- A Stroke Predictor – “the most important part of the whole idea of predicting a stroke.”
- 2 Keys to Preventing Recurrent Stroke– “High blood pressure can put you at risk for having another stroke.”
- Clot-busting stroke drug safe, says expert review– “Most strokes are caused by a clot blocking the flow of blood to the brain.”
- Wide Variations Seen in U.S. Stroke Care– “There are disparities in emergency stroke care across the United States”
- New research finds that stroke ages person’s brain function by almost eight years – “That includes controlling blood pressure and cholesterol, stopping or avoiding smoking, controlling blood sugar in diabetes, and being active even in older age. “
- Stroke: Not just an adult condition – “What is more, only 36% considered stroke as a possible cause of their child’s symptoms.”
- Strange and overlooked signs of stroke in women – “60 percent of stroke deaths occur in women and 40 percent in men”
- Hurricane Preparedness for Caregivers – “The season lasts from June 1st to November 30th”
- African Americans and Stroke – “strokes occur earlier in life for African Americans”
A Stroke Predictor
Updated November 01, 2015.
It turns out there is a surprisingly reliable way to predict a stroke, even years before it happens. If an adult starts to have trouble with what doctors label as ‘executive function’ or maintaining independent ‘activities of daily living,’ that is a powerful predictor of stroke.
What are executive function and activities of daily living?
Having the ability to maintain independent activities of daily living means being able to do the things you need to do to take care of yourself, such as keeping up with personal hygiene, including bathing, shaving and taking care of your hair or makeup.
Other activities of daily living include getting dressed, getting around your own home and eating.
Executive function means problem solving. So, executive function defines your ability to do things like sewing on a button if it falls off or cleaning up a mess after a spill. In general, executive function has to do with planning out actions and responding to unexpected events that might throw off your regular routine.
How far ahead of time can a stroke be predicted?
Recent research studies have shown that a decline in executive function and activities of daily living can be documented as long as 10 years prior to a stroke!
A research study from Harvard School of Public Health found that adults who experienced worsening activities of daily living were far more likely to have a stroke than adults who did not have a problem maintaining independent activities of daily living. The authors of the study even took the data a step further and compared adults who survived a stroke with adults who died from a stroke. It turned out that the adults who died from stroke had a worsened level of independence prior to the stroke than the adults who survived the stroke.
Another research study, published in The Journal of Neurological Sciences found that worsening executive function could predict a stroke as far as 10 years down the road. The study authors write that, “Testing for executive dysfunction may help identify individuals at risk for stroke in time to prevent them.”
Would you notice if you had a problem with executive function?
Some people might notice their own developing problem with executive function, but many of us might not notice if we were to experience a setback in executive function or activities of daily living.
Often, a spouse or close relatives, friends or coworkers are the ones who recognize a problem with these skills. It is very difficult to point out to someone that he seems to be having a problem with executive function or activities of daily living. So, that brings up the next point- is there anything can you do about it?
Can you do anything to change the chances of having a stroke?
This is the most important part of the whole idea of predicting a stroke. While it is true that worsening executive function and declining ability to independently carry out activities of daily living have predicted a stroke up to 10 years down the line, that doesn’t mean that you can’t make some changes to reverse your stroke risk. In fact, a decline in your capabilities should be a warning sign to start taking care of your health if you haven’t been doing so already.
Some proven ways to reverse your stroke risk include getting medical check ups and following your health care team’s advice to maintain a healthy blood pressure and control diabetes. Maintaining healthy blood levels of fat and cholesterol have been shown to reduce the risk of stroke. Lifestyle changes, such as starting moderate exercise, reducing stress and, most importantly, quitting smoking can dramatically reduce your risk of stroke.
If your loved one is the one experiencing these problems, you need to be the one to take the initiative to inform her doctors so that she can get the best medical treatment possible to reduce her long-term chances of having a stroke and improve her quality of life.
2 Keys to Preventing Recurrent Stroke
Posted by Teresa Bitler Oct 01 2015
High blood pressure can put you at risk for having another stroke. So can depression. According to a new study, though, the risk skyrockets to more than 80 percent for stroke survivors experiencing both. Take these precautions to ensure you don’t fall into either category.
Understanding the Risk
The study found that, in the first four years after a stroke or heart attack, depressed survivors with high blood pressure were 83 percent more likely to have another stroke or heart attack, heart failure, or die due to heart disease than were their counterparts who had normal blood pressure and were not depressed.
It is such a significant percentage that the study suggests doctors should not only closely monitor stroke survivors’ blood pressure but also screen them for depression.
