Getting The Message Out––

Stroke Is Life-Threatening, Needs Immediate Attention

By Dottie Evans

Dr John M. Murphy of Associated Neurologists in Danbury spoke February 23 to his fellow St Rose Church parishioners at the monthly Health and Wellness Seminar sponsored by the Parish Nurse Ministry.

His topic, “The Stroke Connection,” touched on a very serious cardiovascular disease that strikes more than 700,000 Americans each year. The topic had relevance for every person in the room over the age of 50, the age at which risk of stroke begins to rise. Many had already experienced the effects of stroke through watching friends or family members fall victim to its sudden and devastating onset.

“Heed the warning signs. Do not delay getting medical help, because time is brain,” Dr Murphy said more than once.

 In his 15 years practicing neurology, Dr Murphy has seen hundreds and perhaps thousands of stroke victims struggling to come back from the effects of stroke on the brain and on all bodily functions controlled by the affected areas of the brain.

 “At Danbury Hospital, we see nearly 250 cases a year, and of those, nearly one-third die,” he added.

Aside from these dire statistics, some hope could be found in administering drugs that can halt the devastating progression of a stroke. Dr Murphy also presented a clear list of avoidable or treatable risk factors that individuals could avoid, thereby lowering their likelihood of suffering a stroke.

In quiet, measured tones, he explained exactly what stroke is and why doctors consider it so serious that medical help must be sought within hours rather than days.

“Stroke kills 165,000 people each year. It is the third leading cause of death after heart attacks and cancer. Even those who survive stroke may spend the rest of their lives in assisted living facilities,” Dr Murphy said.

Ischemic Stroke: Caused By A Blood Clot

A stroke occurs when brain cells die, either because they are deprived of oxygen by a blood clot (ischemic stroke) or because they are swamped by blood pooling from outside due to a rupture in a nearby blood vessel (hemorrhagic stroke).

Brain neurons can die quickly, leading to permanent damage of the brain where the event occurred. In some cases, especially in younger stroke victims, other neurological pathways may become established around the damaged area so that full function can be restored. Sometimes through therapy and over time, new connections can be forged. In other cases, the effects of stroke are permanent and life-changing.

Ischemic stroke occurs in 80 percent of the cases. Clots that travel from the heart to the brain form for a variety of reasons, often because of a failure in the heart muscle itself. If the pumping function is faulty, blood flow is decreased and there is a build-up of blood in one of the heart chambers. If coagulation occurs, a clot may develop and break off.

“In this case, acute treatment is very important. Clot busters may be administered, but they must be given very quickly,” Dr Murphy cautioned.

Stroke may occur in the middle of the night while a person is sleeping. When the individual wakes and tries to get up, he or she falls and it seems that a stroke has just occurred when actually it happened much earlier and valuable time has been lost.

“If you witness someone who has suffered a stroke, call an ambulance right away. Don’t try to drive the victim to the hospital yourself,” he warned.

This is because the EMTs (Emergency Medical Technicians) in the ambulance can treat a stroke patient immediately, and they will call ahead to the Emergency Room so the victim is triaged even before arrival, Dr Murphy said.

A rare type of ischemic stroke is a TIA, or transient intermittent attack.

“This is a very small stroke in which the blood flow to the brain has been temporarily interrupted. It comes and goes and leaves no permanent damage, yet sufferers should pay attention to such episodes. TIA is a harbinger of what might follow.”

Hemorrhagic stroke affects 20 percent of all stroke victims. In a hemorrhagic stroke, a blood vessel in the brain bursts and the blood pools around the brain cells, eventually killing them. The pooled area may spread if the blood continues to leak out from the site.

Hypertension, or high blood pressure, can be a cause of hemorrhagic stroke. Trauma, such as a blow to the head, can be another cause.

“A sudden, severe headache is the first symptom of hemorrhagic stroke, and it may be accompanied by weakness on one side of the body,” Dr Murphy said.

He added that with hemorrhagic strokes, the clot-busting drugs are not effective since the blood is already flowing freely from the point of rupture.

A subarachnoid hemorrhagic stroke occurs when a part of a blood vessel that has ballooned out, actually bursts. Two percent of individuals have this condition where a bubble has formed but they may never suffer a rupture.

“If the balloon does rupture,” he said, “most will die as a result.”

 

Warning Signs And Risk Factors

There are definite early signs of stroke that individuals should heed. Be prepared to call a doctor or an ambulance immediately if any of the following occurs: sudden weakness on one side of the body; sudden confusion accompanied by trouble speaking or trouble understanding; difficulty in walking, drinking, or swallowing food; and sudden, severe headache the likes of which you have never experienced before.

“The headache would be instantaneous and explosive. Not like a migraine, which builds slowly,” Dr Murphy said. “If any of these severe signs occur you should call 911 right away.”

Ignoring the signs or putting off calling for help could be life threatening because doctors have approximately 180 minutes in which to deliver medicines that can counteract a stroke.

Among the risk factors that people can avoid or treat are the following: cigarette smoking; high blood pressure, also known as hypertension; diabetes; and heart disease, such as atrial fibrillation, in which the upper chambers of the heart quiver instead of beat, allowing the blood to pool.

Other risk factors include a lack of physical activity and the excessive use of alcohol amounting to more than two drinks a day at four fluid ounces per glass.

“Illegal drugs such as cocaine, crack, or amphetamines may cause a sudden rise in blood pressure, and a stroke could result,” Dr Murphy added.

Other risk factors that are “nonmodifiable,” meaning that a person would have no control over them, are the following: age, because the risk doubles with every decade over 55; gender, because men are at a higher risk than women; family history; and race, because sickle cell anemia, one cause of stroke, has a higher incidence in the black population.

 Diagnosis and treatment after a stroke occurs includes administering a CAT scan (computerized axial tomographic scan) after six to eight hours to identify the area of the brain affected; an MRI (magnetic resonance imaging) which affords detailed information regarding the affected areas; and an MRA (magnetic resonance angiography) a noninvasive procedure producing detailed images of the blood vessels leading to the brain.

 One audience member asked Dr Murphy whether taking an aspirin each day would be good preventative medicine.

 “If you are over 45 to 50 years old, you might want to take ½ a baby aspirin daily to reduce the risk. I do want to emphasize that prevention is far more important than treatment,” Dr Murphy said. “Once a stroke occurs, a cascade of events follows that cannot easily be halted.”