Stroke:
Awareness of warning signs is key
Henry Jenkins is almost 70 years old and is not doing too bad these days.
His stroke didn’t ruin his ability to remain relatively independent.
His speech is a little slower and the right side of his body is no longer strong. Walking is not as easy as it once was. But he manages, with the help of a short leg brace and four-pronged cane.
While it takes a little more time, he can still dress himself. He is proud of the fact that he has mastered buttoning his shirt with one hand, his left hand, the one that he seldom used before the stroke.
A health aide comes over twice a week to give him a bath, but for the most part, Jenkins is one of the fortunate ones.
According to the American Stroke Association, someone has a stroke every 45 seconds, and someone dies from a stroke every three minutes. Strokes are the third leading cause of death in America, and a staggering one out of 16 deaths are the result of complications brought on by the chronic disease.
Worse, it is the leading cause of adult disability.
It knows no barriers — black or white, rich or poor, professional athlete or weekend gardener. And the impact on a neurological system is as varied as the damage wrought on oceanfront property during a hurricane, leaving some without the ability to talk or walk or understand. Others are left virtually unscathed.
In Boston, the death rate from stroke in blacks is about 50 percent higher than that for Latinos and whites, and almost three times the rate in Asians.
Despite having hypertension and high blood cholesterol — two red flags for a potential stroke — Jenkins said he didn’t know a stroke was coming, and worse, he didn’t even want to know.
His fear of medical bad news was so strong that whenever his friend made appointments for a yearly physical, he would simply wait around the doctor’s office — then walk right back out without seeing even a nurse, much less a doctor.
“I was healthy,” he said. “I was always active. I loved to walk a lot and work around the house.”
Having a stroke was the farthest thing from his mind — with good reason.
Aside from the medical complications, strokes have developed a hard-earned reputation and a depressing social stigma.
“A lot of people would rather die than suffer from all the disabilities associated with strokes,” said Dr. Lee H. Schwamm, a leading expert on strokes and director of Acute Stroke Services and Vice Chairman of neurology at Massachusetts General Hospital.
Unlike heart attack survivors, those who have come through a stroke are much more reluctant to share their stories publicly. For a variety of reasons, there remains just too much embarrassment, too much denial and too much fear.
“A lot of people tend to have a way of magical thinking when it comes to chronic diseases like stroke,” Schwamm said. “They believe that if they don’t know about it, the problem will somehow go away.”
It doesn’t work like that. Most people — particularly those most vulnerable — tend to deny their risk factors and ignore what are very real symptoms.
For African Americans, the problems are worsened by the slew of risk factors that plague black health — diabetes, high blood pressure, high “bad” cholesterol, smoking, poor nutrition and lack of exercise.
In plain language, a stroke is a “brain attack.” It is a sudden hurricane of neurological problems that can leave a person without the ability to speak or see or move entire regions of their bodies.
The attack occurs when a blood vessel in the brain becomes clogged or breaks. Sometimes a clot breaks free from another part of the body — typically the heart or the arteries in the neck — and moves through the blood stream to the brain.
Ischemic strokes, the most common type, are the result of blood clotting. One of the biggest culprits is atherosclerosis — fatty deposits, or plaque. Over time the plaque can grow large enough to narrow the artery, causing the blood to flow abnormally — if at all.
The second type is called hemorrhagic strokes and occurs when the walls of a weakened artery rupture and causes bleeding within the cranial cavity. These kinds of strokes are often triggered by high blood pressure.
In both types of stroke, the brain is robbed of much-needed oxygen and nutrients, and if left untreated, can cause irreparable damage.
It is estimated that almost 2 million brain cells die each minute a stroke is untreated. If the damage is severe, the parts of the body that are controlled by the affected part of the brain no longer function correctly.
Very often, the symptoms are mild and last for only a short period of time, usually less than five minutes, but can persist up to 24 hours. This is called a transient ischemic attack, or TIA, commonly referred to as a “mini-stroke.”
The symptoms may be minor and disappear, but TIAs are often repeated and can be the harbinger of a bigger stroke at a later time.
According to the National Stroke Association, the likelihood of having another stroke within three months following a TIA is 11 percent. It’s 20 percent within two years.
By all accounts, Jenkins wasn’t having a minor stroke last year on September 30.
He was 68 years old at the time, and was watching television when he felt the right side of his body, including both his arm and leg, just getting “weaker and weaker.”
He thought it would just go away and decided to go to sleep.
But he couldn’t sleep. His right side was still deteriorating, and before he could do anything about it, he had fallen off the couch, barely able to call for help.
It’s a miracle that his friend heard the thud and Jenkins’ slurred cries for help. She called 911.
He was quickly taken to Brigham and Women’s Hospital. It’s all a blur to him now, but he was there for about a week and underwent several procedures, including an angioplasty to open the arteries in his neck.
But treating Jenkins was difficult, largely because he couldn’t remember when he started having weakness in his side. The timing question is not a trivial matter.
If the stoke is caused by a clot, it may benefit from the administration of a clot buster called tissue plasminogen activator (tPA), which breaks up the clot in the brain and may reduce permanent disability.
The treatment is time-sensitive. tPA must be administered within three hours of the onset of symptoms.
It is estimated that only about 5 percent of stroke victims arrive at the emergency department in time to receive tPA.
Not all strokes benefit from the treatment.
The Massachusetts Department of Public Health recognized the need for a system of emergency care for the diagnosis and emergency treatment of strokes and has already designated 69 hospitals as Primary Stroke Service Hospitals across the state.
These hospitals have a multidisciplinary team available 24 hours a day, seven days a week to offer immediate diagnostic and therapeutic services for acute stroke.
“Every minute counts,” says Dr. Schwamm. “The sooner one realizes that they are having stroke, the better it is to get to a hospital. tPA doesn’t work if administered after three hours. But it is twice as effective if given within the first hour compared to at 3 hours.”
Quite naturally, Jenkins would live his life a little differently, knowing what he now knows about strokes.
But the one thing he still has trouble understanding is that his perception of a stroke was much different from the reality.
It is a point that underscores the mysteries associated with stroke.
When he was watching television that night and his body was starting to break down, he remembers one thing very clearly.
He was never in pain. |
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Henry Jenkins thought he was healthy. He didn’t know he had both high blood pressure and high cholesterol — he was too afraid to go to the doctor for checkups. Since his stroke, Jenkins encourages everyone to get screened.
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| Lee H. Schwamm, M.D., Director of Acute Stroke Services and Vice Chairman of Neurology, Massachusetts General Hospital. |
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