people are women. Why? Most of the evidence points toward a delay in seeking or receiving treatment.

Knowing the risk factors for stroke, recognizing the warning signs and seeking prompt emergency care can help improve the outcome if you or someone you know has a stroke.

Every Second Counts
The majority of strokes occur when a blood vessel, blocking blood flow to a portion of your brain (ischemic stroke). Similar to a heart attack, a stroke can be considered a "brain attack". The group of brain cells normally nourished by the oxygen in the affected blood vessel dies almost immediately after the blood is blocked, while surrounding brain cells experience reduced blood flow. Your brain cells can tolerate this slowdown in blood flow only briefly before permanent damage begins to occur. The longer the wait until blood flow is restored, the more damage that's done.

Stroke is a potentially treatable disease when caught early on its onset. Given the narrow window of opportunity to halt stroke damage and prevent serious complications, prompt treatment is critical to obtaining the best possible outcome.

What's Behind the Delay
There are many possible reasons why people put off seeking treatment for stroke symptoms. One may be lack of awareness of the symptoms of stroke. Signs and symptoms of heart attack have been drilled into the public consciousness on a much greater and more widespread level than have the warning signs of stroke.

Another important factor - and one that is inherently harder to address - is that symptoms of stroke can be disabling, leading to impaired movement, communication and thinking. This can prevent a person from calling for help and is particularly concerning for the person who lives alone.

Surprisingly, perhaps, calling your doctor instead of calling an emergency number such as 911 is another cause for delay. After hearing your symptoms, your doctor will most likely tell you to seek emergency care, but in the meantime, precious minutes are lost. When you experience signs and symptoms of stroke (or heart attack), call 911 or your local emergency number immediately.

Individual characteristics also have an effect on how long it takes to seek help. For example, not taking your symptoms seriously, wanting to tough it out for being unaware that you're at risk can all contribute to delay in treatment.

More pre-hospital stroke deaths occur among women than among men, and research suggests that women experience longer delays to treatment than men do. Why this occurs is unclear, but part of the reason may be that women, and sometimes their doctors, aren't always fully aware or convinced that they're at risk of heart disease and stroke.

The Importance of Prompt Treatment
Possibly the most effective treatment for ischemic stroke, and the one most likely to improve your chances of a full recovery, is injection of a clot-busting (thrombolytic) drug - such as a tissue plasminogen activator (TPA) - to dissolve a blood clot.

Sometimes this clot-buster is delivered through your artery system directly to the site of the blockage. The drug may also be given into a vein, in which case the therapy must start within three hours of the onset of symptoms. After this period, the risks of the therapy - bleeding and possible brain hemorrhage - begin to outweigh its benefits. Some cases of ischemic stroke may not be compatible with TPA therapy. TPA therapy also isn't used to treat hemorrhagic stroke, a less common type of stroke caused by a blood vessel rupturing and bleeding into the brain.

Other treatment options available at some medical centers include use of a tiny instrument called a "retrieval device" that can directly remove the clot from the blocked artery. New treatments are under study, as well. All of these potential treatments require prompt medical attention. Clot-busting therapy must start within three hours of the onset of symptoms. After this period, the risks of the therapy - bleeding and possible brain hemorrhage - begin to outweigh it's benefits.

After an ischemic stroke, your doctor may perform several tests, including blood tests and an evaluation of your arteries and heart. This will assist your doctor in determining the best way of preventing another stroke. A program to prevent further strokes may include use of certain blood thinners, and your doctor may recommend surgery or a balloon procedure to unblock or widen the arteries to your brain if they're severely narrowed.

Reducing Your Risk
Women are just as much at risk of stoke as are men, so don't make the mistake of thinking the possibility of a stroke doesn't apply to you. In addition, many factors can increase your risk. Some factors you can't control, such as a family history of stroke and increasing age. But there are other risk factors that are more manageable, including high blood pressure or cholesterol levels, smoking, diabetes, obesity, physical inactivity, drug and alcohol abuse, and cardiovascular disease. The risk associated with these factors can often be reduced through diet, exercise and medications, when needed.

There are also risk factors to which women may be particularly susceptible. These include migraines with aura (visual disturbances preceding a migraine); use of oral contraceptives or oral hormone therapy; autoimmune diseases, such a lupus; or a clotting disorder, sometimes indicated by multiple miscarriages, blood clots in your lungs or legs, or a condition marked by purplish, net-like discoloration of your skin (livedo reticularis ).

Your doctor can help you estimate your personal risk of developing cardiovascular disease, including stroke, over the next ten years. Knowing what your risk is can motivate you to take the steps needed to prevent a stroke.

Recognizing Signs and Symptoms of Stoke
Knowing the signs and symptoms of a stroke may make it possible for you or someone you know to get prompt treatment. The warning signs usually occur suddenly; frequently there's more than one. They include:

1. Sudden numbness, weakness or paralysis of your face, or leg - usually on one side of your body.
2. Sudden difficulty speaking or understanding speech (aphasia).
3. Sudden blurred, double or decreased vision.
4. Sudden dizziness, loss of balance or loss of coordination.
5. A sudden, severe, "bolt out of the blue" headache or an unusual headache, which may be accompanied by a stiff neck, vomiting or decreased consciousness.
6. Confusion, or problems with memory, spatial orientation or perception.

If these symptoms occur briefly and then go away, you may be experiencing a transient ischemic attack (TIA). A TIA is a temporary interruption of blood flow to a part of your brain. The signs and symptoms of TIA are the same as for a stroke, but they last for a shorter period - several minutes to 24 hours - and then disappear, without leaving apparent permanent effects. A TIA should be taken very seriously. It indicates an underlying risk that a full-blown stroke may follow. See a doctor immediately.