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Q&A on stroke - Answers from Dr. Farhad Bahrassa of the Neurosurgery Divsion

July 07, 2015

Published in the July issue of Healthcare News of Western Mass.

Questions answered by:

Dr. Farhad Bahrassa

Neurosurgery Division

Baystate Medical Center

Q. I recently visited my doctor and learned that I have type 1 diabetes. I told her that I was worried about someday having to go on dialysis, but she told me to be worried more about having a stroke. Why am I at greater risk of having a stroke?

A. Since you have diabetes, that means you have a 1.5 times higher risk of stroke than others without diabetes. Diabetes can harden or clog your brain arteries with plaque, a condition we call atherosclerosis. As a result, it is harder to get blood to the brain, especially when needed most, such as during a stroke caused by a blocked artery. Adding to the stroke risk is the fact that other brain arteries, which can usually provide extra blood to the brain in such a situation, are less effective when affected by atherosclerosis.

Q. As a diabetic, how can I lower my risk of stroke? And, as the overseer of my family’s health, how can I reduce their general risk of having a stroke?

A. Following a healthy lifestyle and controlling your blood sugar can help keep your risk of stroke low. Diet and lifestyle changes are very important factors that you can control to protect you and your family. Not smoking, regular exercise, maintaining a healthy body weight, controlling your blood pressure and cholesterol, and limiting alcohol consumption all lower the odds of having a stroke. Medications can also play a role in optimizing these factors. Taking medicines for diabetes, high blood pressure, and cholesterol, as prescribed by your doctor, can work along with lifestyle changes to prevent a stroke.

Q. What causes a stroke?

A. A stroke occurs when part of the brain suddenly has a disruption in its blood supply. There is lack of blood flow, so part of the brain does not receive oxygen and nutrients. As a result, the brain tissue is damaged. Most strokes happen because a blood clot blocks an artery in the brain or neck.

Q. How will I know if I or someone else might be having a stroke?

A. The signs of a stroke start suddenly. These include drooping of one side of the face, weakness on one side of the body, numbness on one side of the body, trouble understanding language, trouble speaking, loss of balance, walking difficulty, and loss of vision. These warning signs may only be temporary, which could mean you have had a TIA (mini-stroke). A TIA raises your risk for a future stroke.

Q. Does everyone have some form of paralysis after having a stroke. What disabilities are most common?

A. The disabilities after suffering a stroke are variable, depending on the part of brain damaged and the timing and effectiveness of treatment. Earlier treatment with restoration of blood flow to the brain can reduce the damage, thus the disability, and allow for improvement in function. The common disabilities after stroke can be weakness of one part of the body, numbness of one part of the body, loss of balance or coordination, speech loss, vision loss, or any combination of these. In the long term, there can be movement problems, pain, numbness, problems with thinking, memory loss, or problems with speaking. Also, emotional problems and depression can occur after a stroke.

Q. Can paralysis be reversed, and to what extent?

A. In many situations the signs and symptoms of a stroke can be reversed, at least partially, when treatment to restore blood flow to the brain is effective within the first several hours after onset of the stroke. This results because some of the brain that was lacking blood flow has not yet become damaged, and it can recover with return of blood flow. Unfortunately, other times the brain is fully damaged and reversal of the disabilities does not occur.

Q. I know it is important to get help immediately when having a heart attack, I’m assuming it is the same when you have a stroke? My father has high blood pressure and like most men, would probably ignore his symptoms.

A. High blood pressure is the highest risk factor for stroke. In stroke, just like in a heart attack, time is a critical piece in the end result, especially where your father is concerned. Every minute in a stroke - when the brain is starved of blood flow, oxygen, and nutrients - about two million brain cells will be damaged. The phrase "Time is brain!" emphasizes the importance of immediate stroke treatment to reduce the severity of or possibly reverse a stroke. A stroke is an emergency, and if you or someone near you has any symptoms, call 911 at once.

Q. What are some of the latest treatments available?

A. One treatment for stroke caused by a blocked artery is an intravenous medication known as tPA. It is a clot-busting medicine the works to dissolve the clot that has clogged an artery in order to restore blood flow to the brain. It must be given as soon as possible and within the first 3 hours (sometimes up to 4.5 hours) after the symptoms of stroke begin. Not everyone can receive this medication, especially if you've had internal bleeding or recent major surgery. Another way to restore blood flow is to remove the clot from the brain artery. This process involves using a device that travels internally up through the arteries from the groin artery to the brain artery in order to remove the blood clot. A surgery called carotid endarterectomy removes plaque from inside the carotid artery in the neck, which supplies much of the blood to your brain. This procedure will help reduce the risk of a future stroke, as will cartoid stenting (a procedure that can be used to open narrowed cartoid arteries) and angioplasty (a procedure involving the insertion of a slender, metal-mesh tube, called a stent, which expands inside your carotid artery to increase blood flow in areas blocked by plaque). Following a stroke, there are exercises, speech therapy, physical therapy, and occupational therapy to help people restore function and relearn skills. Psychological counseling is also beneficial. Much of stroke treatment is designed to prevent future problems and focuses on following a healthy lifestyle, such as eating healthy meals, regular physical activity, managing blood sugar levels, and quitting smoking.