The next time you think about stroke, think "brain attack." That's the message the American Heart Association and the National Stroke Association want to deliver. The symptoms of stroke should have the same alarming significance in identifying a brain attack that acute chest pain has in identifying a heart attack.

Stroke, or a "brain attack," occurs when vessels that deliver oxygen-rich blood to the brain become plugged or rupture. The sudden loss of blood flow kills brain cells in the immediate area of the stroke. Brain tissue is permanently damaged by the CVA (cerebral vascular accident), and the amount of permanent damage caused by a stroke is often devastating.Each year 550,000 Americans suffer a stroke; and 150,000 die, making it the third leading cause of death. Strokes cost the United States $30 billion a year. Brain attacks are fatal in 30 percent of the cases.

Stroke can be caused by traumatic or nontraumatic hemorrhage. The risk factors for a CVA include:

- Age (greater than 50 years old)

- Birth control pill use

- Excessive weight

- Hypertension

- Heart disease

- Sickle cell disease

- Substance abuse, particularly "crack" cocaine.

Transient ischemic attacks are closely associated with - and sometimes confused with - CVAs, since TIAs mimic many of the same signs and symptoms as stroke. The main difference between a TIA and stroke is that the symptoms of TIA are transient, lasting from several minutes (75 percent last less than 5 minutes) to several hours, with a return to normal neurological function at that time. TIAs should be considered a serious warning sign of potential impending stroke, as about one-third of all those with a TIA will suffer a CVA within two to five years of their first TIA. Consult with a physician should they occur.

The most common type of stroke (about 80 percent of cases) is "ischemic," with a clot either forming in a brain artery (thrombotic stroke) or traveling from the heart to the brain and plugging the artery (embolic). In about 20 percent of cases a blood vessel ruptures (a menorrhagic stroke). Other causes include a tumor pressing on a blood vessel, a blood vessel spasm, and an aneurysm (ballooning out of blood vessel).

Symptoms of stroke

- One-side weakness, numbness or paralysis of face, arm or leg on one side of the body.

- Blurred or decreased vision, especially in one eye.

- Problems speaking or understanding.

- Dizziness or loss of balance.

- Sudden, severe unexplained headache.

First aid

Current out-of-hospital first aid is limited to supportive victim care.

- If the victim is unconscious, check the ABCs - keep the airway open, check breathing and pulse. If there is no pulse or breathing, give CPR if you are trained. If there is a pulse but no breathing, give rescue breaths every five seconds.

- Call the emergency medical service usually by telephoning 911 in most communities. Hospitals staffed with teams trained to treat acute stroke offer the best chance for stroke victims. The first six hours are critical for minimizing brain damage.

- Lay the victim down with the head and shoulders slightly elevated. If the victim is unconscious but breathing, keep in the "recovery position," which is on his left side and chin extended to keep the airway open.

View Comments

Hospital medical care

Since clot-busting drugs (thrombolytics) have been effective for heart attacks, interest has picked up for treating early CVAs with them. The question is: Is it safe for victims of stroke? Unfortunately, the answer is not yet clear. Early research on streptokinase (STP) showed a high mortality rate. Recent studies involving tissue plasminogen activity (tPA) holds more promise for strokes.

Providing thrombolytic therapy in a short time is difficult. Even though most strokes are the result of a clot, clot-busting drugs could prove fatal if the stroke was caused by hemorrhage. The cause of a stroke can currently only be determined through angiography, computerized tomography or magnetic resonance imaging. None of these procedures can presently be performed in the field, and all take 30 minutes or more to complete.

Stroke is the most devastating, debilitating illness. Once a CVA occurs, rapid entry into the EMS system, proper assessment and manage-ment and prompt transport to the hospital contribute to ensuring successful victim outcome. In addition, thrombolytics and other medications may find a place in treating CVA victims.

Join the Conversation
Looking for comments?
Find comments in their new home! Click the buttons at the top or within the article to view them — or use the button below for quick access.