Stroke

Stroke, also known as a cerebral vascular accident (CVA), is one of the leading causes of death in America. According to the National Stroke Association (NSA), an ischemic stroke occurs when a blood clot blocks an artery (a blood vessel that carries blood from the heart to the body) or a hemorrhagic stroke occurs when a blood vessel (a tube through which the blood moves through the body) breaks, interrupting blood flow to an area of the brain. When either of these things happens, brain cells begin to die and brain damage occurs.

Brain cells control speech, movement and memory. During a stroke the amount of damage is dependent on the number of cells that die during the stroke. For example, individuals who have a minor stroke may only experience weakness on one side of the arm or leg or momentary unconsciousness. Other people may experience paralysis. Some people recover with few visible side effects, but more than two-thirds of survivors have some type of disability.

Similarly, a Transient Ischemic Attack (TIA) is a brief episode of stroke-like symptoms that can last from a few minutes to 24 hours, but usually causes no permanent damage or disability. TIAs are serious warning signs of an impending stroke. Up to 40 percent of people who experience a TIA may have a stroke. Aspirin and other medications have been shown to reduce the risk of stroke in patients with TIAs. Symptoms of a TIA include weakness on one side, numbness, speech distortion, loss of vision or double vision and unsteadiness.

Risk Factors
The risk of having a stroke increases with age and family history. After the age of 55, stroke risk doubles for every decade a person is alive. Women are more likely than men to have strokes. African Americans have twice the risk of stroke when compared to Caucasians Hispanic and Asian/Pacific Islanders also experience a higher risk than Caucasians. Recurrence is an issue; 24 percent of women and 42 percent of men who have had a stroke are more likely to have another stoke within 5 years, according to the NSA. Diabetes doubles the risk of stroke With lifestyle changes, seniors can prevent strokes by controlling the risk factors that lead to these “brain attacks.” The major controllable risk factors are:

  • High blood pressure
  • Smoking
  • Blood sugar, especially for diabetics
  • High levels of LDL (bad) cholesterol
  • Obesity
  • Alcohol
  • Irregular heartbeats

Prevention

    • Reduce hypertension since the heart pumps harder to push blood through the body, weakening blood vessels and damages other organs.
    • Stop smoking. It’s never too late to get the benefits of quitting Choose a date & taper off (using patches or prescription aids if necessary).
    • Control blood sugar, especially HbA1c in diabetics, to help prevent strokes.
    • Understand your renal health and take care of your kidneys.
    • Manage LDL cholesterol in the bloodstream that can clog arteries, which is one of the major causes of atherosclerosis. Discuss with your physician the frequency and instructions for a successful fasting blood test.
    • Control excess weight that can put strain on the entire circulatory system.
    • Reduce excessive amounts of alcohol consumption.
    • Ask your physician if you have atrial fibrillation, which can cause blood to collect in your heart and possibly form clots that are carried to the brain.
    • Share with your doctor any unusual events such as fast heart rate, unprovoked shortness of breath, unusual fatigue, poor sleep patterns or new anxiety that is not related to life events.
    • Take medications to prevent TIAs.
    • Treat a TIA as an emergency by going to an emergency room as soon as possible.
    • Medicare will pay for a 12-hour fasting lipid panel for high-density lipoproteins and triglycerides for beneficiaries every five years if there is no apparent sign of cardiovascular disease. The tests can included a total cholesterol test, cholesterol test for high-density lipoproteins and triglycerides. There is no co-pay. Local health fairs offer low cost blood tests if Medicare will not cover the costs.

Screening
The NeuroTexas Institute® has developed the following Stroke Risk Screening Tool. Knowing the risk for stroke is the first step toward preventing stroke. For each risk factor below, choose the answer from the column (High Risk, Caution or Low Risk) that most closely matches your profile.

Risk factor High Risk Caution Low Risk
Blood Pressure More than 140/90
or
I don’t know		 120-139 / 80-90 120/80 or less
Heart– History of atrial fibrillation, heart surgery or carotid disease Yes Don’t know No
Cholesterol Total cholesterol more than 240
or
LDL more than 130
or
I don’t know		 Total cholesterol more than 200
or
LDL more than 100 if you have any other risk factors		 Total cholesterol less than 160
and
HDL greater than 60
and
LDL less than 100
Diabetes Yes Borderline – any pattern of elevated blood glucose No
Smoking Yes Nonsmoker, but frequent exposure to second hand smoke Nonsmoker and little exposure to second hand smoke
Diet/Weight I know I’m overweight
or
My waist measures 40 inches or more for men; 35 inches or more for women		 I suspect or know that I should weigh less or my waistline should be smaller My BMI (body mass index) is within normal range; I eat 7 servings of fruits, vegetables and whole grains a day andI balance my calorie intake with exercise output.
Exercise My job and interests require me to sit a lot and I get little exercise I exercise, but not regularly or in a focused way I usually exercise 45 minutes at least four times a week.
An immediate family member had a stroke or heart attack when they were younger than 55 years
or
I am a man over 45 years
or
I am a woman over 55 years		 Yes Not sure No

-If you chose three or more answers from the High Risk column, please consider starting stroke prevention as soon as possible. Consult your primary care physician.
-If you chose four or more answers from the Caution column, your risk for stroke is lower but you may want to consider further emphasis on reducing these risk factors.
-If at least six to eight of your answers were in the Low Risk column, your lifestyle contributes to minimizing your risk for stroke.

