Ischemic stroke occurs when blood stops flowing to part of your brain and cells begin to die. Depending on what area of the brain is affected, one can experience a loss of movement, speech, understanding and, if extensive enough, death. A patient’s lifestyle choices and proper physician management can avoid many strokes and minimize the impact of those that do occur. When patients fail to modify risk factors and physicians fail to provide necessary care, a stroke can strike at any time. Here are some things you should know:
- Patients need to do their part and check their blood pressure, watch their cholesterol and exercise regularly. Although blood pressure readings at physician offices can be artificially high, repeated blood pressure measurements at home provide a more realistic assessment of one’s blood pressure. Elevated blood pressure above 120 / 80 increases the work the heart must do to pump blood to the body. This increased pressure in the small arterioles going into the brain causes wall thickening that reduces blood flow. High cholesterol and elevated lipids lead to atherosclerosis, which also compromises the lumen of the arterioles the blood must flow through to get to the brain. Finally, aerobic exercise reduces your risk of both heart attack, stroke and cognitive decline. By monitoring your blood pressure, checking your cholesterol and exercising, patients can reduce their risk of stroke.
- Physicians need to do their part by looking for and treating hypertension and hypercholesterolemia in their patients. By aggressively treating high blood pressure and reducing it to under 120/80, the risks of both stroke and cognitive decline can be reduced. By treating hypercholesterolemia and hyperlipidemia, physicians can also reduce atherosclerosis that builds up in vital arteries and reduce the risk of ischemic stroke. Failing to address hypertension and hypercholesterolemia falls below the level of care one should expect from a physician and can lead to an unnecessary stroke. Over time, uncontrolled blood pressure and cholesterol will cause occlusion of critical brain arterioles and stroke.
- Physicians and patients both need to be alert for the signs of acute stroke. FAST – Facial droop, Arm weakness or Speech difficulties mean Time to call 911. Getting to an emergency room as soon as possible after an ischemic stroke is critical if one is going to benefit from the clot-dissolving drug, tissue Plasminogen Activator (tPA). TPA can be given intravenously up to 4.5 hours after acute onset of symptoms and can reverse the occlusion, restore function and prevent permanent disability. When patients present to the ER with signs of possible stroke, a Code Grey should be called to start the rapid workup with a CT scan of the brain to confirm that the stroke is ischemic and, unless there are contraindications, offer the patient treatment with tPA. Failing to offer tPA treatment to an acute stroke patient who presents within that 4.5 hour window falls below the expected standard of care and risks the loss of a chance of cure.
Recent studies have shown that, even if the 4.5-hour window for intravenous tPA is missed, mechanical removal of large clots with a catheter threaded into the brain can now be done successfully and save many patients from life-long disability that previously was unavoidable. When MRI studies confirm that viable brain tissue exists, mechanical thrombectomy provides a last chance to cure a patient from the devastation of stroke.
Too often, stroke patients fail to realize that preventative care and available treatment can preempt permanent stroke injury. Patients can take the first step in avoiding stroke by making smart lifestyle choices. Physicians can minimize the risk of stroke by recognizing and aggressively treating elevated blood pressure and cholesterol in their patients. If an ischemic stroke occurs, physicians need to take immediate action to prevent its permanent and devastating effects.