Managing High Blood Pressure
Your doctor probably already closely monitors your blood pressure and, if necessary, has prescribed medication to keep it within a normal range (typically, 120-140 over 80-90). To reduce your risk of another stroke, take your medications as prescribed and monitor your blood pressure at home to ensure it is not fluctuating between visits.
These steps can also help keep your blood pressure under control:
• Eating a healthy diet
• Reducing salt intake
• Exercising and maintaining a healthy weight
• Managing stress
• Avoiding smoking
• Limiting alcohol consumption
After a stroke, diagnosing depression can be a challenge since nearly half of all stroke survivors experience the pseudobular affect (PBA)—sudden outbursts of uncontrollable crying or laughing—in the first few months after a stroke. This online quiz can help you determine whether you might be one of them.
In any case, if you or a loved one has survived a stroke, it’s important to know the signs of depression:
• Persistent sad, anxious, or “empty” mood
• Feeling hopeless
• Feeling guilty, worthless, or helpless
• Feeling irritable
• Loss of interest in activities or hobbies
• Decreased energy or fatigue
• Difficulty concentrating or making decisions
• Difficulty sleeping or oversleeping
• Appetite and/or weight changes
• Thoughts of death or suicide
• Ongoing aches or pains
If you think you or your loved one might be depressed, talk to your doctor. He or she can prescribe a treatment plan that may include medication and/or psychotherapy (talk therapy).
In addition to your doctor’s recommendations, you can:
• Get involved in activities with family or friends
• Find a support group
• Volunteer to help others
Clot-busting stroke drug safe, says expert review
24 July 2015
- From the section Health
A panel of independent experts has decided that a clot-busting drug often used to treat strokes is “safe and effective”.
The UK medicines watchdog wanted the benefits and risks of alteplase to be analysed after concerns were raised about its safety.
The panel concluded that the best time to use the drug is up to four and a half hours after the start of symptoms.
But some other doctors are still not convinced by the evidence.
Most strokes are caused by a clot blocking the flow of blood to the brain.
Many patients are given the drug alteplase to break down and disperse the clot – a treatment known as thrombolysis.
“I didn’t get the feeling there was a real examination of the evidence – most of it came from people working in the field” – Sir Richard Thompson, Royal College of Physicians
Benefits outweigh risks
The independent expert panel, chaired by Prof Sir Ian Weller, said it had looked at all available data on alteplase and decided that the earlier the drug was given to patients, the greater the chance of a good outcome.
Used up to four and a half hours after the onset of symptoms, the benefits of the drug were found to outweigh the risks.
But it added that the benefits of using alteplase to treat strokes were “highly time-dependent” and, in a small number of people, there was a risk of haemorrhage.
Prof Weller explained: “The evidence shows that for every 100 patients treated with alteplase, whilst there is an early risk of a fatal bleed in two patients, after three to six months, around 10 more in every 100 are disability-free when treated within three hours.”
Five more patients in every 100 are left with no disabilities when treated between three and four-and-a-half hours after a stroke, he said.
However, there are still medical experts who have concerns.
Sir Richard Thompson, past president of the Royal College of Physicians, who sat in on proceedings as an observer, said he felt no progress had been made.
“An investigation like this should look at the evidence from both sides like a court of law. I didn’t get the feeling there was a real examination of the evidence. Most of it came from people working in the field.”
Dr Roger Shinton, a stroke expert, said there was more to find out.
“I’m sure there will be some further information, which we will all find helpful and that is to be welcomed.
“But I’m worried that most of the key bits of information that will help resolve this debate are still not going to be available.”
Dr June Raine, the director of vigilance and risk management of medicines at the MHRA – the UK’s medicines watchdog – said a thorough scientific assessment had been carried out, using all the latest evidence.
She added: “We will continue to monitor the safety of alteplase and if any new evidence emerges we will reassess the benefit-risk balance.”
Dr Dale Webb, director of research and information at the Stroke Association, said the findings of the review were “extremely welcome news for stroke patients and their families”.
“Eligible patients treated with thrombolysis [using alteplase] are more likely to lead more independent lives.
“However, this type of treatment is not suitable for everyone struck down by stroke.”
The Stroke Association says it is funding research into other ways to help improve recovery rates from the condition.
Wide Variations Seen in U.S. Stroke Care
Only small percentage of patients receive clot-busting drug or other urgent treatment, study shows
By Amy Norton
TUESDAY, July 7, 2015 (HealthDay News) — Americans’ odds of receiving a drug that can halt strokes in progress may vary widely depending on their ZIP codes, a new study finds.