The Health Library has developed an online Stroke Risk Assessment Tool that provides individual recommendations based on genetics, lifestyle, and diet for stroke prevention. In addition to the screening tools to assess the risk of stroke, your health care professional may conduct lab tests. According to the American Stroke Association, ultrasound may be used to screen for blocked neck arteries in individuals who have symptoms or other stroke risk factors

Diagnosis
A physician will evaluate your medical history, perform a physical and neurological examination, order laboratory (blood) tests, and possible a CT or MRI scan to diagnose a stroke.

Treatment & Management
The National Stroke Association STARS (Steps Against Recurrent Stroke) program helps stroke survivors reduce the risk for another stroke. STARS helps individuals make lifestyle changes and manage
medical conditions through many of the following methods:

      • Stop smoking because smoking doubles the risk of another stroke.
      • Manage high blood pressure, with an optimal reading of 120/80 through diet, exercise and/or medications.
      • Manage high cholesterol with diet, exercise, and/ or statin medications. Other medications may be prescribed as well.
      • Keep diabetes under control. The goal is to have a fasting blood sugar that is under 110 The HbA1c level should be 6 percent or less.
      • Manage atrial fibrillation, a type of irregular heartbeat with medications.
      • Eat low-fat foods — especially foods low in saturated fat including vegetables, fruits, lean meats such as chicken and fish, low-fat dairy products and a limited number of egg yolks. Bake, broil, steam or grill your food (instead of frying) Add fiber to your diet, including whole grains or dried beans.
      • Exercise five or more times per week such as walking for 30 minutes a day. Every little bit of exercise can improve your health such as a brisk walk, a bicycle ride, swimming or yard work. Make small changes such as taking the stairs instead of the elevator or park farther out in the parking lot. Make time each day to exercise.
      • Control alcohol use — Talk with a doctor about alcohol use and how it can best be used to prevent another stroke.
      • Control the folic acid level through diet by eating more fruits and vegetables including lentils, chickpeas, asparagus, ready-to-eat cereals, fortified bread, pasta and rice.
      • Determine Vitamin B12 and B6 absorption levels. Eat fortified cereals, low-fat meat, fish, poultry, milk products, bananas, baked potatoes and watermelon to ensure consumption of Vitamin B12 and B6 Only take vitamin supplements on the advice of a health care practitioner.

Questions For Your Doctor

      • How likely is another stroke?
      • If another stroke occurs, will it likely be more severe than the first?
      • Am I getting the rehabilitation services I will need to achieve my goals?
      • What kinds of health specialists are going to be a part of my stroke recovery team?
      • Should I be getting treatment for depression?
      • When should I call my doctor?
      • How do I manage atrial fibrillation?
      • What is my goal for blood sugars and HbA1c?

Tips

      • Aspirin is the most commonly used medication to prevent stroke because it reduces the risk of stroke in people who have already had a TIA or ischemic stroke. Discuss all the medications, vitamins, minerals, and herbs you take with your pharmacist, as there are some medications that should not be taken with aspirin.
      • If you see a specialist, have that physician confer with your primary care doctor prior to starting any new medications.
      • Angry outbursts increase your risk of stroke. Don’t suppress your anger, but learn to manage it so that it does not reach explosive levels. When very angry, try to distract yourself momentarily with constructive, gentle, physical activity, such as walking or raking leaves, until you cool down.
      • Folks who snore loudly often have sleep apnea, which is characterized by periods of not breathing that can last up to two minutes. Sleep apnea can put people at risk for stroke.
      • If you believe you are having a stroke, go to a Joint Commission Certified Stroke Center. These centers offer a) a 20-minute stroke alert to CT completion policy for patients with a stroke or TIA; b) 24-hour-a-day, 7-day-a-week on call neurologists and neurosurgeons; and c) close partnerships with emergency medical services to assure rapid response to all incoming stroke and TIA patients.

Helpful Resources
National Stroke Association or call 1-800-787-6537
American Stroke Association or call 1-888-478-7653
NeuroTexas Institute or call 512-544-5000
Centura Porter Hospital Stroke Program or call 303-778-1955

Download This Stroke Monogram