Dear Doctors Column, February 9, 2009

"Time Lost is Brain Lost." Know the Warning Signs of Stroke

Question: How can I tell if someone is having a stroke?

Answer: Knowing the warning signs and symptoms of stroke can mean the difference between life and death, and for those who survive a stroke, the difference between high and low quality of life. Everyone should learn the signs and symptoms of stroke, particularly people at high risk for stroke and partners or caretakers of those at high risk. The warning symptoms and signs of stroke are:

• Sudden weakness or numbness of the face, arm, or leg, especially on one side of the body;
• Slurred speech or trouble talking or understanding what other people are saying;
• Sudden blurred or decreased vision in one or both eyes;
• Unexplained dizziness, unsteadiness, or sudden falls;
• Sudden, severe headache with no known or apparent cause.

Stroke is an emergency; call 911 immediately. Today, with rapid evaluation and treatment, much can be done to minimize damage following a stroke . Coordinated stroke care begins with emergency assessment and treatment and continues through rehabilitation and long-term follow up.

Stroke is the nation's third leading cause of death behind heart disease and cancer, and is a leading cause of serious long-term disability. On average, a stroke occurs every 45 seconds, and every 3 minutes someone dies of stroke, according to the American Stroke Association (ASA), a division of the American Heart Association. Immediate medical attention is vital in reducing injury to the brain when a stroke occurs, yet people having a stroke tend to wait 3 to 6 hours after symptoms begin to get to a hospital. The ASA stresses "Time lost is brain lost."

Also known as a "brain attack," a stroke is similar to a heart attack. It occurs when a blood vessel bringing oxygen and nutrients to the brain bursts or is clogged by a blood clot. This rupture or blockage keeps part of the brain from getting the oxygen it needs. Without oxygen, the nerve cells in that area cannot function and die within minutes. The part of the body these cells control cannot function, which may lead to death. The symptoms and signs of stroke vary depending on the portion of the brain affected.

Early detection and immediate treatment of stroke may prevent permanent brain injury. Tissue plasminogen activator (tPA), a clot-dissolving drug that may help reduce disability from stroke caused by a blood clot (the most common type of stroke), must be administered within 3 hours after the onset of stroke symptoms to be most effective.

Often, people do not recognize these symptoms as early warning signs of stroke because they can disappear within a few minutes. Stroke symptoms that occur for a short time and disappear are called transient ischemic attacks (TIA) or "mini strokes" — about 30% of people who have a stroke have had a previous TIA. Appropriate treatment after a TIA can decrease the chances of a full-blown stroke. Treatments range from taking aspirin to decrease the chances of another clot forming to procedures to relieve blockages in the carotid arteries in the neck, which carry blood to the brain. It is important to remember not all of these symptoms occur in every attack, and sometimes they go away.

The most important thing to remember about treatment of strokes today is that all treatments have the best chance of preserving brain function and limiting disability if begun within the first few critical hours after stroke symptoms appear.

The ASA recommends people suspected of having a stroke be treated in hospitals that provide specialized stroke care. If you suspect someone is having a stroke, call for emergency help and get to the hospital right away. Getting immediate medical help as soon as you or a loved one experience any signs or symptoms of stroke is your best hope of avoiding permanent paralysis and the loss of speech and mental function stroke can bring.

Stroke is largely preventable by practicing healthy lifestyle habits that reduce the risk of heart disease and stroke: Controlling high blood pressure; maintaining healthy blood cholesterol levels; eating foods low in saturated fat and cholesterol; being physically active; maintaining a healthy weight; stopping smoking; and getting regular medical checkups. Take the time now to evaluate your lifestyle and make the necessary adjustments to reduce your risk.

For more information on stroke visit the ASA Web site and the National Stroke Council.