Experts said the findings, reported in the July issue of the journal Stroke, help verify what everyone has suspected: There are disparities in emergency stroke care across the United States, specifically in the use of a clot-busting drug called tissue plasminogen activator, or tPA.
And the magnitude of the disparities was “striking,” said senior researcher Dr. James Burke, of the University of Michigan in Ann Arbor.
In 20 percent of hospital markets, not a single stroke patient received tPA over four years, Burke’s team found. In others, up to 14 percent of stroke patients received the drug.
The big question is: Why? “We really don’t know what’s driving this,” Burke said.
The hospital markets that most often gave tPA were scattered across the country, in urban and rural areas, the investigators found. And they included both regions with relatively high and relatively low rates of stroke.
Whatever the reasons, Burke said, there is clearly a need to close the regional gaps in tPA use.
“We have a treatment that works,” he said. “We need to figure out how to best get it to the patients who can benefit.”
Most strokes are caused by a blood clot in the arteries supplying the brain. If tPA is given in time, it can break up the clot and limit brain damage from the stroke. But that’s not as simple as it sounds.
First, tPA has to be given within three hours of the initial stroke symptoms. So people have to quickly recognize those symptoms, then get to the emergency room.
From there, doctors have to be sure the stroke is caused by a blood clot, which requires a CT scan. (Some strokes are caused by bleeding in the brain, and giving tPA could worsen the situation.)
Most U.S. hospitals have the technical capability to give tPA, Burke said. What varies, he added, is their experience and comfort with using the drug.
Neurologist Dr. Koto Ishida directs the NYU Langone Comprehensive Stroke Care Center in New York City. She agreed that experience and comfort level are key.
“This drug does have risks, and it’s definitely not right for all stroke patients,” said Ishida, who was not involved with the study.
Those risks include bleeding in the brain, which happens about 6 percent of the time, according to the American Academy of Neurology. Plus, certain people — such as those with uncontrolled high blood pressure — should not receive tPA.
Ishida also pointed to the relative complexity of emergency stroke care: It’s a “team effort,” she said, involving paramedics, ER doctors, nurses, a neurologist, radiologist and a pharmacist to mix the tPA.
At a smaller hospital, those specialists might not be readily available all the time, Burke suggested.
And in general, Ishida said, hospitals that see more stroke patients — particularly those certified as a “primary stroke center” — will have a more efficient process in place for getting patients the right treatment.
Still, in this study, living near a primary stroke center made only a minor difference in the likelihood of receiving tPA, Burke said.
Other research has shown that delayed hospital arrival is a major reason that stroke sufferers cannot receive tPA.
That’s why people need to know the signs of stroke, both Burke and Ishida said. Symptoms include sudden weakness or numbness in the face, an arm or a leg; slurred speech; blurry vision; dizziness or trouble with balance and coordination.
“It’s not like a heart attack, where pain will often drive people to call 911,” Ishida said. “With stroke, people often wait to see if the symptoms go away. But you can’t predict whether you’ll get better. Don’t wait to call 911.”
The current findings are based on more than 840,000 Medicare patients who suffered a stroke between 2007 and 2010. Each lived within one of 3,436 U.S. hospital markets.
In 20 percent of those hospital markets, no stroke patients received tPA. In the top-20 percent, tPA was given to 9 percent of patients, on average. Some markets — in states spanning from California to Iowa, Minnesota, Pennsylvania and North Carolina — were in the range of 10 to 14 percent.
According to Burke, it will be important to understand why some hospital regions have high rates of tPA use and, if possible, repeat their success elsewhere.
If all hospital markets could reach the 14-percent mark, that would mean an additional 93,000 patients getting tPA, the researchers estimated. And that, they suggested, could allow more than 8,000 people to survive their stroke disability-free.
According to Burke, a treatment rate of 10 percent to 15 percent is a “credible goal.”
“I think that until we reach 10 percent nationwide, we’ve still got a lot of work to do,” he said.
The American Stroke Association has more on stroke warning signs.
SOURCES: James Burke, M.D., clinical lecturer, neurology, University of Michigan, Ann Arbor; Koto Ishida, M.D., director, NYU Langone Comprehensive Stroke Care Center, New York City; July 2015, Stroke
Last Updated: Jul 7, 2015
Copyright © 2015 HealthDay. All rights reserved.
New research finds that stroke ages person’s brain function by almost eight years
Published on June 8, 2015 at 4:08 AM
Having a stroke ages a person’s brain function by almost eight years, new research finds – robbing them of memory and thinking speed as measured on cognitive tests.
In both black and white patients, having had a stroke meant that their score on a 27-item test of memory and thinking speed had dropped as much as it would have if they had aged 7.9 years overnight.
