Understanding Strokes

Recognizing and responding immediately to the warning signs of stroke by calling 911 can significantly improve survival and recovery.

Only 20 per cent to 25 per cent of those who have a stroke actually get emergency care and treatment within the early hours of the onset of symptoms–the critical time frame during which clot-busting drugs are most effective. A stroke can be treated, IF you recognize and respond to the five warning signs of stroke.

• WEAKNESS: Sudden loss of strength or sudden numbness in the face, arm or leg–even if temporary.
• Sudden difficulty speaking or understanding; or sudden confusion–even if temporary.
• Sudden trouble with vision–even if temporary.
• Sudden severe and unusual headache.
• Sudden loss of balance, especially in conjunction with any of the above signs.
  
  Source: Heart and Stroke Foundation of Manitoba

Bret Michaels wasn’t the first, of course, but his stroke last spring seemed to be the first domino to fall in a string of celebrity stroke incidents. Initially, the rocker’s spokesperson said that Michaels was “fighting for his life,” but miraculously, within days he was in the midst of a remarkable recovery–appearing just weeks later on the Celebrity Apprentice finale apparently none the worse for wear. Not so with former child star Gary Coleman, who was dead of a stroke just weeks later.

These two cases put stroke front and centre in the minds of many who typically hadn’t given Canada’s third leading cause of death any thought. They also illustrated the two extreme outcomes of stroke, but in between lies a range of stroke-related impairment that costs Canada’s health care system $2.5 billion a year, according to a recent study by Dr. Mike Sharma, director of Ottawa Hospital’s regional stroke program, who says, “The cost of stroke is far more than we expected—at least double previous estimates.” In Manitoba, there are approximately 2800 hospitalized cases and 700 stroke-related deaths every year.

Surprise, surprise, the higher a person’s degree of obesity, the higher their risk of stroke–regardless of race, gender and how obesity is measured, according to a new study published in Stroke: Journal of the American Heart Association.

It has become a running gag to joke about smelling “burning toast”–having a stroke–after a momentary lapse in concentration, but many would be hard-pressed to define what a stroke actually is, and it’s no laughing matter.

About 80 per cent of strokes are “ischemic,” caused by the interruption of blood flow to the brain due to a blood clot, and about 20 per cent of strokes are “hemorrhagic,” caused by uncontrolled bleeding in the brain due to a burst artery. There are over 50,000 strokes in Canada each year–roughly one stroke every 10 minutes–and stroke kills 14,000 of those victims outright. At any given time, about 300,000 Canadians are living with the effects of stroke, with 75 per cent living with some sort of residual impairment, and 50 per cent suffering severe impairment–many so severe that long-term care is required.

Doctors attributed Michaels’ remarkable recovery to the fact that he recognized what was happening, “fought to stay conscious,” and sought immediate medical attention. That made all the difference because with stroke, time is the key. For each hour without treatment, the brain loses as many neurons as it does in about 3.6 years of normal aging.

For those who suffer significant impairment, the effect on quality of life can be devastating. Fred Wahl is a local man who, as he puts it, “got up one morning and was just out of it.” The long-time milkman who had missed only four days of work in almost 40 years now relies on regular visits from Heart and Stroke Foundation of Manitoba care workers, but his wife Gail is his primary caregiver. He can’t go out into public places where there are a lot of people and noise without getting a headache. In a sense, because doctors also say Fred can’t be left alone because of the risk that he might wander away, Gail has also become homebound by Fred’s stroke.

Now that you’re good and spooked, it’s time to talk cause. High blood pressure is the number one risk factor for stroke, yet 43 per cent of Canadians with high blood pressure don’t even know they have it because there are no symptoms. “It’s a looming kind of thing because of the fact that obesity is increasing along with high blood pressure,” says Lisa Scharf, physical activity and heart health manager for the Heart and Stroke Foundation of Manitoba. “The statistics about high blood pressure are alarming; between 1994 and 2005, high BP rates have skyrocketed by 77 per cent,” Scharf notes. “The thing about that is that we’ve got a demographic of younger people aged 35 to

49 for which the prevalence of high blood pressure has increased by 127 per cent, making stroke a very serious concern, but the scariest part is, a lot of the risk factors for stroke–obesity, high blood pressure and diabetes–are also increasing.”

One of the most unsettling aspects of stroke is the fact that people often mistake warning signs for benign “spells” of some sort. “A lot of times, people don’t recognize the warning signs, or they notice them, but don’t feel that they are having a stroke,” emphasizes Scharf, adding that a person might experience a headache that seems to be a bit different from their typical headache, but they don’t necessarily make the connection that this headache might actually be a warning sign for stroke. “They may experience something called a TIA (Transient Ischemic Attack),” she explains, “and maybe will get a temporary dizzy spell, and then, once that has passed, they think that everything is fine. What they probably don’t realise is that something bigger may potentially be brewing and that it needs to be checked out. Your body is very good at warning you of things to come, so if you experience any of those warning signs, you need to seek medical attention.”

Along with the array of fearsome residual effects of stroke, victims often end up with regret, just to twist the knife, due to the fact that risk factors are so easy to mitigate. “Men need to get their blood pressure checked regularly,” emphasizes Scharf, “know their numbers and take action to make sure that blood pressure is controlled. High blood pressure is very preventable, and it’s the number one modifiable risk factor for stroke.” Read that: Stroke is, in many if not most cases, preventable.

“You try to explain to friends and family what you are going through,” says Wahl, “but they don’t understand the serious effects of stroke. Nobody should have to go through what I am going through. I’d just like people to know to keep an eye on their blood pressure. I didn’t and that’s why (this stroke) came in the middle of the night without warning. There’s so much that I used to take for granted. A lot of people say I am lucky, but in a way I am not because I can’t do things like I used to.”