Preparedness—The Key to Getting Top Stroke Care

If you value your health and that of your loved ones, don’t leave stroke care up to chance. Instead, spend some time learning how to prevent this health emergency, how to recognize its symptoms when it occurs, and what to do to ensure that you or your loved one gets the best possible treatment.

A stroke is an interruption of blood flow to the brain that starves brain tissue of oxygen and nutrients, damaging or destroying it. It may occur when a cerebral blood vessel ruptures and floods the brain (hemorrhagic stroke), or when a clot blocks blood flow in a vessel supplying the brain (ischemic stroke). Either way, a stroke is a major cause of death or disability.

“When a stroke occurs, every second counts,” says Jonathan Rosand, MD, MSc, Chief of the Division of Neurocritical Care and Emergency Neurology at MGH. “When you believe that someone is suffering a stroke, call 911 immediately and ask for an ambulance. It’s extremely important to get stroke treatment as fast as possible.


How great is your risk for a brain-damaging stroke? To find out, calculate your stroke risk using the Harvard Disease Risk Index, an interactive tool provided by Harvard School of Public Health at the following Internet address:

“Several highly effective stroke therapies—tissue plasminogen activator (tPA), which is used to dissolve clots that block blood vessels in the brain, and activated factor VIIa, which limits bleeding within the brain—must be administered within about 4.5 hours after the onset of a stroke. It is urgent that the patient arrives at a hospital within this time window to minimize damage from the stroke.”

As important as it is to receive prompt treatment, a surprising number of stroke victims may not arrive within this time window, a new study suggests. According to research presented at the American Stroke Association’s International Stroke Conference in February 2017, just 3.8 percent of 563,087 stroke patients received tPA. Previous research suggests that as many as three-fourths of patients may arrive after the time window for tPA has closed.

Thinking Ahead

Learning as much as you can about stroke could be a lifesaver one day. Of course, recognizing and addressing risk factors for stroke are essential to reduce vulnerability in the first place. If a stroke occurs, knowing when to react and how to react maximizes the chances of having the best possible medical outcome. These four steps are critical:

  1. Learn the symptoms of stroke. A good way to remember them is by memorizing the mnemonic BE-FAST, which indicates some of the major problems people experiencing a stroke might display. These include difficulty with their Balance, loss of vision in one or both Eyes, Face drooping, Arm weakness, and Speech difficulty—all signs that it’s Time to call 911.
  2. Call 911 immediately! Ask for an ambulance to take the stroke victim to the nearest stroke center.
  3. Find out in advance where to get the best stroke care. Learn which hospitals near you provide highly-rated care for stroke patients. These might include hospitals associated with universities and medical schools; regional stroke centers or stroke-certified hospitals (Google “Find a Certified Stroke Center Near You: NPR”); and hospitals participating in the American Heart Association’s Get With The Guidelines stroke program (Google “Get with the Guidelines—Stroke Hospitals,” then click on “View List of Hospitals”). Ask ambulance attendants if they are heading to one of these institutions. “In most areas of the country, ambulance attendants know where to take stroke patients,” Dr. Rosand says.
  4. Make sure medical staff know they are dealing with an emergency. Tell ambulance attendants, nurses and other medical staff that a stroke is suspected, and ask whether tPA or activated factor VIIa might be appropriate.

Avoiding a Stroke

The American Heart Association estimates that 795,000 Americans suffer strokes each year. Of these, 129,000 die of stroke-related causes and hundreds of thousands more may suffer permanent physical, mental, and behavioral disabilities associated with injury to their brain. About 13 percent of strokes are hemorrhagic strokes; the others are ischemic strokes.

There are many risk factors for stroke, some of which are beyond the individual’s control, such as older age, male gender, a family history of stroke, or a prior stroke or heart attack. However, even in higher-risk groups, it’s possible to improve the odds of avoiding a stroke through preventive measures, such as: managing medical conditions; reducing stress; consuming a nutritious low-fat diet; getting plenty of exercise; watching your weight; and avoiding smoking or excessive alcohol intake (more than one drink a day for women, or two a day for men).

These preventive measures can help prevent or decrease the impact of controllable risk factors, such as the following:

Hypertension: Hypertension (high blood pressure) is the top risk factor for stroke. A level of 140/90 or greater stresses the heart and leads to hardening of the arteries, which alone is a risk factor for stroke.

Atrial fibrillation (Afib): This heart arrhythmia can lead to the formation of blood clots in the heart that may break free and travel to the brain, causing a stroke. Afib increases risk for stroke by almost five-fold, and is linked to about 70,000 strokes each year.

Diabetes mellitus: Diabetes is strongly associated with hypertension, and it can cause damage to the blood vessels in the brain. What’s more, people with high blood sugar have a greater chance of dying after suffering a stroke, and their brain damage is often more extensive than that of stroke patients with normal blood sugar levels.

Heart disease: Many forms of heart disease can trigger clot formation that can lead to stroke. Atherosclerosis, or the buildup of fatty deposits within the blood vessels, can narrow blood vessels and make blockage more likely. Fat deposits in the carotid artery are an especially dangerous example of such a buildup.

Transient ischemic attack (TIA): A TIA, or mini-stroke, which produces brief stroke-like symptoms but does no permanent damage, is a significant warning of stroke vulnerability that requires medical followup. It must be taken seriously.

High cholesterol levels: High levels of LDL (“bad”) cholesterol (130 mg/dL or higher) can increase stroke risk, and low levels of HDL (“good”) cholesterol (less than 40 mg/dL for men, 50 mg/dL for women) may also raise stroke risk.

Dietary factors: Too much salt in your diet can lead to high blood pressure and increased stroke risk. Too few fruits and vegetables make you vulnerable to stroke as well. Studies suggest that people who eat five or more servings of fruits and vegetables may have a 30 percent lower risk of stroke.

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