Ducking the Stroke

Lloyd Sparks
Jan 8, 2019 · 5 min read
Image from Harvard Health — Harvard University

Some 800,000 people suffer a stroke every year in the United States. Most are unaware of the early symptoms resulting in delayed treatment and poor outcomes. Cerebral stroke is a leading cause of serious permanent disability.

Restoring blood flow to the brain is the number one concern in any circulatory event. If you can recognize the symptoms early and get help, you stand a much better chance of avoiding permanently debilitating issues and health complications.

Atrial fibrillation

Atrial fibrillation is a major risk factor for stroke and is rather common, especially in the elderly. The heart beats irregularly, causing turbulence in the atrium which can initiate a clot. If the clot escapes the atrium and is propelled through the ventricle and out of the heart into the aorta and carotid arteries, it may wind up in the brain.

A-fib feels like your heart is dancing around in your chest. The beat is irregular in both strength and timing. In some cases, it may cause alarm. Other times, it may be barely noticeable and ignored. My atrial fibrillation went on for over a year and a half before it was diagnosed, and I’m a doctor!

A-fib is diagnosed from an EKG — a readout of electrical activity of your heart. Because A-fib increases the likelihood of a stroke, your doctor will probably put you on blood thinners. These drugs carry their own risks associated with bleeding, so you should avoid activities associated with accidental cuts and bruising. I reluctantly gave up Taekwondo and knife juggling. (Just kidding about the knife juggling.)

Ironically, a bleeding stroke is more serious than a clot stroke, but because clot strokes are much more common, the increased risk of serious bleeding is considered worth it.

Hypertension

High blood pressure can increase your risk of stroke by weakening your blood vessels, and eventually causing a leak or rupture. High blood pressure also leads to the formation of blood clots which, if they make it to the brain, cause a stroke.

For this reason, your doctor will make every effort to keep your blood pressure normal. (Except letting you see your bill.) Because hypertension is often symptomless, it is usually diagnosed on routine screening. Readings above 140/90 mm Hg have long been the accepted values that diagnose hypertension, but target values for treatment are at or below 130/80.

Cutting out salt and limiting stimulants like coffee are part of the initial lifestyle recommendations, but the doctor will often prescribe a diuretic to lower blood volume and pressure early on. A popular second drug is a beta blocker, which lowers the heart’s sensitivity to adrenaline. Other drugs may be added until blood pressure is under control.

Vision problems

Among the most common first symptoms of a stroke are problems with seeing such as double vision, blurred vision, and loss of sight in one eye. Although the optic nerve is thick, the nerves that serve the eye are numerous and thin, making them especially vulnerable to a sudden decrease in oxygen from a stroke. A quarter of the brain’s cortex is devoted to vision as well and fibers from the eyes have to traverse the entire cerebrum to reach it, located at the back of the head. A relatively large proportion of the brain is involved in vision in some way or other.

One-sided numbness or weakness

Numbness is another warning sign that shouldn’t be dismissed, especially if limited to one side of the body. In fact, numbness and weakness at the level of the face, arms, and legs on either side of the body is the most common presentation of a stroke. In severe cases, paralysis occurs on the opposite side of where the stroke occurred in the brain.

Because language processing occurs on the left side of the brain in most people, a stroke on that side will often render the patient unable to talk, understand speech or both. A left-brain stroke also results in numbness, weakness and possibly paralysis on the right side of the body.

Dizziness and exhaustion

Stroke patients often feel dizzy and exhausted. Because so many other things cause dizziness and fatigue, strokes are rarely considered as the cause initially, delaying treatment.

Sudden severe headache

A headache the patient may describe as “the worst one in my life” may indicate a stroke, especially a hemorrhagic stroke. This event must be treated as soon as possible to prevent pressure on the brain squeezing the vital centers and killing the victim. Fortunately — if fortunately is the word I want here — the pain is so severe that people commonly seek help right away.

Shoulder pain or a stiff neck may also occur with a stroke. If you become unable to touch your chest with your chin due to the stiffness and pain, do not delay in getting yourself to a doctor. Even if the headache or neck rigidity are not due to a stroke, the other common cause — meningitis — is also a medical emergency.

Who gets strokes?

Anyone can suffer a stroke, but they tend to occur more commonly in older men, people who have high blood pressure, smokers, diabetics, and people with cardiovascular disease.

Other risk factors include alcohol and drug abuse, obesity, poor nutrition, depression and anxiety, lack of physical exercise, sleep apnea, and various neurological issues.

What to do

If you are alone and think you might be having a stroke, you should immediately call 911. Do not drive yourself to the hospital. Don’t eat or drink anything and, above all, remain calm.

If you find yourself helping a person who appears to be having a stroke, you should call 911 and follow their instructions. Keep the patient on their side with their head elevated in case they vomit. Stay calm and speak in a calm, reassuring manner.

Am I making too big a deal out of staying calm? Your primary concern with a stroke — whether you are having one or treating someone with one — is to get them medical help as quickly as possible. I would advise you to panic if panic helped, but it doesn’t.

Getting medical help requires thinking clearly, so take a couple of deep breaths and do it.

Lloyd Sparks

Written by

Lloyd Sparks MD is a neuroscientist who writes on the subjects of health, fitness and fearless living.

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