Preventative Medicine: Advice from a Neurologist

We have all heard the business-world phrase, “Time is money.”  In the medical world, when it comes to the matter of strokes, we have a similar phrase: “Time is brain.” 

Through my conversations with members of our community, I have found that many people are insufficiently informed and experience confusion when dealing with certain critical medical conditions. Unfortunately, even when patients seek medical advice, they do not always receive answers that sufficiently address their needs. One such medical condition is a stroke, a disease where early recognition of symptoms and fast access to the appropriate care is vital to the prevention of dangerous, often permanent side effects. 

Having completed a specialty fellowship in stroke management, and further equipped with over 18 years of experience in a clinical and hospital setting, I would like to highlight some information that is most critical to the treatment and prevention of strokes.  In this article, I will be addressing two areas that patient must be aware of: 1) stroke symptom recognition and timely access to medical care, and 2) the risk factors that increase the possibility of a stroke.

Before I continue, allow me first to summarize what exactly a stroke is.  There are two kinds of strokes: ischemic strokes and hemorrhagic strokes.  An ischemic stroke occurs when a blood clot either forms in or travels to a blood vessel in the brain, thereby restricting blood flow.  A hemorrhagic stroke occurs when a blood vessel in the brain either leaks or bursts.  In both cases, lack of sufficient blood/oxygen supply to all parts of the brain can result in the permanent death of brain cells and tissue.  The brain, our most vital organ, one that regulates and controls all of our body’s functions, is composed of approximately 100 billion neurons that make up a huge interconnected network much like a computer.  Depending on the type and size of a stroke, a person can lose numerous, sometimes even billions, of these neurons. And depending on the location of a stroke in the brain, loss of these neurons can result in a person experiencing a variety of often irreversible neurologic symptoms, including but not limited to: body weakness/stiffness, language issues including difficulty speaking as well as processing speech, memory loss, and even death.  

So, in the matter of strokes, what are the signs that a person must be aware of?  Symptoms of an acute stroke can be both obvious and more subtle.  The American Stroke Association provides the following acronym for the early signs and symptoms of a stroke: FAST

Facial weakness – this can include visually observable drooping of one side of the face or mouth, or a sensation of numbness/tingling.

Arm weakness – this will usually occur on one side of the body.  Put your arms at your sides, close your eyes, and raise both your arms out in front of you to shoulder height.  Open your eyes.  Are your arms at equal height?  If not, you might be experiencing a stroke. 

Speech changes – this can include slurring of words, as well as use of incoherent language and lack of comprehension.  

Time – gain fast access to medical care, call 911 or Hatzolah.

In any case, even when in doubt about whether you or someone you know is experiencing a stroke, it is always better to seek medical attention sooner than later and not to simply think that the symptoms will pass. Due to modern technology and treatment options, it is possible to reverse the symptoms of an ischemic stroke (the more common type) if treated within three hours of onset with a medication called tPA, and up to 12 hours after onset by way of clot-retrieval devices. I cannot emphasize enough how crucial time is to the prevention and treatment of strokes – never delay. I have witnessed far too many patients who have suffered the regrettable consequences of not recognizing/addressing stroke symptoms and accessing the appropriate care early enough. In the event that you do not call 911 or Hatzolah, take the patient to a comprehensive stroke center, which can usually be found at the larger hospital centers.     

What are the major risk factors that increase the possibility of a stroke?  Obviously, it is ideal for one to never experience a stroke in the first place.  Please be aware of the following key underlying medical conditions that contribute to the likelihood of a stroke:

High Blood Pressure (Hypertension).  In simple terms, elevated blood pressure usually occurs when blood vessels in the body constrict, thereby making it harder to push blood through the vascular system and forcing the heart to work harder than it should.  When this happens, different vital organs including the heart itself and the brain do not receive adequate blood/oxygen supply. Blood pressure 140/90 and above needs to be routinely observed/monitored and treated appropriately.  Often as doctors, we see that patients neglect their elevated blood pressure.  Remember: Even if you are asymptomatic and do not feel your high blood pressure, it can contribute to more severe medical issues down the line.

High Cholesterol (Hyperlipidemia).  Elevated cholesterol levels cause blood vessels to become clogged, thereby increasing the risk of stroke occurrence. Ideally is to keep Cholesterol levels less than 200 and LDL levels less than 100 or higher.  As with high blood pressure, high cholesterol can contribute to severe medical issues without you feeling it.  Cholesterol levels can be assessed by a blood test.

Diabetes.  Diabetes is a disorder where one experiences high blood sugar levels over a prolonged period of time.  A patient is considered diabetic when they present with a Hemoglobin A1C of 6 or higher.  Hemoglobin A1C is a blood test that measures your average sugar levels over the past three months.  Diabetes can lead to more severe complications including neuropathy, heart disease, and strokes.

Smoking.  Smoking is a major risk for any cardiovascular related problem, causing the hardening of blood vessels and blood circulation issues.  It is also linked to cancer development including, but not limited to, lung and oral cancers.  Smoking should be stopped by all means. 

In managing these risk factors and conditions, I strongly encourage patients to work harder in taking charge of their general health and well-being.  Efforts should be made towards the institution of vital lifestyle changes, from the development of healthier eating habits including dietary choices and restrictions, to the incorporation of daily exercise routines, to better sleeping patterns.  For many, it can be a tough undertaking, but if you do experience any or all of the above risk factors I would further encourage you to visit a specialist for help with devising a constructive plan on how to manage your condition.  In many cases, responsible and regular use of prescribed medications can be a tool in reducing your medical risk.  Think about what life would be like if you were to become severely debilitated by a stroke; consider the burden that could be on your loved ones.  You alone stand at the frontlines of ensuring your sustained health and quality of life.