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How to Spot a Stroke

While many Americans are familiar with the long-term effects of a stroke, such as its effect on speech and balance, they may not realize that immediate treatment is crucial to minimizing the impact of a stroke on the body.

In most cases, brain cells are damaged during a stroke when blood flow to the brain is blocked by a sudden blood clot. This occurs in the same way that a blood clot in a vessel supplying the heart muscle causes heart attack. If treatment for this type of stroke is received within a few hours, it can help dissolve clots and minimize the potential consequences.

Dr. Thomas Kwiatkowski, chairman of the department of emergency medicine at Long Island Jewish Medical Center, reviews risk factors, early warning signs of strokes and discusses the many benefits of rehabilitation.

What happens when you have a stroke?
There are really two major types of stroke that we see. The most common type of stroke is what we call an ischemic stroke, and that's where the blockage of the brain results in a loss of blood supply to a part of the brain, which then causes the symptoms.

About 20 percent of all strokes that we see are caused by hemorrhage. In these strokes, bleeding into the brain itself does damage to the brain.

How common is stroke?
Stroke is a very common medical problem in our country. There are about 750,000 new cases a year. There are about three million people living who have had a stroke and who have survived their stroke. It is the third-leading cause of death in this country from any major illness. And it's also the leading cause of disability among adults in this country.

Who is most likely to have stroke?
Like heart disease, stroke is slightly more common in men than in women. Stroke is also a little bit more common in patients who are black or Hispanic. Stroke is also more common as you get older. So the typical patient who has a stroke is about 70 years of age.

What are some of the risk factors for stroke?
There are many risk factors for stroke, and I like to divide them into two categories. There are risk factors that you have no control over such as gender, age or race. Then there are also modifiable risk factors, which can be managed with lifestyle changes or medication. These include high blood pressure or hypertension, heart disease, cigarette smoking, diabetes and high cholesterol. Patients who have a sedentary lifestyle and patients who are overweight all have an increased risk of stroke.

One other thing that recently has been shown to be a risk factor for a stroke is heavy alcohol use.

What are some of the warning signs that you might be having a stroke?
There are many warning signs of a stroke. I think the important thing to keep in mind is that they happen quickly A stroke does not occur over a long period of time; it's a sudden event. Some of the more common warning signs of stroke would include sudden weakness or numbness on one side of your body.

Another warning sign might be difficulty with speech, either your speech is slurred or you're unable to speak normally as you have in the past. Someone who becomes suddenly confused could be having a stroke. Some patients actually may lose some or all of their vision in one or both eyes as a warning sign of stroke.

Other warning signs of stroke could be difficulty walking, where you may have a minor weakness or a minor numbness that prevents you from maintaining your normal balance.

Sometimes patients have these symptoms and they last only a few minutes, and that's what we call a TIA or a transient ischemic attack. Even if it goes away quickly, it's very important to see a doctor or go to a hospital quickly. because that is a warning sign that you could have a more severe stroke in the near future.

What should be your first action if you suspect that you're having a stroke?
Your first action should be to call 911. A delay in getting to the hospital will make it less likely that we'll be able to give you a treatment for your stroke. And even though we only have one acute treatment for stroke, we can only give it to patients who get to the hospital very early, usually within a couple of hours of the onset of their symptoms.

The one treatment that has been approved for stroke is called tPA, and it's what we call a clot-buster. It's the same type of drug that we use for patients who have a heart attack. It actually dissolves the clot that is causing the blockage in the artery in your brain. It is only good for the ischemic stroke where there is no bleeding in your brain.

What happens after you've had the stroke?
There is tremendous variation in the severity of the symptoms for each individual patient. About half of all patients who have a stroke will have a moderate to severe stroke that will leave them with permanent symptoms that will affect their life. About another 25 percent will have very mild symptoms that will allow them to live a relatively normal life. But about 20 to 30 percent of patients will die from their stroke within one year.

However, even patients who have moderate to severe symptoms can benefit from rehabilitation, and we recommend it to all patients who can cooperate with rehab. We start rehab within the first two to three days following a stroke. It is continued, depending upon on the severity of the patient symptoms, for up to several weeks. And if you have a moderate to severe stroke, you would typically go to an inpatient facility, where you would have several hours a day of intensive rehab.

What kind of rehabilitation is offered?
Since there are a lot of different types of stroke symptoms that a patient can have, there are a lot of different types of rehab that we can offer a patient. If a patient has a very severe motor weakness or a weakness in their limbs, we can offer them physical therapy that will improve the tone of the muscles that have been affected. It may even help them regain some of the strength that was lost as part of the stroke.

If someone has difficulty with speech following a stroke, they often will benefit from speech therapy where we can help them learn to speak again. This is a process that takes a long period of time, but still can result in significant improvement.

There is another type of rehab that we call occupational therapy where patients who may be left with certain long-term or permanent deficits or disabilities such as a weak leg or a weak arm are taught new ways to do simple tasks in life. So they are taught new ways to dress themselves, new ways to walk, often with the assistance of another person, a walker or cane.

Another important aspect of stroke is that many patients develop depression or anxiety following their stroke. These are things that can be treated, but people need to be referred to an appropriate specialist who can treat them with psychotherapy or medications.

Is rehab difficult for some people to manage?
I think one of the major issues that affects someone's ability to benefit from rehab is how severe their stroke is. Some strokes affect your ability to understand or to comprehend. And for those types of patients, it's very hard to get them to cooperate with rehab, because they don't understand what rehab is all about.

I think the important thing that patients and families should understand is that rehab is a long process. And successes are made in small steps, so you need to be very patient and family members need to be very supportive. Because regaining the ability to speak, walk and perform simple activities, such as dressing yourself or feeding yourself, may take time.