By James Santiago Grisolía, MD
Every year in the United States, more than 500,000 people suffer from a “brain attack,” or stroke. Many of us have a grandparent or other relative who is still paralyzed and disabled from a stroke. In many cases, this tragedy is preventable, if we realize that a “brain attack” is an emergency like a heart attack, and call 911 at the very start of stroke symptoms.
“Stroke produces more disability than any other disease,” according to Roberto Gratianne, MD, Chula Vista neurologist familiar with the Latino community. “Each year, stroke costs some 50 billion dollars to the U.S. economy, without counting the human tragedy to the patient and his or her family.”
The most common stroke, or brain attack, results from a blood clot that forms in one of the arteries feeding blood to the brain. This clot blocks the normal flow of blood, causing damage to brain cells in the affected area. Since the brain controls our thought, speech and movement, a brain attack can cripple the patient, resulting in inability to speak or move, need for chronic nursing care, or death.
In recent years, a new treatment can sometimes reduce or eliminate the brain injury by dissolving the blood clot that causes the stroke. This treatment, called tissue plasminogen activator or TPA, was developed and tested here in San Diego, in collaboration with other stroke research centers across the country. This treatment is now accepted worldwide as the most important stroke therapy, but suffers from the severe limitation that it must be given as soon as possible, but in all cases within 3 hours of the start of stroke symptoms.
To benefit from TPA and other treatments for stroke, the community must become aware of the symptoms of stroke and the urgency of seeking emergency care. This means becoming aware of these symptoms when they occur in ourselves, in a family member or friend, and calling 911 immediately, at the very first symptoms before worsening occurs.
The key symptoms of stroke, or brain attack, include the following, all starting suddenly:
· Weakness or numbness of the face, an arm or leg.
· Vision loss in one or both eyes, or double vision.
· Slurred speech, sudden confusion or loss of comprehension.
· Dizziness or instability of walking.
Important risk factors for stroke include high blood pressure, diabetes, high cholesterol, heart disease, tobacco or drug use, or excessive alcohol use. All these factors are controllable with medical help. Everyone with these risk factors, and all elderly people, should consult their doctors to control risk factors when possible, and to discuss the possible benefits of taking daily aspirin or other treatments to prevent stroke and heart attack.
At the very start of symptoms, 911 should be called, so the patient can be taken to the nearest qualified hospital as quickly as possible. Local hospitals, neurologists, paramedics and emergency physicians are working to develop an effective stroke system throughout San Diego County. According to Dr Charles Simmons, Director of Emergency Services at Scripps-Mercy Hospital, “Our aim is to ensure a uniform, consistent response in every hospital emergency department throughout the Scripps system, and we are working with other health systems to extend the same quality of care to all hospitals that wish to make the necessary commitment.”
Dr Grisolía is Chief of Neurology at Scripps-Mercy Hospital, a member of Operation Stroke through the SD chapter of the American Heart Association, and an investigator in the original studies of TPA in acute stroke. He also serves as Communications Chair for the SD County Medical Society.