FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

MINI-STROKE NEEDS TO BE TREATED TO PREVENT MAJOR STROKE

Question: My father died from a stroke more than 10 years ago. Lately, I've had several headaches that I thought were the start of a stroke. My doctor tells me that I haven't had one, though. How can I tell if I'm having a stroke?

Answer: Once a portion of the brain is deprived of its normal circulation for more than a few minutes, those specific cells die. Therefore, the function they served is lost. Immediate death occurs when a stroke affects brain centers that control breathing or other essential life functions. Destruction of other important but less life-threatening areas results in paralysis of one side of the body, blindness in one eye, partial loss of vision in both eyes, difficulty with speech, or other symptoms characteristic of stroke.

I think the following numbers emphasize the magnitude of the problem stroke causes. It is the third leading cause of death in the United States following heart disease and cancer. About 500,000 people have a stroke each year, and 150,000 of these individuals die from it. The estimated total cost to our society from stroke, when counting lost productivity and necessary health care, is $20 billion each year. That is "real" money, even for a politician.

Strokes are caused by a disruption in the blood supply to the brain. This can be from either blockage or rupture of a blood vessel. When loss of circulation is caused by blockage of the supplying artery, it creates what we doctors call an "ischemic stroke." This is by far the most common type of stroke accounting for 80 percent of cases and can be caused by hardening of the arteries, or a blood clot that produces an abrupt blockage of the blood flow. The other 20 percent are "rupture strokes" in which the vessel's contents are spilled destructively into the surrounding tissue instead of delivering its oxygen and nutrients to the brain in the normal fashion. Doctors call these "hemorrhagic" strokes.

One's risk of stroke is influenced by a number of factors. Family history is an important one, and your history puts you at some risk. Age is the most predictable factor, however. The risk of stroke doubles for each decade one survives beyond age 55. High blood pressure, smoking, diabetes, high cholesterol, irregular heartbeat and having abnormal heart valves are among other risk factors.

Headache is a common symptom in several subtypes of ischemic and hemorrhagic strokes. Fortunately, though, because almost everyone has occasional headaches, it is not the only symptom in these strokes. Loss of sensation or the use of some body part is typically present, too. So if you only have a headache, you probably aren't having a stroke.

Individuals who are prone to stroke can experience a stroke-like episode that clears up in 5 to 10 minutes. This is called a transient ischemic attack, or TIA, and should not be ignored. Without appropriate medical treatment, the temporary slowing of blood supply to an area of the brain that causes the TIA can become a permanent blockage. In other words, a TIA can turn into a full-blown stroke. If you think you've had a TIA, you should go to the emergency room of your local hospital as soon as possible.

If you have a full-blown stroke, the damage may be irreversible. Brain cells don't grow anew when they are damaged as skin cells do. Other brain cells may be able to assume a portion of the duties of stroke-damaged cells and, thereby, help you regain some of the lost function. But the amount of this recovery is always much less than we desire. That is why stroke is so devastating.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.