Health: Optimal Treatment for Stroke Victims

by Erik Everhart, Ph.D., Janet L. Shucard, Ph.D. and Teresa Quatrin, M.D. and David W. Shucard, Ph.D.

Optimal stroke treatment protocols have been developed, but many hospitals fail to follow them. Stroke is the MOST PREVENTABLE cause of death and disability in the US. Yet more than 750,000 Americans experience strokes each year...approximately 160,000 of these people die ...and 200,000 live with lasting disability. It behooves everyone, then, to get educated and seek the latest facts about stroke. Changes are that you or someone you love will be seriously debilitated or die from a stroke.

What is a stroke? A stroke occurs when the blood supply to a part of the brain is interrupted. Without oxygen and nutrients, brain cells die within minutes, potentially damaging areas that control movement, speech and even involuntary activities, such as breathing. First, let's understand the types of stroke and then we'll discuss optimal treatments.

There are two types of strokes:

1. Ischemic. Approximately 80% of strokes are ischemic - a blood clot stops the blood supply to an area of the brain. Carotid stenosis is only one type of several ischemic strokes, but accounts for more than 50% of all strokes. When fatty deposits accumulate in the carotid artery, which carries blood up through the neck, they can impede brain circulation enough to cause a stroke.
2. Hemorrhagic. An estimated 20% of strokes are hemorrhagic - a broken or leaking blood vessel causes bleeding into or around the brain. Many people are deeply concerned about strokes because stroke is the most preventable cause of death and disability in the US. Yet more than 700,000 Americans experience strokes each year...approximately 160,000 of these people die ...and 200,000 live with lasting disability.

What is a TIA, or Transient Ischemic Attack?

A TIA can cause dizziness, numbness or paralysis on one side of the body...or other stroke symptoms that disappear after minutes or hours. Sometimes, people fall to the floor and can't account for the event except to say that they "sat down" or "fell down". They may not be able to move for a few minutes, or the episode might be so fleeting that it passes in seconds. However, every TIA dramatically increases risk for a full-blown stroke. After a TIA, ask your doctor about taking anti-platelet medication, such as aspirin, (Plavix) or Aggrenox along with aspirin.

Why do Strokes Happen?

You can't change some risk factors. If you have a parent or sibling who has a stroke, you are at greater risk yourself. Your age also plays a role. Overall risk increases as we grow older. More than two-thirds of strokes occur in people older than age 65.

With so many misdiagnosed and mis-treated strokes, what is going wrong?

According to a US survey, only a very small percentage of stroke patients are getting tissue plasminogen activator (tPA), a powerful clot-busting drug that must be administered within three hours of the start of a stroke to have a beneficial effect. Researchers reviewed the records of nearly 2,100 people treated at 15 hospitals in Michigan who had an ischemic stroke, the type of stroke caused by a blood clot.

Only about 2% of the patients received tPA according to the survey. The survey found that 41% of the stroke patients did not receive tPA because they got to the hospital after the three-hour time frame.

Why the Delay?

"The first problem is people don't recognize the warning signs of a stroke, and don't act on those warning signs...Those patients receiving tPA - which dissolves stroke-causing clots-within three hours of the onset of symptoms are three times more likely to have a good outcome as those who are not given tPA. Yet only 2% and 3% of stroke patients receive this treatment."

Approximately 10% of patients who experienced a TIA go on to have a stroke within the next three months. If you think you are having a stroke, call 911. Studies have shown that treatment may be delayed if you first call your doctor or hospital. While waiting for emergency help (do not drive), lie down in a comfortable position that allows you to breath freely.

Caution, It is not recommended that you take aspirin for a suspected stroke. While its clot-fighting ability may help if you are having an ischemic stroke (or heart attack), it could make things worse if you are actually having a hemorrhagic stroke.

The Right Diagnosis

At the hospital, brain imaging is one of the first tests performed to help diagnose a stroke and determine its type. Usually, this is done using a standard computed tomography (CT) scan. This painless, non invasive test takes multiple detailed images of the brain.

Risk Factors

If you have a parent or sibling who has a stroke, you are at greater risk yourself. Your age also plays a role. Overall risk increases as we grow older. More than two-thirds of strokes occur in people older than age 65.

Early Research Points to Gender Differences

Some early research is beginning to detect slight gender differences that can account for stroke To recognize faces facial expressions, young boys use more of their right brains, while young girls use more of their left brains. This suggests that the brains of boys and girls are organized differently. It may also suggest that men and women who suffer brain injuries will benefit from different treatment regimes.

At the State University of New York at Buffalo School of Medicine and Biomedical Sciences, D. Erik Everhart, Ph.D., Janet L. Shucard, Ph.D., Teresa Quatrin, M.D. and David W. Shucard, Ph.D. conducted research with children and teenagers to see if boys' and girls' brains are already differentiated before puberty.

To recognize faces and identify facial expression, both with equal skill, boys use more of their right brain and girls use more of their left brain. This suggests that the brains of males and females are organized differently before adulthood, and may mean that men and women who suffer brain injuries will benefit from different treatment regimes.

"It is possible," the authors speculate, "that boys process faces at a global level (right hemisphere), whereas girls process faces at a more local level (left hemisphere)." If so, they add, "the girls' approach could be more of an advantage in detecting the fine changes in affective expression, and thus they would be better at reading people."

Finally, the authors explore their implications for how injury to different parts of the brain, for example from strokes, might differently affect the sexes. "The deficits in face processing and emotion perception that occur following injury to this [face-processing] region," they write, "impact the patient socially and have wide-ranging effects on their relationships, employment and more." Understanding the differential damage caused by a brain lesion can, they explain, help determine the future course of treatment based on gender characteristics.

Resources:

Know stroke: Know the signs. Act in time.
PubMed Literature Research Tool [1]
Acute Stroke Management [2]

Reference:

"Sex-Related Differences in Event-Related Potentials, Face Recognition, and Facial Affect Processing in Prepubertal Children". D. Erik Everhart, Ph.D., Janet L. Shucard, Ph.D., Teresa Quatrin, M.D., and David W. Shucard, Ph.D.; Neuropsychology, Vol. 15. No. 3. Juy8, 2001

Stroke Guide [3]: WebMD