When your grandmother suffers a devastating stroke, it is a family tragedy, but it does not necessarily make the headlines. When Luke Perry has a massive stroke at age 52, it does. Stroke remains a surprisingly common occurrence, striking someone in the United States every 40 seconds, and killing someone every 3 minutes and 45 seconds. Not only one of the top 4 causes of death in the U.S., but stroke is also the leading cause of serious long-term disability in our country.
The good news is that these numbers are smaller than they used to be, the stroke death rate having decreased almost 22 percent. New interventions have appeared over the last 15 years which makes stroke rescue much more likely, if those stricken seek help immediately. Comprehensive stroke centers have sprung up throughout the United States, where intervention in the first hours of stroke onset can actually completely reverse brain damage and return the patient to normal life. These interventions rely on the combination of clot-busting drugs and mechanical clot retrievers. Think of the latter as plumbing in the human brain. Miniscule catheters are snaked through the pipes of the arterial system from the groin artery into the brain where the pipe is blocked, and then the clot is yanked out. These techniques are guided by advanced imaging techniques rapidly obtained in the emergency room, and the 3D data then brought into the interventional suite where experienced neuro-interventionalists (think very advanced degree plumbers) can open up the critical flow of blood that the brain needs within minutes.
Unfortunately, insufficient numbers of comprehensive stroke centers exist in the United States. Orange County is lucky to have created a comprehensive stroke network of select hospitals, to have trained emergency responders to bring patients rapidly to those centers for intervention. The critical factor is recognizing stroke symptoms in the earliest stages, and calling 911: a sudden change in strength either in the face or the arm, sudden significant speech difficulty, or sudden loss of balance and visual disturbance. Note the keyword, sudden, as in stroke.
Stroke more often afflicts older folks, but can strike young people in whom certain underlying conditions exists, for example, a hole in the heart that transmits small clots from the right-sided circulation (where they can be filtered in the lungs) directly into the left-sided part of the circulation feeding the brain. Also, direct traumatic insults to the pipes leading to the brain from sudden torsion of the neck can lead to pipe blockage or inner wall damage causing clots that produce strokes.
Approximately 10 percent of strokes are produced not by pipe blockage, but rather pipe bursting allowing a sudden rush of blood into the brain tissues. Those strokes are less likely to be rescued, but when they occur from rupture of an aneurysm inside the brain they also can be treated by the minimally interventional techniques to seal the pipes that leaking.
A greater degree of stroke awareness, especially the recognition of symptoms very early on, and proper direction of acute stroke patients to comprehensive stroke centers with capability for rescue will continue to impact the improving statistics of this devastating disease.
Michael Brant-Zawadzki is senior physician executive, and endowed chair, Pickup Family Neurosciences Institute, Hoag Hospital, Newport Beach, CA.
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