Text by Henrylito D. Tacio
Photos: Mayo Clinic, neuroskills.com, and cardiosmart.org
KAREN, 45, has just finished eating her supper. She went straight to her living room and watched her favorite soap opera. After a few minutes, she stood up, but to her horror, she could not move – as if half of her body was dead. She tried to call her daughter, who was still in the kitchen, but her speech was garbled. She lost vision in one eye and saw double for a few minutes.
Karen was experiencing what medical science called a “transient ischemic attack” (TIA), also known as a mini-stroke. TIA, which lasts only seconds, is a warning that a full-blown stroke could happen in the near future.
Unfortunately, most people ignore TIAs. It’s not until they have a stroke or “brain attack” that they start doing something about it. By this time, it’s already too late. Stroke is the third-leading cause of death in Asia – after cancer and heart disease, according to the regional office of the World Health Organization based in Manila.
“Don’t confuse a stroke with a heart attack,” reminds Dr. Isadore Rosenfeld, the bestselling author of “The Best Treatment.” “A stroke is what happens when the blood supply to a portion of the brain is interrupted; a heart attack is what you suffer when the blockage is in an artery within the heart.”
The American doctor further explains: “Since the brain controls speech, movement, sensation, intelligence, and a host of other vital bodily functions, whether or not one survives a stroke, and in what condition, depends on the mechanism by which the blood supply to the brain was cut off, the size of the artery involved, and the specific area of the brain that was damaged.”
The Mayo Foundation for Medical Education and Research, based in Rochester, Minnesota, says there are two main types of stroke: ischemic and hemorrhagic. In ischemic, about 80 percent of strokes are caused by atherosclerosis (buildup of cholesterol-containing fatty deposits called plaque). The growth of plaque roughens the inside of the artery. The irregular surface can cause turbulent blood flow around the buildup – like a boulder in a rushing stream – and trigger the development of a clot.
More than half of ischemic strokes are caused by stationary (thrombotic) blood clots that develop in the arteries leading from the heart to the brain – typically the carotid arteries in the neck.
A less frequent form of ischemic stroke occurs when a tiny piece of clotted blood breaks loose from the artery wall and is swept through larger arteries into smaller vessels of the brain. A clot that may have developed in a chamber in the heart can also break loose. If the moving (embolic) clot lodges in a small artery and blocks blood flow to a portion of the brain, a stroke occurs. “An ischemic stroke usually affects the cerebrum, the portion of your brain that controls your movement, language and senses,” says the Mayo Foundation.
The hemorrhagic type of stroke occurs when a blood vessel in the brain leaks or ruptures. Blood from the hemorrhage spills into the surrounding brain tissue, causing damage. Brain cells beyond the leak or rupture are deprived of blood and are also damaged.
According to the Mayo Foundation, one cause of hemorrhagic stroke is an aneurysm. This “ballooning” from a weak spot in a blood vessel wall develops with advancing age. Some aneurysms may also form as a result of a genetic predisposition. As an aneurysm forms, the vessel wall becomes thin and stretched. An aneurysm that grows to at least three-eighths of an inch in diameter (about the size of the head of a thumbtack) is most likely to rupture.
The most common cause of hemorrhagic stroke is high blood pressure (hypertension). The constant force exerted by uncontrolled high blood pressure can weaken blood vessel walls. Eventually, the small blood vessels in the brain can hemorrhage. Hypertension increases the risk of a hemorrhagic stroke whether or not a person has an aneurysm.
An uncommon cause of hemorrhage is the rupture of an arteriovenous malformation. This congenitally malformed network of thin-walled blood vessels can burst and allow blood to lead into the brain, damaging or destroying tissue.
“Hemorrhagic strokes are less common than ischemic strokes – but more often deadly,” warns the Mayo Foundation. “About 50 percent of people who have hemorrhagic strokes die compared to about 20 percent for ischemic strokes. Strokes that occur in young adults are typically hemorrhagic.”
Up to 80 percent of strokes may be preventable through lifestyle changes or drugs. Some risk factors that cannot be controlled are age (older people have a much greater stroke risk than their younger counterparts), being male, diabetes (although this disease is treatable, having it makes a person much more likely to suffer a stroke), heredity (risk is greater for people who have a family history of stroke), and prior stroke (the risk of stroke for someone who’s already had one is many times that of someone who has not).
While those mentioned above can never be treated, there are those that you can do something about. These are:
· High blood pressure. Experts claim that if hypertension is controlled, the risk of stroke is greatly reduced. This is the reason why everyone’s blood pressure should be checked annually. Oftentimes, simply eating a healthier diet and maintaining proper weight can control hypertension. Drugs to control blood pressure are also available.
· Heart disease. Anyone with any type of heart disease should see a doctor regularly. Good management of heart disease reduces the risk of stroke.
· Cigarette smoking. Recent studies show that cigarette smoke is an important risk factor for stroke. Quitting smoking reduces the risk of stroke, even in long-time smokers. Studies have shown that within years after men and women stop smoking, their stroke risk declines to the level of nonsmokers.
· High red blood cell count. An increase in the red blood cell count is a risk factor for stroke. The reason is that increased red blood cells thicken the blood and make clots more likely. This problem is treatable by removing blood or administering “blood thinners.” A complete blood count is a simple test that can detect this problem.
· TIAs. Only about 10 percent of strokes are preceded by mini-strokes. Nevertheless, TIAs are extremely important; they’re strong predictors of stroke. Antithrombotics such as aspirin, which interfere with blood clotting, are the standard therapy.
If a doctor believes that a person runs the risk of suffering a stroke, he may well put that person on drug therapy that lessens the chances that a clot will form, blocking an artery either leading to the brain or within it.
Meanwhile, for many people recovering from a stroke and for their families, dealing with psychological and social consequences is more difficult than adapting to physical and mental limitations, according to the Mayo Foundation.
Studies have shown that up to 60 percent of people who have a stroke develop symptoms of depression. About one-third feel angry or anxious. Others have periodic bouts of sadness or crying.
Social isolation, meanwhile, initially stems from a physical disability but often continues even when physical limitations are overcome. Feelings of depression or anger may cause a sense of isolation.
If you’re one of those who have suffered from crippling strokes, don’t be disheartened (no pun intended). There is life after a stroke. Look again at the case of Patricia Neal, who suffered a series of near-fatal strokes in 1965. Though pregnant at the time of the first stroke, she bore a normal child. She resumed her acting career in 1968 and received an Academy Award nomination for Best Actress for her electrifying performance in The Subject Was Roses.
American president Dwight David Eisenhower made a quick and complete recovery from a stroke in 1955. The following year, he was re-elected to a second presidential term. In retirement, he remained active in politics and wrote three books. An avid golfer, he scored his only hole in one in 1968, 13 years after his stroke and a year before his death.
And who can forget George Frederick Handel, a German-British composer who suffered a stroke in 1737, at age 52? Five years later, he composed The Messiah and continued to compose until his death in 1759.
Now, who says there’s no life after a stroke?