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The Importance of Stroke Recognition and Prevention

Strokes are an important preventable cause of death and disability in the United States.  Many of you know that we Georgians lie in a region of the country fondly known as the Bible Belt, but the medical community has given this same area of the country a much scarier name:  the Stroke Belt.  Americans living in the southeastern United States are 34% more likely to suffer from strokes and cardiovascular disease than the rest of the country.  While these statistics are worrisome, it is reassuring that this increased risk is due to factors that we have the ability to change, both for ourselves and our loved ones.  Due to the life-altering impact a stroke can have on a family, it is important for everyone to understand strokes, recognize them, and employ measures to lower risks for themselves and their families.

The key to understanding the two different types of strokes is to think about a pipe leading to a sink faucet.  If there is a clog somewhere in the pipe, water cannot run to the faucet.  This is a good way to think of an ischemic stroke, where the blood supply to an area of the brain is cut off by a clot or other obstruction in a blood vessel.  In fact, the word “ischemic” simply means that an organ or tissue in the body is not receiving the oxygen it needs.  Ischemic strokes account for about 80% of all strokes, where the obstruction results most commonly from plaques in arteries, caused by atherosclerosis.  Atherosclerosis, the buildup of fat and cholesterol in an artery, is a process driven by other conditions, like high blood pressure, diabetes, obesity, and cigarette smoking.  An ischemic stroke can also be caused by diseases like atrial fibrillation (a relatively common type of irregular heart rhythm), in which a blood clot that is formed in the heart is sent (embolized) through the arteries and up into the blood vessels of the brain, where the clot can become wedged, thereby cutting off oxygen “downstream.”

Returning to our pipe analogy, if a clogged pipe under pressure explodes, and water is spurting out underneath the house, water is not going to make it to the faucet.  This is a hemorrhagic stroke, in which smaller blood vessels burst, and blood leaks into the brain.  Though this type of stroke is less common (about 20% of all cases), it can be more life-threatening, as the leaking blood builds pressure in the tight confines of our skulls.  In either major type of stroke, the part of our brain that is starved of blood suffers from a lack of oxygen and nutrients, causing local damage and often permanent death to neurons within minutes.

Our brain is an amazing, 3-pound organ with about 100 billion neurons packed tightly inside.  It controls every aspect of our day, from the ability to feel joy and sadness, to coordinating the complex movements of our legs while we walk.  When neurons die in a stroke, they do not regenerate much (if at all), and the area of the brain that is affected will stop working as well (or may stop working completely) and produce symptoms.  The most common and characteristic symptoms of stroke are outlined in the American Heart Association’s FAST exam.

It is important to recognize that a person does not need to have all (or any) of these symptoms to have experienced a stroke; they may also experience symptoms like numbness or tingling on one half of their body, acute weakness of a leg, a complete loss of balance, or confusion.  Some strokes, in certain areas of the brain, may produce no obvious symptoms – only sophisticated brain imaging or other procedures can identify them.  Timely stroke recognition and treatment by a medical professional are essential:  for every 15 minutes that goes by without treatment, patients have a smaller chance of complete functional recovery.

A stroke can unfortunately create permanent challenges for patients and families.  A stroke survivor may have leg, hand, or arm weakness that makes day-to-day tasks incredibly difficult.  Strokes can affect personality, and depression is common after a stroke, in both patients and their caregivers.  These changes may be irreversible after a stroke (although they may improve with time), so that is why the focus on stroke prevention is critical.  The number one modifiable risk factor for both ischemic and hemorrhagic strokes is uncontrolled high blood pressure (also called hypertension), which presents a challenge, since many patients do not know they have high blood pressure or find it difficult to remember to take medications for their blood pressure when they feel well.

With regular visits to your physician to check and control blood pressure and blood sugar, smoking cessation, and a focus on healthy weight, we can begin to close the gap between the Stroke Belt and the rest of the nation.

Michael Trainer is a third-year medical student at the Mercer University School of Medicine.

This article was originally published in the Farmers and Consumers Market Bulletin Mercer Medical Moment on Wednesday, June 19, 2019.