Stroke is the third leading killer and the leading cause of disability in the United States. It affects about 500,000 people annually of which 150,000 die. A stroke is the set of signs and symptoms caused by an interruption of blood flow to the brain that lasts long enough to damage it.
Two types of stroke exist: ischemic (about 85 percent of all strokes) and hemorrhagic (about 15 percent of all strokes). Ischemic stroke victims usually have a history of other illnesses, such as hypertension, diabetes or cardiovascular disease. Ischemic stroke victims have a narrowing and obstruction of the brain's arteries causing clots to develop that cut off the flow of blood. Sometimes clots formed elsewhere (e.g., carotid arteries) can break loose and travel to the brain, causing an obstruction in blood flow. Victims of ischemic strokes have little or no headache. Victims with ischemic stroke may present with numbness and/or weakness on only one side of the body. Many victims have facial weakness that may not be on the same side as extremity weakness or numbness. These victims will have weakness, paralysis or sensory loss in one or more extremities (usually half the body).Hemorrhagic strokes tend to occur abruptly and victims may report severe "thunder clap" headache. They may also have nausea, vomiting and neck stiffness or pain. These victims tend to be very healthy prior to the onset of the stroke and may have signs on both sides of the body. The main signs and symptoms to look for are:
- Paralysis of one or both extremities on one side of the body.
- Diminished level of responsiveness, varying from alert to unresponsiveness.
- Difficulty with speech, varying from slight slurring to complete silence.
- Difficulty with vision, varying from temporary blurring to complete blindness.
- Seizures.
- Difficulty with swallowing or with breathing.
- Loss of facial expression or facial motion, usually on one side of the face.
- Headache.
Victims themselves often fail to recognize the symptoms of stroke so recognition of stroke by family members and friends is imperative. About 85 percent of all strokes occur at home, and an increasingly larger number of the elderly live alone. The term "brain attack" is replacing the term stroke. It is recognized that "time is brain" for the stroke victim, just as we have recognized for decades that "time is muscle" for heart attack victims. Stroke should be treated with the same urgency as heart attack.
Take the following steps:
- Check the ABCD: Airway open? Breathing? Circulation (is pulse present?) Disability, shown by change of mental status and/or paralysis.
- Check the pulse at the wrist and the neck. Be sure to check both carotid arteries, as the absence of a carotid pulse on one side may indicate a stroke.
- Do not allow anything to increase a victim's anxiety. Use care in what you say and what you do. Even though the victim may be unable to speak or may appear to be unconscious, he or she may still be able to hear and to understand what is taking place.
- Do not give the victim anything by mouth, as the muscles of the throat may be partly or completely paralyzed. Even a conscious victim may be unable to swallow. They will often choke on saliva or mucus, especially if they cannot swallow.
- Transport the victim quickly by calling the 911 or the local emergency telephone number.
- Place a responsive victim on his or her side, with the paralyzed side down and the head elevated about six inches. Cushion and protect the paralyzed side from injury.
While prevention and control of risk factors such as smoking, hypertension, diabetes, obesity and heart disease are the best means for decreasing the stroke rates in our country, stroke victims need rapid transport and treatment. The therapeutic window for treating stroke victims is usually less than six hours from the onset of symptoms, and the earlier the victim receives medical attention the greater the chance for improvement.
For more information on brain attacks (stroke) contact the National Stroke Association, 8480 Orchard Road, Suite 1000, Englewood, CO 80111; (303) 771-1700.