A deadly enemy attacks almost 700,000 Americans each year, killing nearly one in four and leaving most of the rest disabled for life. Millions more are on the killer's list of potential victims, but most don't know it -- and they probably wouldn't know how to recognize the enemy if it struck them.
And even though there's an effective weapon to fend off this lethal foe, only 3 percent of those who might use it actually do. Hundreds of thousands die or suffer needlessly because they don't take defensive action fast enough.
The enemy in question is stroke, the third most common cause of death in the United States and the leading cause of long-term disability. Right now, doctors and scientists are waging an all-out war to improve diagnosis and treatment of stroke, and to raise public awareness of the risks and symptoms of these "brain attacks".
But a University of Michigan Health System stroke expert says that all Americans need to join the fight, and make a battle plan for themselves and their loved ones to fend off the effects of a brain attack.
"The numbers are simply staggering, and they're increasing" says Phillip Scott, M.D., a researcher in the U-M Stroke Program and assistant professor of emergency medicine at the U-M Medical School. "It is common, it is lethal, and it is expensive for families and for society as a whole. And with the aging of the baby boom generation it will be a much greater problem in the decades to come."
Scott urges men and women to learn whether they or their loved ones might be at risk for brain attack, to know how to recognize the symptoms of brain attack, to learn what to do when one occurs, and to plan where to seek the most effective medical treatment if a stroke strikes.
The first step in any such plan, he advises, is to realize just how severe stroke can be. "A 'brain attack' is the term that has been developed for a stroke, in order to help patients feel the same sense of urgency they would with chest pain and a heart attack," he explains. And just like heart attacks, preventive measures and quick response in an emergency can make all the difference between life and death.
Second, learn whether you or someone you love is at risk of having a stroke. The biggest risk factor is age -- stroke risk doubles in each decade of life after age 55. Smoking also increases stroke risk, as does being African American or Asian.
So do medical conditions such as high blood pressure, diabetes, cardiovascular disease (problems with the heart or blood vessels) or atherosclerotic disease (hardening of the arteries). And anyone who has had a stroke or "mini-stroke" (called a TIA for transient ischemic attack) in the past is likely to have another, even more serious brain attack in the future.
Many of these risk factors can be changed, Scott notes. With a better diet, regular exercise, and perhaps drugs to control high blood pressure, many at-risk people can cut their chance of a stroke.
The third step in your battle plan for yourself or your loved one is to get to know the basics about what a stroke is and what can be done about it.
The most common form of brain attack, Scott explains, is an ischemic stroke, where a blood clot lodges in a blood vessel and disrupts blood flow to the brain. This accounts for more than 80 percent of all strokes. The other variety, hemorrhagic, occurs less frequently, where there is actually bleeding into the brain from a weakened blood vessel.
There is only one effective treatment for ischemic brain attack: the speedy administration of a drug known as tPA, which stands for tissue plasminogen activator. This 'clot busting' drug, if given within three hours of the onset of the stroke, can dissolve the blood clot and restore blood flow to the brain, minimizing or even reversing permanent damage.
This time factor is a significant challenge in treatment because many people delay going to the hospital when they have a stroke, and because many hospitals across the country are unable to both confirm the stroke is ischemic and administer the medication quickly.
Shockingly, only about 2 or 3 percent of Americans experiencing a stroke receive tPA within three hours of the start of symptoms, though tPA has been available since 1996. Many don't realize they are experiencing a stroke. Others experience the stroke at night when there is no one to help them.
Scott and others are working to help emergency responders and doctors at smaller hospitals understand how to identify patients who could benefit from tPA, and help them or get them to a center that can treat them. Meanwhile, research at UMHS and other major stroke centers is focusing on testing the next generation of treatments beyond tPA, including drugs that can protect the brain from damage or help tPA do its job, and interventions to take clots out of the way.
For the time being, though, tPA is the best weapon available against most strokes. Here's how it works: When a clot is lodged in a blood vessel in the brain, the oxygen supply the brain needs is blocked. As brain cells experience oxygen starvation, they begin to die. This is why people experiencing a stroke have the symptoms they do: portions of the brain are dying, so the brain isn't sending good messages to muscles or organs.
TPA can dissolve clots so that oxygen-rich blood can again nourish the brain. The sooner tPA is administered, the greater the chance of minimizing or avoiding permanent brain damage. In some cases, damage can even be reversed.
The fourth key component for any brain attack battle plan is for the at-risk person and those who love him or her should know what the signs of stroke are, and to act as soon as they happen.
Because the symptoms of a brain attack are so varied, it is often difficult for a patient -- or those nearby -- to understand that a medical emergency is taking place. Typical signs and symptoms of ischemic strokes that everyone should be aware of include:* Sudden weakness in an arm or leg* Sudden onset of vision changes * Sudden sensory loss* Sudden numbness or tingling* Dizziness or vertigo, including sensations of spinning.
Hemorrhagic strokes often feel like the sudden onset of a severe headache, often referred to as a 'thunderclap' or the worst headache of a person's life. This type of stroke should never be treated with tPA, but emergency medical treatment is still essential. A CT scan can show what's going on.
This list includes only the most common symptoms, Scott notes -- any sudden change in a person's condition should be heeded.
"There's a wide variety of symptoms in people who come to the emergency room, and the range of severity is fairly broad," he says. "For example, one person may have weakness in a hand, and not be able to lift a coffee cup, but another person might have an entire half of the body paralyzed." A recent study led by a U-M physician found that women are much more likely than men to have "non-traditional" symptoms from strokes, including pain, shortness of breath and palpitations.
Lack of familiarity with symptoms is a huge problem, Scott says. "From data published by the American Heart Association, 25 to 40 percent of all patients can only name one sign or symptom of a stroke. So many patients are having strokes and they don't recognize it early enough, or their friends and family don't recognize it," he explains. Many times, though, it is a family member or someone close to the patient who first recognizes that something is unusual.
The fifth aspect to an anti-stroke battle plan is knowing what to do when a brain attack hits.
The willingness to pick up the phone and call 911 is all-important. Emergency health care providers everywhere urge people to call 911 and not worry about over-reacting when a stroke is suspected. Research shows that patients who call 911 get to the hospital faster for diagnosis and treatment than those who drive themselves or have someone else drive them to the emergency room.
Scott recommends that people at risk for stroke should make sure they -- and those close to them -- are aware of the nearest emergency room that can quickly diagnose stroke and treat it with tPA. Not every hospital has the 24-hour medical imaging, experienced staff and on-call specialists that are all needed to treat stroke promptly. Scott and others are working to change that.
If you're not sure if your local hospital is prepared, call them or your physician now to ask where the nearest stroke center is. That way, you'll be ready to head to the right place if a stroke strikes. Those who live alone should arrange to have someone check in on them regularly.
All in all, Scott urges everyone to take up arms in the war against brain attacks. "Patients with risk factors for stroke would be well-advised to have a plan in place to seek proper medical attention should the signs or symptoms of a stroke present themselves," he says. Together with the medical community, individuals can help turn the course of the war.
For more information, visit the following web sites:
U-M Health Topics A to Z: Strokehttp://www.med.umich.edu/1libr/topics/brain13.htm http://www.med.umich.edu/1libr/heart/highbp05.htm
American Stroke Associationhttp://www.strokeassociation.org
National Institutes of Health: Strokehttp://health.nih.gov and scroll to stroke
Written by Mary Beth Reilly and Kara Gavin
RSS