May 22, 2003
Physicians promote awareness, prevention of stroke
By Lisa Uzzle Gates
Health and Research News Service
JACKSON, Miss.—Charles Turner’s memory is very clear about some things. He can remember selling the first fax machine in the state in the early 1970s. He remembers how much he loves playing the banjo. He remembers the stroke he had decades ago and he remembers the blinding headache that gripped him for three days in February.
The Jackson resident does not remember the five weeks following that headache, which turned out to be the warning sign of another stroke.
Stroke is the third leading cause of death in the United States and is a leading cause of long-term disability. Every 45 seconds someone in America has a stroke and every 3.1 minutes someone dies of one, according to the American Stroke Association.
Doctors and staff at Methodist Rehabilitation Center urge everyone to learn the warning signs of stroke during May, National Stroke Awareness Month.
The Jackson hospital sponsored two free stroke screenings earlier this month and will sponsor another on May 28 from 8:30 a.m. to 11 a.m. at Northpark Mall in Ridgeland.
Not every headache is a warning sign of a stroke, but Dr. David Collipp, director of rehabilitation surgery services at Methodist Rehab, said severe headaches that are persistent and unusual for someone could be a warning sign.
“I often have it described to me as the worst headache of their life,” Dr. Collipp said. “Headaches are associated with the onset of stroke because they can be the result of a vascular spasm or hemorrhage. While it would not be a good idea to have a scan for every single headache, if you are having reoccurring headaches it would be wise to have a neurologist evaluate you.”
General good health will go a long way toward preventing strokes, Dr. Collipp said, especially for people in the high risk groups. “You need to have very good control over other medical conditions, such as diabetes or high blood pressure. And, it’s important to have a good diet, exercise and watch your cholesterol and fat intake,” Dr. Collipp said
Turner says he wishes he had known the warning signs. Though he had had a stroke before, it was preceded by different symptoms. When he first developed the headache, he blamed it on the thick pollen in the Alabama campground where he and his wife, Martha, were vacationing. He took a pain reliever but the headache didn’t go away. As the headache entered the third day, the pain medication seemed to finally be working.
He remembers having a great day, playing the banjo with other campers and eating pizza, but then the “headache” came back with a vengeance. “It was just the calm before the storm,” he said. Martha Turner remembers the storm. “He grabbed his head and said, ‘It hurts,’” she said. He didn’t say another word for five weeks.
A stroke is a sudden decrease in the flow of blood to part of the brain. When the blood can’t reach the brain, brain cells become deprived of oxygen and die taking with it some functions.
Turner’s initial prognosis was not good. He was in intensive care in an Alabama hospital for 10 days and remained comatose for his entire stay. Doctors aren’t sure what changed, but shortly after arriving at Methodist Rehabilitation Center, Charles Turner started making his comeback.
He and his daughter, Deanne Turner, were in his room the day he arrived at Methodist. Out of the blue, he began to talk to her. Since then, Turner has worked hard with his doctors, nurses and therapists to get back as much of his mobility and independence as possible.
“Every day I’m able to do a little more,” he said. Since leaving the hospital, he has continued with home health care and will eventually continue outpatient therapy at the hospital’s east campus off Lakeland Drive. He attributes his recovery to fervent prayers from friends and family in five states, along with a great medical team and his own desire to get better. “You can’t lay around. You’ve got to want to do it. I want to get well. (The medical team) will tell you how and you have to do it,” he said.
Along with the lessons learned about rehabilitation, Turner has learned how important it is to understand the warning signs of stroke. He was in a high risk category because he has diabetes and had suffered previous strokes. Though his two previous strokes were very mild, statistics show that puts him at increased risk. Doctors at Methodist Rehab urge everyone to understand the warning signs developed by the American Stroke Association:
- Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
- Sudden confusion, trouble speaking or understanding
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking, dizziness, loss of balance or coordination
- Sudden, severe headache with no known cause
If you notice one or more of these signs in another person or yourself call 9-1-1 or your local emergency medical services number immediately. Treatment can be more effective if given quickly. People in these categories should be especially aware of the warning signs. Not all of these signs occur with every stroke. Sometimes they go away and return.
- Increasing age—The chance of having a stroke more than doubles for each decade of life after age 55. While stroke is common among the elderly, many people under 65 also have strokes.
- Men and women—The latest data show that, overall, the incidence and prevalence of stroke are about equal for men and women. However, at all ages, more women than men die of stroke.
- Family history and race—The chance of stroke is greater in people who have a family history of stroke. African Americans have a much higher risk of disability and death from a stroke than whites, in part because blacks have a greater incidence of high blood pressure, a major stroke risk factor.
- Prior stroke—The risk of stroke for someone who has already had one is many times that of a person who has not.
- High blood pressure—High blood pressure is the most important risk factor for stroke. In fact, stroke risk varies directly with blood pressure. Many people believe the effective treatment of high blood pressure is a key reason for the accelerated decline in the death rates for stroke.
- Cigarette smoking—In recent years, studies have shown cigarette smoking to be an important risk factor for stroke. The nicotine and carbon monoxide in cigarette smoke damage the cardiovascular system in many ways. The use of oral contraceptives combined with cigarette smoking greatly increases stroke risk.
- Diabetes mellitus—Diabetes is an independent risk factor for stroke and is strongly correlated with high blood pressure. While diabetes is treatable, having it increases a person's risk of stroke. People with diabetes often also have high cholesterol and are overweight, increasing their risk even more.
- Carotid artery disease—The carotid arteries in your neck supply blood to your brain. A carotid artery damaged by atherosclerosis (a fatty buildup of plaque in the artery wall) may become blocked by a blood clot, which may result in a stroke. If you have a diseased carotid artery, your healthcare provider may hear an abnormal sound in your neck, called a bruit (BROO ee), when listening with a stethoscope.
- Heart disease—People with heart problems have more than twice the risk of stroke as those whose hearts work normally. Atrial fibrillation (the rapid, uncoordinated beating of the heart's upper chambers) in particular raises the risk for stroke. Heart attack is also the major cause of death among stroke survivors.
- Transient ischemic attacks (TIAs)—TIAs are "mini strokes" that produce stroke-like symptoms but no lasting damage. They are strong predictors of stroke. A person who's had one or more TIAs is almost 10 times more likely to have a stroke than someone of the same age and sex who hasn't.
- High red blood cell count—A moderate or marked increase in the red blood cell count is a risk factor for stroke. The reason is that more red blood cells thicken the blood and make clots more likely.
What other factors can affect the risk of stroke?
- Season and climate—Stroke deaths occur more often during periods of extremely hot or cold temperatures.
- Socioeconomic factors—There's some evidence that people of lower income and educational levels have a higher risk for stroke.
- Excessive alcohol intake—Excessive drinking (an average of more than one drink per day for women and more than two drinks per day for men) and binge drinking can raise blood pressure, contribute to obesity, high triglycerides, cancer and other diseases, cause heart failure and lead to stroke.
- Certain kinds of drug abuse—Intravenous drug abuse carries a high risk of stroke from cerebral emboli. Cocaine use has been closely related to strokes, heart attacks and a variety of other cardiovascular complications. Some of them have been fatal even in first-time cocaine users.
How are heart disease risk factors related to stroke?
Other risk factors are secondary risk factors for stroke. They affect the risk of stroke indirectly by increasing the risk of heart disease. They include:
- High blood cholesterol and lipids
- Physical inactivity
- Obesity or overweigh