By Marti Webb Slay
Since stroke is the leading cause of death and disability in the US, Jitendra Sharma MD, MS, with Brookwood Baptist Health System, wants physicians to communicate more with their patients about stroke, its prevention, risk factors, and the growing prevalence of it in younger populations.
“We are realizing that prevention is more important than treating the disease,” Sharma said. “We are now seeing stroke in younger populations, in those who are in their 40s and 50s. Why? The number one issue is obesity.
“The new information we need to bring to the younger community is they should exercise three times a week, eat healthy, and keep weight under control. Because if we can manage our weight, that will prevent blood pressure and cholesterol issues, and that can prevent a stroke or heart attack in the future. That’s where the money is now.”
The risk factors for having an ischemic stroke, or stroke due to blood clot, are age itself, high blood pressure, diabetes, cholesterol issues, smoking, atrial fibrillation and irregular heart rate. Smoking and high cholesterol are also high-risk factors for hemorrhagic stroke, or stroke from a brain aneurysm or a brain bleed due to high blood pressure.
“The discussion should be started early, although changing at-risk behaviors at any time can make a difference,” Sharma said. “Smoking increases the risk of blockages of carotid artery and arteries of the heart. If someone can quit smoking, their risk drops down. Same thing is true of blood pressure, cholesterol and diabetes. Maximizing risk factor management means maximizing medications and healthy lifestyle to reduce the risk of stroke.
“It’s important for patients to understand the signs of stroke so they can respond quickly. Patients should be taught the acronym BE FAST: Balance loss, Eyesight (vision problems), Face drooping, Arm weakness, Speech difficulty, and Time -- call 911 immediately.
“We have a saying about Ischemic stroke: time is brain. Anyone having a stroke may have speech problems, difficulty talking, or feel weak on one side. If that happens, we know blood flow to the brain has stopped. We say time is brain, because every minute, millions of brain cells can die, so call 911 and get to the hospital.”
A stroke victim may be eligible for clot buster medications, or thrombolytic therapy, to halt ongoing damage from ischemic stroke. If they come to the hospital within a three-hour window, they may be eligible for IV medication that can dissolve the clot and restore the blood flow.
“Another aspect of ischemic stroke is carotid artery disease, or blockages in the neck,” Sharma said. “That also has to be treated so we may schedule a visit to the clinic for a carotid stent. Patients with carotid artery disease may experience a transient ischemic attack (TIA), which is a temporary shortage of blood flow to the brain, and then improve. TIA are signs for bigger stroke in the future.”
Two Birmingham hospitals offer an additional treatment for ischemic stroke. “In patients where the clot buster medication may not work, we can do mechanical thrombectomy,” Sharma said. “We go inside the blood vessel and pull the blood clot out. This special procedure helps us extend the window 24 hours for anyone who is having a stroke and threw a blood clot that’s closing the vessel. In Birmingham, only two places offer mechanical thrombectomy, Brookwood and UAB. Brookwood typically receives mechanical thrombectomy patients within a 100-mile radius.”
Brookwood also offers a special technique for hemorrhagic stroke to close off the aneurysm with a minimally invasive approach called aneurysm coiling, also known as endovascular embolization. Coils made of soft platinum metal and shaped like a spring are inserted into an aneurysm to prevent blood flow, in order to keep the aneurysm from rupturing. Once the aneurysm is closed off and the patient is evaluated, they can go home the next day.
Sharma feels that more discussion between physicians and patients about stroke will not only encourage patients to develop better preventive strategies, but will also help the physician identify patients who may be at higher risk for stroke. “If they notice an at-risk patient, send them to us and we can screen them better,” he said. “Any time they are worried about aneurysm or carotid artery disease, or TIA, a stroke workup should be completed. Refer them to us for further evaluation.”