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Posted: May 1, 2010 12:30 a.m.

Recognizing stroke precursors

Stroke is the third leading cause of death and a major cause of disability in the United States. Despite these alarming statistics so many stroke-like symptoms are overlooked or unrecognized by patients. A stroke occurs when a blood vessel that supplies a portion of the brain is blocked or ruptures. As a result, that part of the brain does not get the needed blood, oxygen and nutrients. These cells then die, and the results are a stroke. These effects can be permanent because dead brain cells do not regrow, any return of function is due to other parts of the brain taking on the action of the now dead brain cells.

The signs of a Transient ischemic attack — usually referred to as a "warning stroke" or a "mini-stroke" in the community — and a stroke are the same. This basically means that a person has stroke-like symptoms that resolve themselves before 24 hours and often within minutes. TIAs are a medical emergency because the symptoms are indistinguishable from a stroke and they require immediate medical attention. These symptoms include sudden or acute onset of any of the following: loss of vision, double vision, weakness of the face, arm and or leg especially on one side of the body, numbness of the face, arm and or leg especially on one side of the body, confusion, difficulty speaking and difficulty understanding spoken or written words. If present, these symptoms should be evaluated by medical personnel. Even if the symptoms are resolved they should be evaluated so the proper treatment can be initiated.

The main differences between a TIA and a stroke are that in the case of a TIA, the MRI of the brain does not show new damage. There’s also lack of permanent brain injury and the duration of symptoms is usually quite short. However, in some patients, small strokes can also seem to resolve quickly but the imaging is abnormal. TIAs usually signal that a stroke could be impending and about 15 percent of strokes are preceded by a TIA. Unlike TIAs, strokes don’t always have a complete recovery and most people are left with disabilities. Most patients if not seen by a physician are likely to have a stroke within a month of having a TIA. That is why it is so important to seek medical attention even if the symptoms have resolved.

Stroke and TIAs can occur at any age but are more prevalent in the older population. In addition to age, other risk factors are hypertension, diabetes, high cholesterol, smoking, obesity, heart disease and race. Risk factors for stroke usually considered in the younger population (under 55) and in women include clotting disorders, migraine with aura, PFO (patent foramen ovale), birth control pills (especially in women who smoke and who may have migraine with aura), hormone replacement therapy and autoimmune diseases. There is also a higher incidence of strokes among African Americans, most likely a direct result of the higher incidence of the above mentioned risk factors. Blacks have almost twice the risk of first time stroke compared to whites; they also have twice the death rate.

The American Stroke Association has 3Rs which are important to win the fight against stroke: REDUCE, RECOGNIZE and RESPOND. Reduce your risk factors, recognize the warning signs and respond by calling 911 immediately if you or someone you know has the warning signs. You can reduce your risk factors by controlling your blood pressure, blood sugar, cholesterol, not smoking, exercise and eating a low fat and low cholesterol diet. Do not drink alcohol or if you do, drink in moderation.

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