By: Dr. James Lee
Would you know the signs of stroke if someone you loved developed them? Would you know what to do if someone was having a stroke? May is Stroke Awareness Month and a good time to review the signs of stroke, what to do if you suspect someone is having a stroke, and what you can do to prevent a stroke.
Every year there are more than 795,000 people in the United States have a stroke. That is one person every 40 seconds. This results in 137,000 deaths in the US or 1 death every 3.5 minutes. Of these strokes, 185,000, nearly 1 in 4, are in people who have had previous strokes. In Louisiana, there were 2,566 deaths from stroke in 2020. Stroke is the leading cause of serious long-term disability and stroke related cost in the United States was $53 Billion between 2017 and 2018. Most importantly, 80% of strokes are preventable with lifestyle changes.
F.A.S.T is a pneumonic to help remember the warning signs of stroke. “F” stands for facial drooping. One side of the face loses muscle tone, resulting in the appearance of drooping eye and down-turned corner of the mouth. “A” stands for arm weakness. A stroke victim will not be able to raise and hold both arms at shoulder height. They also may have leg weakness on the same side as arm weakness, making it difficult to walk. “S” is for slurred speech or unintelligible speech. “T” stands for time to call 911. The more time it takes to recognize and get someone medical care, the more brain cells die and result in increased disability. Other symptoms include numbness on one side of the body, confusion, difficulty seeing in one or both eyes, and severe headache without a cause.
There are two types of strokes, Ischemic and hemorrhagic. Ischemic strokes are caused by a blockage that prevents blood flow to the brain, usually a clot. A few minutes of blockage can result in significant, long-lasting disabilities. 87% of strokes are ischemic. A TIA or transient ischemic attack, or “mini-stroke” are blockages that occur for a very short time with no long-term effects. TIA is a warning sign, and the symptoms are like a stroke, but go away quickly. Often, this is ignored, but it needs to be taken seriously and reported to your doctor because the risk of a serious stroke is higher in patients with TIA. Hemorrhagic stroke occurs when an artery in the brain ruptures. The resultant bleeding causes an increase in pressure on the brain cells causing damage. High blood pressure is a major risk factor for hemorrhagic stroke, but aneurysms, blood thinners, and trauma can all lead to hemorrhagic stroke.
Risk factors for stroke can be separated into those that can be changed or managed, and those that cannot. High blood pressure, heart disease, diabetes, birth control pills, obesity, lack of exercise, high cholesterol and lipids, tobacco use, more than two drinks a day, and illegal drug use can all be avoided or managed to decrease the risk of stroke. Increasing age, African American race, prior history of stroke, and family history of strokes cannot be changed. Gender also plays a role; with a stroke occurring more often in men but resulting in death in more women than men. Interestingly, strokes are more common in the Southeastern United States than in other areas. It is thought that this may be due to regional differences in lifestyle, diet, race, and smoking habits. If you have any of these risk factors, you should be having a discussion with your doctor about what can be done to reduce your risk of stroke.
There is no cure for stroke once it has occurred. Ideally, treatment should be started within 60 minutes after arrival at the hospital. The sooner stroke is identified, and the patient gets to the hospital, the better the outcomes. Treatment is based on the type, cause, and severity of the stroke, as well as where it occurs in the brain. It also is dependent on the overall health and how a patient responds to therapy and medicine. Medications to treat stroke include clot-busting drugs, life support measures, and medications to reduce brain swelling. Surgery can be used to relieve pressure and remove clots from the brain or repair bleeding. Surgery can also be used as a preventative measure for strokes, such as blockages in the carotid artery, aneurysms in the brain, and holes in the heart from birth.
In summary, stroke is a leading cause of death and disability in the United States. Rapid recognition, including the F.A.S.T pneumonic, leads to quicker treatment and results in improved outcomes in patients who have had strokes. Identification of personal risk factors for stroke should prompt you to have a discussion with your doctor about strategies to reduce your risk of stroke. Finally, lifestyle changes should be made and include tobacco cessation, diet, and exercise, limiting alcohol intake, avoiding illegal drugs, and taking the medication your doctor prescribes for your medical conditions.
Dr. James Lee serves as the Coroner of Winn Parish. He is a General Surgeon and Surgical Oncologist who has been practicing in Winnfield for over ten years. Dr. Lee attended the University of Colorado for his medical degree. He completed his residency in Surgery at the University of Oklahoma before completing a fellowship in Surgical Oncology and Endoscopy at Roswell Park Cancer Institute in Buffalo, NY. Dr. Lee and his wife Scarlett live in Winnfield with their son and are active in the community.