Andrew Siegel, MD Blog #96
The medical term cerebrovascular accident (CVA) is more commonly referred to as a stroke because many years ago it was felt that it occurred when God “struck a person down.” Essentially, a CVA arises when there is a sudden cessation of blood supply to the brain, or alternatively, a rupture of a blood vessel within the brain. Strokes are a major cause of disability and death in Western nations and, in fact, are the number 4 cause of death in the United States. A stroke occurs every 40 seconds in the USA and a death from a stroke occurs every 4 minutes.
The brain, as with all tissues in the body, requires arterial blood flow to supply oxygen and vital nutrients in order to sustain function. When there is a blockage of blood flow to the brain or bleeding into brain tissue, there is insufficient oxygen supply to the area of concern, and within a short period of time, infarction, or tissue death, occurs. This is not unlike a heart attack (myocardial infarction), in which a region of the heart muscle dies because of insufficient blood flow; therefore, a stroke can be referred to as a “brain attack.”
There are two major kinds of strokes, ischemic and hemorrhagic. An ischemic stroke occurs when there is insufficient blood flow to the brain. This generally occurs from either a ruptured fatty plaque (thrombosis) of one of the arteries in the neck or alternatively, a clot that forms in the heart and is pumped into the brain, acutely blocking the arterial supply (embolism). Ischemic strokes account for 87% of strokes. A hemorrhagic stroke occurs when a blood vessel in the brain ruptures. Thirteen (13)% of all strokes are hemorrhagic, but the morbidity and mortality of a hemorrhagic stroke is much greater than an ischemic stroke, with hemorrhagic strokes accounting for approximately 30% of deaths from strokes.
A transient ischemic attack (TIA) is a temporary neurologic dysfunction caused by insufficient blood flow, and is the greatest predictor of stroke. TIAs do not cause permanent brain tissue damage, as do strokes. The symptoms of a TIA or stroke are very much dependent upon the location and extent of the brain tissue that is affected. Classic symptoms are the following: sudden weakness or numbness on one side of face or limb; sudden trouble speaking or comprehending; confusion; sudden visual problems; sudden difficulty walking; dizziness/balance problems; and sudden headache. Sometimes a stroke will cause no overt symptoms whatsoever; such silent strokes have been correlated with the occurrence of dementia.
The greatest risk factor for TIA and CVA is high blood pressure (hypertension). The high pressure within the arterial wall promotes dislodgement of a fatty plaque, or alternatively can stress the arterial wall to the point where the blood vessel itself ruptures. Other risk factors include the use of tobacco, excessive alcohol intake, obesity, a poor diet, and a sedentary lifestyle with insufficient exercise. Promiscuous eating is certainly a risk factor for TIA and CVA. A big risk factor for an embolic ischemic stroke is atrial fibrillation, a not uncommon cardiac arrhythmia that promotes clot formation within the heart.
To avoid or mitigate hypertension, lifestyle improvement measures are imperative. These include weight loss; the DASH (Dietary Approaches to Stop Hypertension) diet; decrease in salt intake; increase in potassium intake, which works to lower blood pressure; exercise on a regular basis; and moderate consumption of alcohol.
So what to do if you experience symptoms suggestive of a TIA or stroke? The first thing to do is to get to the Emergency Room ASAP or call 911 so that you be transported to an ER as expeditiously as possible, since time is of the essence in the management of a CVA. Many emergency rooms, in fact, have a “stroke protocol” in order to expedite the process, which requires evaluation, imaging (with computerized tomography or magnetic resonance imaging), and rapid management.
The emergency room will schedule the appropriate tests to make the distinction between an ischemic and hemorrhagic stroke. This is of fundamental importance, insofar as they are treated differently. With ischemic strokes, the expeditious use of a clot-busting medication such as tissue plasminogen activator (tPA) can make a major difference in terms of the presence or extent of the disability sustained after an ischemic cerebral infarction.
A hemorrhagic stroke (intra-cerebral hemorrhage) results in bleeding within the brain, a highly compact organ located within the closed space of the skull that has little margin for the swelling that occurs as a result of the ruptured vessel. Treatment of a hemorrhagic stroke aims to save the life of the stroke victim, alleviate symptoms, fix the bleeding and prevent complications. Blood pressure needs to be controlled, the brain swelling minimized, and supportive care administered. On occasion, a collection of blood known as a hematoma, will need to be evacuated surgically in order to take the pressure off the brain. Long-term treatment aims to help the stroke victim recover as much function as possible and prevent future strokes.
BOTTOM LINE: Maintain a healthy, active lifestyle in order to minimize the risk factors for stroke. Should you experience TIA symptoms or an actual stroke, time is of the essence: get to an ER immediately in order to maximize your chances of survival and reduced debilitating aftereffects.
Andrew Siegel, M.D.
Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food: www.promiscuouseating.com
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