Different strokes for different folks: prevention through understanding - includes related information - Cover Story

Nutrition Health Review, Summer, 1996

"THE STROKE OF GOD'S HAND" were the words physicians used 400 years ago to describe what is now called simply a stroke. A stroke is a medical emergency that is every bit as dire as a heart attack, a similarity that has led some experts to call it a "brain attack." Because strokes damage the brain, the organ that guides the very core of our humanity, they are more frightening than diseases that sour the stomach or stiffen a knee.

By one estimate, the cost of stroke to the United States each year is more than $23 billion is spent on hospital and nursing home services, $2.2 billion on doctors and nurses, $400 million on drugs, and $3.4 billion on lost productivity.

More important than money, however, is the health of our nation. In the United States, stroke is the greatest cause of serious long-term disability, and is the third leading cause of death, trailing only heart disease and cancer. About 500, 000 people in the United States have a stroke each year, and nearly one third die within a few months. Among the survivors, approximately 10 percent return to their previous level of activity, about 50 percent return home but require some assistance, and 10 percent require institutionalization and a great deal of help in daily living.

A stroke, or "cerebrovascular accident," is a catchall term for two distinctly different events. What these events have in common is an injury to the blood vessels that provide the brain with the basic fuel for life: oxygen and nutrients. Deprived of a constant supply, the cells that make up the brain begin to die, taking with them the person's ability to move, speak, feel, or even think. Recovery after a strobe is limited by the inability of the brain to replace or regenerate dead cells. Sometimes recovery is better than expected, however, because other portions of the brain may spontaneously assume (or can be trained to take over) duties that had been performed by the lost tissue.

The most common consequences of stroke include motor impairment and loss of sensation, usually on one side of the body; difficulty with speech and language; limited field of vision and visual perception; loss of emotional control and changes in personality and mood; and cognitive deficits such as problems with memory, judgment, problem solving, or a combination of these.

Two major types of stroke exist, each of which has a different cause. About 80 percent of these events are ischemic in origin, which means they are caused by an interruption in the flow of blood to the brain that is almost always because of the blocking of a blood vessel by a blood clot The remaining 20 percent are hemorrhagic (bleeding) strokes, caused by the rupture of a blood vessel in the brain. In a sense, these strokes are also ischemic, since the subsequent accumulation of blood compresses crucial vessels that nourish brain tissue. The signs and symptoms that a patient displays in the hours following the onset of a stroke often provide clues about the type and location.

Just as symptoms after a stroke vary from patient to patient, so does the path that stroke takes. Men and Negroes are more likely to be affected, and because the incidence of stroke increases with age, older individuals also are at risk. For example, only 5.3 Percent of men aged 65 to 69 have had a brain attack compared with 9.8 percent of men aged 80 to 84. For women, the incidence increases from 2.1 percent for those aged 70 to 74 to 7.8 percent for those aged 85 and older. But stroke is not limited to older individuals; 28 percent of strokes occur in people younger than 65. Overall, men have about a 20 percent higher risk compared with women, and the difference is even greater before age 65. The risk of death and disability from stroke is 60 percent higher for Negroes than for Caucasians.

Because the brain is unable to repair itself, the most effective treatment is stroke prevention, and for those who do have a stroke, prompt medical attention is essential for minimizing damage and preventing a second attack.

Transient Ischemic Attacks

A transient ischemic attack (TIA), or "mini stroke," results from a temporary interruption in blood flow to the brain. It looks and feels like a stroke, but the symptoms disappear within 24 hours and cause no permanent damage. Nevertheless, TIAs should be taken very seriously because they offer a window of opportunity for preventing a full-blown stroke.

The symptoms occur suddenly and vary widely, depending on where in the brain blood flow was interrupted. They can include weakness, numbness, or paralysis of the face, arm, or leg; difficulty speaking or understanding; dizziness, loss of balance, or loss of coordination; sudden blurring or loss of vision in one or both eyes; and hemianopia (loss of one half of the visual field in one or both eyes).

A person who experiences any of these symptoms for even a short time should seek medical attention immediately. If the parietal lobe is affected, however, the patient may not be aware of the signs and symptoms, and family members or close friends are often the first to call attention to the problem.