What you need to know about strokes from WCH
Wooster Community Hospital has the only Primary Stroke Center in Wayne County.
Oct. 29 was World Stroke Day as declared by the World Stroke Organization as a means to raise awareness about stroke signs and symptoms, prevention, and risk-factor modification. One in four adults will have a stroke at some point during their lifetime. Stroke is the second-leading cause of death worldwide, only less lethal than heart disease. Its high prevalence and high likelihood that its victims will end up with significant disability make it very important to raise awareness in the community.
Q: What are the signs of a stroke?
A: Stroke can present with a multitude of symptoms, but in short, a stroke creates acute neurologic symptoms that seem to start relatively suddenly. Medically speaking, a stroke is damage to part of the brain as a result of interrupted blood flow.
Our blood carries oxygen and nutrients to our cells. If an artery becomes blocked, or less commonly bursts and bleeds, the cells nearby that depend on that vessel to provide blood flow are suddenly starved of oxygen and begin to die. Brain cells are the starting point for electric signals that originate in the brain and are sent through nerves to make things in our bodies happen. Therefore, death of these cells results in discontinuation of the function circuitry they are part of.
The brain has four different vascular sources of blood supply, two from each side of the body. Therefore, unless multiple arteries are blocked simultaneously, strokes usually result in weakness and/or numbness on one side of the body. They also can present with vertigo. Unfortunately, brain cells cannot regenerate, so once they are dead, it is permanent. This is part of why stroke prevention is so important.
Q: How does a stroke occur?
A: There are several different possibilities. In the most common scenario, buildup of plaque inside of arteries occurs over time and one day clots off completely or comes close enough that it cuts off the oxygen supply to the tissue beyond the blockage. In other situations, clots originate in the heart and are pumped out to the body, and the arteries that supply blood to the brain are most susceptible to receiving those clots, which can result in a vessel upstream being blocked suddenly. Stroke also can occur if a blood vessel in the brain bursts under abnormally high pressure and bleeds.
Q: What are risk factors for stroke?
A: High blood pressure is the largest single risk factor for stroke. Smoking, poor diet, lack of exercise, diabetes, high cholesterol, being overweight and a heart dysrhythmia called atrial fibrillation are other important treatable risk factors. Research suggests if these are adequately managed, as many as 90% of strokes worldwide could be prevented. Assess your risk with the Stroke Riskometer at www.strokeriskometer.com.
Q: What kind of diet modifications does this include?
A: According to the World Stroke Organization, the best diet for stroke prevention is a diet that is mostly plant-based with small amounts of meat and fish. This diet has been described as a “Mediterranean Diet,” and there is a large body of evidence to support its benefits for cardiovascular health and stroke prevention.
Q: How has COVID-19 changed stroke care?
A: By mechanisms that are not yet clear, COVID-19 infection can cause an increase in blood clotting. Having COVID-19 disease increases one’s chance of having a stroke and/or a blood clot in the lungs or legs. This is a relatively late complication of COVID-19 and not likely to occur before one is symptomatic with the illness itself. Across the nation, stroke admissions temporarily decreased, partially due to the public’s fear of coming to hospitals. Given the increased incidence of stroke during the pandemic due to the biologic effects of the virus, it has become more important than ever to seek immediate treatment.
Q: What kinds of treatment options are available for stroke?
A: The most important treatment is an intravenous medication called tissue plasminogen activase, tPA for short. Hospitals can fix some strokes with this medication, but it must be started within 4.5 hours of symptom onset. It has been around and researched for several decades now, and all of the research has broadened our knowledge of how to use this medication to provide the most good with the lowest risk when used appropriately. Clot retrieval, or physically removing the clot from the blood vessel via catheter-based tools, also is available for certain patients. This has been heavily researched and is available at large specialty hospitals. Aspirin and blood-pressure and blood-sugar management also are important components of treatment in the hospital.
Q: What should I do if I think I am or someone I know is having a stroke?
A: Call 911. Time is brain, and every minute matters in a real stroke. Someone having an acute stroke needs to be seen in an emergency department that’s qualified and capable of quickly diagnosing and caring for them. The benefits of getting to the nearest appropriate hospital greatly outweigh the risks including contracting COVID-19. Wooster Community Hospital, as the only Primary Stroke Center in Wayne County, is prepared to take care of all your stroke needs.
Dr. Brad Barone is the stroke program medical director at Wooster Community Hospital.