Emergency Alert Some Critical Questions and Answers on Strokes

Stroke is the third-leading cause of death in the U.S., after heart disease and cancer, and is the number-one cause of adult disability. Each year about 700,000 people suffer a stroke, according to the Centers for Disease Control.

A stroke can cause paralysis, speech problems, loss of sensation, difficulties with thinking and memory, coma, and even death. Recovery can be long and is often incomplete, creating a great burden on loved ones as well as patients.

Fortunately, effective ways exist to prevent many strokes. Knowing what to do when someone appears to be stricken can reduce the risk of permanent damage. The following questions and answers about stroke are based on information from the National Stroke Assoc., the American Stroke Assoc., and the Centers for Disease Control and Prevention.

What is a stroke? A stroke occurs when blood supply to the brain is blocked by blood clots or plaque build-up (an ischemic stroke), or when a blood vessel in the brain bursts (a hemorrhagic stroke). Brain cells begin to die, and permanent damage may occur in the area fed by the affected blood vessel.

Who gets strokes? Strokes can happen at any age, but three-quarters strike people over 65. Recent studies have shown troubling trends, with a threefold increase in strokes among middle-aged (35-54) American women and a much higher incidence in men and women in America than in Europe.

What are risk factors for stroke? The most important risk factors (which can be controlled) are high blood pressure, cigarette smoking, heart disease, and diabetes. Atrial fibrillation (an irregular heartbeat) and high levels of LDL cholesterol in the blood (which cause plaque buildup in blood vessels) can also be treated. In young people, illicit drugs like cocaine are a common cause of stroke. Excess use of alcohol is linked to stroke. Sickle cell disease, family history of stroke, and migraine headaches may increase the risk as well.

What are signs of a stroke? They include sudden onset of (1) weakness or numbness of the face, arm, or leg, especially on one side; (2) trouble speaking or understanding; (3) trouble seeing in one or both eyes; (4) difficulty walking, dizziness, or loss of balance; or (5) severe headache with no known cause.

What should I do if I think someone is having a stroke? “Act FAST,” urges the National Stroke Assoc. In this acronym, F stands for face: ask the person to smile to see if one side of the face droops. A is for arms: ask the person to raise both arms and watch for downward movement. S is for speech: ask the person to repeat a simple sentence and listen for slurring or inability to understand or produce words. T is for time: if any of the above symptoms occur, call 911 immediately. Brain cells begin to die at the onset of a stroke, so time means brain tissue lost or saved. Emergency treatment can reduce the risk of death and disability.

How can I reduce the risk of stroke? Most controllable risk factors for stroke relate to the health of the heart and blood vessels. Control your blood pressure, quit smoking, exercise regularly, and keep regular medical checkups. Manage your cholesterol with healthy diet choices. Avoid drinking alcohol to excess. If you are diabetic or have heart disease, work with your doctor to control these conditions. Find out if you have atrial fibrillation or circulation problems, and correct them if needed.

Balance your food intake with your activities. Eat 5-8 servings per day of fruits and vegetables, limit fat and salt intake, and avoid empty sugar calories (such as sodas and fruit drinks). Above all, make healthy lifestyle choices to maintain a healthy weight.

Where can I learn more about stroke? Visit the National Stroke Assoc. (www.stroke.org), the American Stroke Assoc. (www.strokeassociation.org), or the Centers for Disease Control and Prevention (www.cdc.gov/stroke).

Janet Jankowiak, M.D. is a geriatric neurologist with Radius Specialty Hospital in Boston.