Ten Essential Facts About Stroke

Strokes are survivable. I should know. I've had four. I'm a walking medical miracle.  

But medical miracles tend to happen to people who are prepared to make the most of both medical care and self-care, and who have lots and lots of support both in and out of the hospital. Please read these 10 essential facts about stroke just in case you find yourself needing to take care of someone who has had a stroke, or you find yourself having a stroke — as about 29 percent of people will, sooner or later.

Please share this article with people you know just in case they need to know more about how to help you.

1. Just about anyone can have a stroke.

In the United States alone, 700 thousand people per year suffer a first-time stroke. Not all of them are older adults, contrary to popular belief. About one third of people who have strokes are under the age of 65. About one third of people who have a first-time stroke will die as a result.

In senior citizens and in under-65's alike, stroke is commonly associated with vascular disease, especially high blood pressure. Strokes are also associated with high LDL cholesterol and smoking.

However, it is important to be on the lookout for the symptoms of stroke in people who:

• Recently started certain kinds of antipsychotic medications, especially risperidone (Risperdal) and olanzapine (Zyprexa) and closely related drugs, and especially during the first two weeks of use.

• Overdose on amphetamines, ecstasy, molly, or PCP.

• Recently had a heart attack or had a stent procedure to open a coronary artery, causing debris to travel to the brain.

• Recently started a blood thinning drug (in my case it was Brilinta, which is also known as ticagrelor), loosening up a clot in the brain and causing a hemorrhagic stroke.

• Suffer extreme hypotension (low blood pressure) after loss of blood or dehydration or other causes, at "watershed" location in an artery some distance from the brain. A clot travels from the "watershed" to the brain over a period of minutes, hours, days, or weeks.

It isn't just high blood pressure or high cholesterol or smoking that causes a stroke. Lots of people who "have been sick lately" are at increased risk of stroke. In young adults, strep infections (which cause blood to coagulate), use of oral contraceptive pills (in women), dehydration, fever, migraine headaches, cocaine abuse, and broken bones most often precede stroke.

So how can you tell when someone may be having a stroke?

Get emergency help fast when the person is displaying:

• Sudden loss of motion or sensation, especially if the debility is limited to one side of the body.

• Sudden loss of the ability to speak, or to understand speech.

• Sudden loss of sight, hearing, smell, taste, or touch.

• Sudden changes in personality that don't seem to be related to events, such as aggression and extreme irritability.

• Sudden dizziness or loss of coordination.

• Sudden loss of decision-making skills not due to alcohol or drug use or severe fatigue.

When there are sudden and severe changes in brain-based abilities, get a doctor to rule out stroke.

2. The symptoms of stroke can be subtle.

Since strokes generally occur on one side of the brain, doctors typically look for symptoms on the other side of the body.

Sometimes mild strokes don't cause paralysis. They might cause loss of speech, loss of sight, dizziness, or general confusion. Someone who seems to be having a really bad day emotionally could be having a mild stroke, and some strokes can even be missed entirely for this reason.

3. Clot-busting therapies usually get good results in mild to moderate strokes if they are started within 90 minutes of the onset of symptoms.

Emergency room physicians can treat ischemic stroke (those are strokes caused by blockages in blood vessels) with anticoagulant therapy if the treatment is started soon enough. The emergency room doctor won't offer the treatment, however, unless someone who can communicate was present when the patient "went down" so that the time from onset of symptoms can be determined. The presence of friends and family members is essential for the doctor to know it is safe to use this kind of therapy when stroke interferes with speech.

Clot-busters are not offered to stroke patients who are already on anticoagulants, such as Coumadin, Plavix, or Brilinta.