SPRINGFIELD Dr. Rajiv Padmanabhan doesnt need a calendar to remind him that May is American Stroke Month.
However, the Baystate Medical Center neurologist notes that many people remain unaware of the symptoms of stroke and the importance of getting immediate medical attention to avoid disability and even death.
He adds that the coronavirus pandemic further underscores the importance of calling 9-1-1 when this cerebrovascular accident that impacts blood and oxygen flow to the brain is suspected.
Though not common, Padmanabhan said stroke can be a complication in severe cases of COVID-19, the disease caused by the new coronavirus.
He adds anyone experiencing a life-threatening event like a stroke should not let fear of exposure to COVID-19 prevent them from seeking immediate medical care. He said Baystate is among those in the medical community that has taken extensive steps" to reduce such exposure.
It is very important not to delay care in stroke as the outcome can be worse. It is very important now more than ever to call 9-1-1 right away, Padmanabhan said.
It is important to know that time is brain. The phrase time is brain emphasizes that human nervous tissue is rapidly lost as stroke progresses and emergent evaluation and therapy are required.
Sometimes referred to as a brain attack," a stroke is caused by blockage of blood flow or bleeding into the brain and its symptoms include numbness, confusion and severe headache.
A ruptured brain aneurysm a weakened area of a blood vessel that begins to bleed can also cause stroke.
Interruption in the flow of blood, which carries oxygen and other nutrients to the brain, can cause cells to die and impair function. The act F.A.S.T. evaluation helps with awareness of stroke and the need for quick treatment.
A healthy lifestyle can help reduce stroke risk and other preventative measures include discussions with a medical provider about maintaining the desired blood pressure and whether there is a family history for cardiovascular disease.
Padmanabhan was asked to explain further about stroke, which is the leading cause of disability among adults and one of the top causes of death in the United States.
Q. A stroke can be quite disabling. Why is that?
A. The part of the brain that controls that part of body is unique in its purpose and function and, usually after a stroke, that part of the brain ceases to function resulting in loss of that modality. That being said, each part of brain works in unison with other areas and stroke in one area can affect the connections other parts of the brain rely on.
Thus, strokes can be disabling not only in the loss of function but also by the way of the downstream effects.
Q. What is the difference between ischemic and hemorrhagic stroke?
A. A hemorrhagic stroke is due to rupture in an artery due to weakening of the arterial wall. This results in blood seeping into the brain affecting that part of the body where the bleed occurred.
An ischemic stroke is a clotting type of stroke that occurs when a clot forms within an artery due to plaque, that is, hardening of artery, or due to a clot arising from elsewhere. A clotting stroke and a bleeding stroke affect the body similarly and so to tell the difference urgent scans are needed and treatments change according to the type of stroke.
Q. The death rate from stroke has dropped considerably since the drug tPA, tissue plasminogen activator, was approved by the FDA in the 1990s to treat acute ischemic stroke. How does it work and how are patients evaluated for this treatment?
A. TPA breaks up the clot in a clogged artery in an ischemic stroke and tries to restore flow back to brain. This reduces the number of nerve cells, that is, neurons, to survive, improving the chances of good outcome or recovery and minimizing the severity and consequently decreasing complications from a severe stroke, including death.
Q. Thrombectomy therapy can also be used to treat acute ischemic stroke. Would you explain this and when is it applicable and is it used in combination with tPA?
A. Thrombectomy is most useful when we can actually see a large clot in the artery that can be removed by the way of a catheter device that is threaded up an artery in the groin under anesthesia.
This offers the best hope for patients who otherwise would have worse outcomes. It can be done in some cases until 24 hours of stroke. To identify and treat as quickly as possible, we incorporate scans looking not only at the brain but also the arteries that go the brain in a very rapid manner so we can effectuate treatment much faster.
Q. What success has Baystate seen in treating acute ischemic stroke patients with this therapy?
A. We have had tremendous success in the approaches we have taken both by decreasing the time to treatment by the way of clot busting treatment but also having the ability to quickly get the patient to the catheter lab to remove the clot and restore blood flow in a timely manner.
