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Know Stroke's Warning Signs Before One Strikes

That knowledge just might save your life, doctors say

SUNDAY, May 23, 2004 (HealthDayNews) -- Stroke is the leading cause of disability for American adults, striking some 700,000 people a year.

But many don't recognize its first signs.

Ask yourself this: Can you name any of the most common symptoms of stroke?

The National Institute of Neurological Disorders and Stroke offers this list:

  • Sudden numbness or weakness of the face, arm, or leg (especially on one side of the body);
  • Sudden confusion, trouble speaking or understanding speech;
  • Sudden trouble seeing in one or both eyes;
  • Sudden trouble walking, dizziness, loss of balance or coordination;
  • Sudden severe headache with no known cause.

If you came up with one or more of these symptoms, you deserve some congratulations. Better still, you might be one of the lucky people who, should you suffer a stroke, will have the wherewithal to seek treatment fast enough to save your brain from devastating injury.

If you didn't know any of the symptoms, now might be the time to learn since May is National Stroke Awareness Month.

Strokes come in two varieties: Ischemic attacks, in which a clot blocks blood flow in an artery or vessel; and hemorrhagic, in which a blood vessel in the brain bursts. In either case, the loss of blood starves brain cells in the affected area of nutrients, causing cells to die.

When a stroke is mild, the loss of brain cells can have little or no impact on a person's ability to function. But when neurons die in important centers of the organ, people can be left without the ability to speak, walk or remember.

Treating stroke involves administering a drug called tissue plasminogen activator (tPA) soon after an attack. This substance is a powerful clot dissolver -- the circulatory system's version of Drano -- and it can reduce the neurologic damage from stroke significantly.

Although the National Stroke Association says "time is brain", most people in the United States don't get treated rapidly enough after a stroke begins. According to the group, 13 hours was the median time from onset of the attack to when patients arrived at the hospital in 1993. One in two stroke patients who die do so before they reach a hospital, according to the U.S. Centers for Disease Control and Prevention.

That's especially worrisome because people who reach the hospital within three hours of the start of a stroke have a 30 percent to 50 percent chance of a near or total recovery from the attack, said Dr. Steven R. Levine, a neurologist at the stroke program at Mount Sinai School of Medicine in New York City.

"The brain is an exquisite organ that's very sensitive to time," Levine said. "The sooner you treat within the three-hour window, the better outcome for the patient."

But what happens to areas of the brain affected by blood loss? Can they be regenerated? "That's the zillion-dollar question," Levine said. Experiments with stem cells and other neuron-promoting therapies are under way, he said, but nothing is available yet.

While strokes may occur in the body's hidden machinery, they can be prevented. Smokers, diabetics and people with high cholesterol and high blood pressure are at greater risk of stroke than others. Controlling these risks -- by quitting smoking, exercising and keeping blood sugar, cholesterol and blood pressure in check -- can reduce the odds of a brain attack.

Medications can also help. Drugs such as ACE inhibitors, which control blood pressure, and statins, which lower cholesterol, lower the risk of stroke.

Recent decades have seen major improvements in stroke care beyond the arrival of tPA, which was first approved for use in heart attack patients in 1987. (The drug was approved for use in ischemic stroke patients nine years later.)

Structural changes in stroke care have made a difference, Levine said. These include designating certain hospitals as stroke centers, and transporting patients to these specialized facilities instead of to conventional emergency rooms. Another big advance: Keeping stroke patients in dedicated stroke wards with expert nurses who are trained to watch for signs of infections, leg clots and other complications that can kill stroke victims during recovery.

It pays to learn where your nearest stroke center is, Levine said, in case you need to direct someone, including an ambulance crew, there. "It's a great concept to keep in your mind. It may not be that the ambulance knows where to go."

Most important, he said, know what a stroke feels like -- before you suffer one.

More information

The National Stroke Association tells you how to recognize the symptoms of stroke. The American Heart Association has more on tissue plasminogen activator.

SOURCES: Steven R. Levine, M.D., professor, neurology, Mount Sinai School of Medicine, New York City; National Stroke Association, Englewood, Colo.; U.S. Centers for Disease Control and Prevention, Atlanta
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