For the study, data from more than 4,900 black and white seniors over the age of 65 was analyzed by a team from the University of Michigan U-M Medical School and School of Public Health and the VA Center for Clinical Management Research. The results will be published in the July issue of Stroke.
Researchers married two sources of information for their analysis: detailed surveys and tests of memory and thinking speed over multiple years from participants in a large, national study of older Americans, and Medicare data from the same individuals.
They zeroed in on the 7.5 percent of black study participants, and the 6.7 percent of white participants, who had no recent history of stroke, dementia or other cognitive issues, but who suffered a documented stroke within 12 years of their first survey and cognitive test in 1998.
By measuring participants’ changes in cognitive test scores over time from 1998 to 2012, the researchers could see that both blacks and whites did significantly worse on the test after their stroke than they had before.
Although the size of the effect was the same among blacks and whites, past research has shown that the rates of cognitive problems in older blacks are generally twice that of non-Hispanic whites. So the new results mean that stroke doesn’t account for the mysterious differences in memory and cognition that grow along racial lines as people age.
The researchers say the findings underscore the importance of stroke prevention.
“As we search for the key drivers of the known disparities in cognitive decline between blacks and whites, we focus here on the role of ‘health shocks’ such as stroke,” says lead author and U-M Medical School assistant professor Deborah Levine, M.D., MPH. “Although we found that stroke does not explain the difference, these results show the amount of cognitive aging that stroke brings on, and therefore the importance of stroke prevention to reduce the risk of cognitive decline.”
Other research on disparities in cognitive decline has focused on racial differences in socioeconomic status, education, and vascular risk factors such as diabetes, high blood pressure and smoking that can all contribute to stroke risk. These factors may explain some but not all of the racial differences in cognitive decline.
Levine and her colleagues note that certain factors – such as how many years a person has vascular risk factors, and the quality of his or her education, as well as genetic and biological factors – might play a role in racial differences in long-term cognitive performance.
But one thing is clear: strokes have serious consequences for brain function. On average, they rob the brain of eight years of cognitive health. Therefore, people of all racial and ethnic backgrounds can benefit from taking steps to reduce their risk of a stroke. That includes controlling blood pressure and cholesterol, stopping or avoiding smoking, controlling blood sugar in diabetes, and being active even in older age.
University of Michigan Health System
Stroke: Not just an adult condition
Last updated: Thursday 7 May 2015 at 8am PST
When you hear the word “stroke,” the first picture that pops into your mind is likely to be of an elderly individual. It’s true that older adults are at greater stroke risk; the chance of having a stroke doubles with each decade of life after the age of 55. But did you know that infants and children can also suffer stroke? It can even occur before birth.
Stroke affects 6 in every 100,000 children in the US and is one of the 10 leading causes of death among children in the country.
According to the National Stroke Association, stroke affects 6 in every 100,000 children in the US. It is also one of the 10 leading causes of death among children in the country.
The rate of stroke is much higher in adults than children. Every year, more than 795,000 men and women suffer a stroke and around 130,000 die from the condition. However, studies have found stroke rates are on the rise in children in the US.
In 2011, a study published in the Annals of Neurology reported a 51% increase in ischemic stroke incidence among boys aged 5-14 from the period 1995-96 to 2007-08, while girls aged 5-14 saw a 3% rise in ischemic stroke in the same period.
In many ways, stroke in children – commonly referred to as pediatric stroke – can present more challenges than stroke in adults.
The early signs of stroke in children are much more subtle than in adults, meaning they often go unrecognized. According to the International Alliance for Pediatric Stroke (IAPS), newborns who suffer stroke may not even begin to show any symptoms until the age of 4-8 months.
What is more, because parents, caregivers and even health care professionals do not often associate stroke with children, it may be ruled out as a possibility. As a result, many children fail to receive adequate treatment.
A 2014 study conducted by Dr. Mark Mackay, director of the Children’s Stroke Program at the Royal Children’s Hospital and Murdoch Children’s Research Institute in Melbourne, Australia, and colleagues found that only half of interviewed parents whose children suffered stroke thought their child’s symptoms were serious enough to call 911, while 21% of parents adopted a “wait-and-see” approach. What is more, only 36% considered stroke as a possible cause of their child’s symptoms.
As with most health conditions, early treatment for stroke is key. Unfortunately, around 20-40% of children die after a stroke, and of those who do survive, around 50-80% will have lifelong neurological problems, such a partial or total paralysis.
May is American Stroke Awareness Month. In this Spotlight, we investigate the risk factors for pediatric stroke, the signs and symptoms to look out for, as well as the treatment options for the condition.