This has led to more discharges to home rather than to nursing home.
Q. How is hemorrhagic stroke treated?
A. We usually control the blood pressure to minimize further damage to the brain, and in addition if the patient is on a blood thinner, we have medications to reverse the effects of blood thinner as well.
Q. What are some of the cardiovascular risks for stroke that people should be aware and possibly address to avoid stroke?
There are modifiable risk factors: such as hypertension, that is, high blood pressure, diabetes, smoking, sedentary lifestyle, obesity, high cholesterol.
There is also a correlation with sleep apnea.
Atrial fibrillation can pose a risk for clotting stroke.
Cutting salt, exercising more and checking your numbers with your primary care doctor is important.
Q. How are health care providers better managing these risks in their patients?
A. Primary care providers are on the frontline of these risk factor assessments and management.
It is very important to follow up with your primary care doctor and the ask the question: what are my risk factors, and what are my numbers?
It is also important to tell your primary care doctor of any medical conditions that run in the family, and that may increase the risk for stroke and heart attack.
Q. Signs of stroke can differ by gender. Would you explain?
A. In the Atherosclerosis Risk in Communities Study it was found that men were more likely to experience walking issues with stroke compared to women.
The National Institutes of Health recommends improved education for women and their caregivers to seek care early, especially with mild symptoms, and not wait to call 9-1-1.
Q. Most strokes occur in people over 65, but it is estimated that about 10 percent of strokes occur in those 45 and younger in the U.S. What are some of the causes of this, and is vaping considered a potential risk factor?
A. Stroke in age less than 45, often described as stroke in young, may not only be due to traditional risk factors. There can be additional factors for example, certain rare clotting disorders, tear in the arteries, and due to effects of vaping, smoking and illicit drugs.
One study found vaping increasing the stroke risk by three-fold compared to those who did not.
Adding cigarette smoking to vaping can further increase stroke risk by another two-fold.
Q. What success has Baystate seen in terms of lower morbidity and mortality rates around strokes in the last decade with improved treatment and awareness?
A. There has been a significant improvement in not only the deaths, but also disability following the implementation of specialized stroke systems of care in the last 10 years, thus cutting treatment times, significant improvement in window for treatment of thrombectomy for clot removal especially over the last several years.
Q. Are most of your patients aware of the signs of stroke and the importance of calling 9-1-1 quickly?
A. Many of the patients are not aware of all the stroke signs and symptoms. And in one survey many of the patients did not know their risk factors and importance of controlling them after a stroke had already occurred.
It is important for family and caregivers to be aware of stroke symptoms to be able to act quickly by calling 9-1-1.
Q. What is the No. 1 thing you would like people to know in terms of lowering their risk for stroke?
A. It is important to see your primary care doctor and make sure you ask the risk questions. Majority of strokes are preventable.
Q. Is it too late for older people, especially those with underlying conditions, to reduce their risk for stroke?
A. Not at all, older patients may have several underlying conditions, but with the help of their primary care doctor, it is possible to have a tailored approach to management of risk factors.
Additionally, with the new blood thinners we prescribe for atrial fibrillation to prevent the bleeding, complications have decreased over the years; it is important to know to ask about the newer agents when you visit your doctor.
Q. What more do you want younger people to know in terms of preventing their risk for stroke as they age?
A. It is good to have a healthy routine of diet and exercise and to continue to follow up with your primary care doctor. If you are smoking then quitting smoking now can be very important in preventing stroke and heart problems.
Q. Do brain aneurysms affect stroke risk?
A. Yes, a ruptured brain aneurysm can cause stroke in a manner different from the traditional stroke and can occur in the first 14 to 21 days of aneurysm bleed.
To help prevent and manage such complications we have dedicated staff and protocols in the neurointensive care unit at Baystate.
If an aneurysm is found incidentally and has not ruptured, we do have neurointervenitional clinic expertise that your doctor can refer to to help address this by the way of catheter-guided coiling of the aneurysm to prevent a bleeding from occurring in the first place.
Excerpt from:
May is American Stroke Month; Baystate Health neurologist says know the signs for this brain attack - masslive.com
