Posted on: Saturday, December 4, 2004
PRESCRIPTIONS
Act fast to avoid disabling stroke
By Landis Lum
Q. What is a stroke and how do I know if I'm having one?
A. A stroke is when a blood vessel (artery) in the brain bursts or is blocked by a blood clot. The nerve cells in that area of the brain supplied by that blood vessel can die within minutes or hours if blood doesn't start flowing again.
Symptoms begin suddenly. You may have numbness, weakness or paralysis of your face, arm or leg, especially on one side of the body. You might have double vision or loss of vision, confusion, trouble speaking or understanding, loss of balance, trouble walking, or poor coordination. You may have a bad headache. Strokes can be caused by high blood pressure, diabetes, high cholesterol, heart disease, or smoking.
Before having a stroke, you may have one or more transient ischemic attacks (TIAs), which should warn you that a stroke leading to permanent paralysis or speech impairment might soon occur. TIAs are like mini-strokes because they cause the same symptoms as a stroke, but last only 10 to 20 minutes — sometimes as long as 24 hours.
We all know we should rush to the emergency room when we're having a heart attack, but why don't we do the same thing when we're having a stroke or TIA?
We should.
Not only can a stroke kill you, but we now have a drug that will reduce the chance that you'll become disabled or dependent from your stroke. The trouble is that we generally need to give this drug within three hours of the time your stroke began for it to work. And we can't give this drug if the stroke is from a brain bleed, so to find out, we need to do a CT or MRI scan first. Don't wait to see if you'll get better.
As Dr. Louis Caplan, a neurologist at the Beth Israel Deaconess Medical Center in Boston put it in the Oct. 20 issue of the Journal of the American Medical Association: "Experienced physicians who treat stroke know of many patients who have only slight signs or are improving when first seen but who worsen and develop severe stroke deficits hours or days after onset."
This drug is called tissue plasminogen activator, or t-PA, and it helps dissolve blood clots. It works even better if given within 90 minutes, so we are now telling our patients to think of strokes as "brain attacks" and to go to the emergency room or call 911 immediately if they think they're having one.
Dr. Landis Lum is a family-practice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i's John A. Burns School of Medicine. Send your questions to Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Hono-lulu, HI 96802; fax 535-8170; or write islandlife@honoluluadvertiser.com. This column is not intended to provide medical advice.
