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New research shows strokes may strike earlier than you think 

Risk factors and what to do next

click to enlarge stroke_-_1.jpg

During a stroke, up to 2 million brain cells die every minute.

  Dr. Sheryl Martin-Schild is the statewide stroke medical director for the Louisiana Emergency Response Network (LERN), and the medical director of stroke and neurology at Touro and New Orleans East Hospitals. LERN's purpose is to make sure all Louisiana hospitals are equipped to recognize, evaluate and treat strokes. In 2009, the project launched its system of care for time-sensitive emergency support.

 Martin-Schild says there are two major types of stroke: ischemic stroke, in which an artery carrying blood to the brain becomes blocked (usually by a blood clot), and hemorrhagic stroke, in which one of those arteries bursts and there's bleeding in the brain. Both result in loss of oxygen to cells, which damages the brain. Hemorrhagic stroke is characterized by progression — as the bleeding continues, symptoms worsen.

 Transient ischemic attacks (TIAs) or "mini-strokes" are the result of traveling blood clots that cause temporary stroke symptoms. The blood clots either dissolve or dislodge, allowing normal blood flow to resume. TIAs have been recognized as strokes only for the last decade.

 Even if stroke symptoms are fleeting (many TIAs go unacknowledged), report to a hospital at once. A 2014 article in Practical Neurology cites a report that found 15 to 30 percent of ischemic strokes are preceded by TIA symptoms, often on the same day.

 "If you don't get diagnosed and you don't initiate treatment, you lose the opportunity to prevent another stroke that could be catastrophic," Martin-Schild says.

Think you're too young to have a stroke?

The Journal of the American Medical Association (JAMA) published some startling findings this year. After analyzing national hospital data, researchers found hospitalization for acute ischemic stroke increased significantly from 2003 to 2012 among young adults, doubling for men and women between 18 and 34 years old and increasing 41.5 percent among men ages 35 to 44 years old and 30 percent in women in the same age range. Hospitalizations for hemorrhagic stroke mostly held steady. An editorial published in tandem with the JAMA study suggests classifying TIAs as strokes may be a factor in this increase.

 "The average age at which a person suffers a stroke is 64 years old," Martin-Schild says. "Someone 45 years old or younger is considered young, and a lower proportion of [this age range] will present for treatment in the appropriate time frame because ... they think they're too young (to have a stroke)."

 Further, the JAMA study found the prevalence of a person having three or more of the five most common stroke risk factors increased markedly between 2003 and 2012 — from 19 to 35 percent in men ages 35 to 44, and from 15 to 32 percent in women in the same age group. The five factors are diabetes, hypertension, lipid disorders (high cholesterol), obesity and tobacco use.

 There is concern the data may only suggest an increase in stroke diagnosis. But increased hospitalization rates for ischemic strokes are concurrent with increased incidence of risk factors, suggesting the problem requires a greater focus on education and prevention.

 "Researchers are still trying to understand (the cause), but lots of ... bad living habits such as not exercising, alcohol and illicit drug use ... account for some of the spike," Martin-Schild says.

 Genetics also dictate predisposition to stroke.

 Less commonly known factors are atrial fibrillation or AFib, obstructive sleep apnea and even pregnancy — "Anything that affects the structure or function of the heart," Martin-Schild says.

What to do when you suspect a stroke

The American Stroke Association promotes the acronym FAST to help people recognize the three major stroke symptoms: "face drooping, arm weakness, speech difficulty, time to call 911." Symptoms also may include sudden loss of vision, clumsiness and severe headaches. Stroke victims usually experience loss of function on one side of the body, but it can affect both sides.

 "That's why it's called a stroke — the sudden loss of function is like a stroke of lightning," Martin-Schild says.

 She says calling 911 the moment you suspect a stroke is critical. "Use the right language," she says. "Say 'I think I am having a stroke,' and give the time of onset and what symptoms are present. The dispatcher will get an ambulance there with priority, and paramedics are trained to screen for stroke and will notify the hospital. The emergency department activates the stroke team and is ready to receive you when you arrive — this won't happen if you come by private vehicle."

 She also debunks a stroke myth.

 "Do not give an aspirin," she says, "especially if it's a hemorrhagic stroke — aspirin is a blood thinner and will increase bleeding. Fifty percent of people experiencing a stroke can't swallow, and the aspirin could end up in their lungs. Aspirin is an acid — that can do real damage."

What next?

Stroke is the No. 1 cause of adult-acquired disability. Even though mortality has decreased (Martin-Schild says death from an ischemic attack occurs in less than 10 percent of cases, and the rate for hemorrhagic stroke has decreased from 40 to 20 percent in recent years), it can have long-term effects on cognitive and communicative functions and motor skills. Getting to a hospital as soon as possible is critical. Doctors need to arrest the symptoms and restore circulation, then focus on determining the cause of the stroke and preventing complications, as well as beginning therapies for recovery, which are crucial in the first three months after an attack.

 "A little over 20 years ago, there wasn't much (in the way of treatment) beyond beginning an aspirin regimen and going to rehab after a stroke," she says. "Treatment to minimize long-term damage has changed drastically since 1996, but it is time-sensitive."

 Despite the increase in ischemic strokes and subsequent hospitalizations of young men and women, older people still are more likely to experience stroke, especially if they've already had one.

 "It's a J-shaped curve," Martin-Schild says. "As you get older, your risk increases. There's increased body wear and tear, and possibly accumulated injury to the heart and arteries from conditions like high blood pressure and smoking."

 Early detection is the best prevention. "Having a good primary care provider is essential," she says. "Often, people don't know they have high blood pressure, high cholesterol or even diabetes. A physician helps with aggressive medical management of risk factors, but sometimes (surgical) intervention may be necessary." 


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