Perinatal stroke and childhood stroke
There are two types of pediatric stroke: perinatal stroke and childhood stroke.
Perinatal stroke, also referred to as fetal or prenatal stroke, occurs between the last 18 weeks of pregnancy and the first 30 days of birth. In the US, perinatal stroke occurs in about 1 in every 2,800 live births.
Most cases of perinatal stroke are ischemic, caused by blood clots breaking off from the placenta and becoming lodged in the child’s brain.
Childhood stroke occurs between the ages of 1 month and 18 years. Unlike adults, in whom ischemic stroke is most common, children are equally as likely to have ischemic stroke as they are hemorrhagic stroke – caused by a brain bleed from a ruptured blood vessel.
Around 60% of all pediatric strokes occur in boys, and African-American children are at greater stroke risk than Caucasian and Asian children.
The risk factors for pediatric stroke
Among adults, high blood pressure, irregular heartbeat and atherosclerosis – hardening of the arteries – are some of the most common risk factors for stroke. These factors rarely cause stroke in children, however.
According to the American Stroke Association, around half of all pediatric strokes are triggered by an underlying condition, most commonly sickle cell disease – an inherited blood disorder – and congenital heart disease.
Other underlying conditions that may raise a child’s stroke risk include head and neck infections, abnormal blood clotting, head trauma and systemic conditions, such as autoimmune disorders.
Maternal history of infertility, premature rupture of membranes during pregnancy, maternal preeclampsia and chorioamnionitis – inflammation of the fetal membranes due to a bacterial infection – may also increase a child’s stroke risk.
Though cardiovascular-related risk factors for stroke in adults are rare in children, recent studies have indicated an increase in these risk factors among the younger population. This is down to a rise in high blood pressure, obesity, diabetes, high cholesterol and tobacco and alcohol use among youth.
A 2014 study published in the journal Neurology also suggested colds and other minor infections in childhood may temporarily raise a child’s stroke risk.
“We’ve seen this increase in stroke risk from infection in adults, but until now, an association has not been studied in children,” commented study author Dr. Heather Fullerton, director of the University of California-San Francisco Pediatric Stroke and Cerebrovascular Disease Center.
“It is possible that inflammatory conditions contribute more to the stroke risk in children, however, further research is needed to explore this possible association.”
It is important to note, however, that in around half of all childhood stroke cases, no previous risk factor can be determined.
What are the signs and symptoms to look out for?
As mentioned previously, it can be very hard to spot stroke symptoms among very young children. Around 40% of infants do not show symptoms of early stroke; a parent may not know their baby has suffered stroke until months later when they show reduced movement or weakness on one side of their face.
As well as weakness or numbness on one side of the body, other signs of stroke in children may include severe headache, dizziness and vomiting.
Repetitive twitching of the face, arm or leg can be an indicator of stroke in newborns, as can a pause in breathing alongside prolonged staring and extreme fatigue.
As children develop, the signs of symptoms of stroke are very similar to those in adults. Weakness or numbness on one side of the body and problems speaking or understanding language – such as slurred speech or problems understanding simple instructions – may be signs of stroke.
Other signs of stroke among children may include severe headache, vomiting, fatigue, severe dizziness and appearance of seizures.
The American Stroke Association stress that the F.A.S.T. acronym is an easy way to remember the sudden signs of stroke in both children and adults:
Face drooping. Is one side of the face numb or drooping? Is the individual able to smile?
Arm weakness. Is one arm numb or weak? Ask the individual to lift both arms. Does one arm drift downward?
Speech difficulty. Is the individual’s speech slurred? Do they find it hard to speak or are they hard to understand? Can they correctly repeat a simple sentence, such as “the sky is blue?”
- Time to call 911. If the individual shows any of these symptoms, call 911 immediately, even if the symptoms disappear. Check the time at which first symptoms appear.
“Think stroke, act fast and call 911. That message applies to adults and children,” says Dr. MacKay. “Getting to the hospital quickly is an essential first step to develop strategies to improve access to emergency treatment in children.”
Treatment options for pediatric stroke
For adults suffering ischemic stroke, the first port of call in terms of treatment is the medication tissue plasminogen activator (tPA), which works by dissolving any blood clots that are blocking the arteries, restoring blood flow to the brain. Such treatment must be administered within 3 hours of symptom onset – 4.5 hours for some patients.
The use of tPA among young children with ischemic stroke, however, is controversial. Since children and adults have physiological differences, health care professionals are concerned about the drug’s safety and efficacy among children – something that is currently being investigated.
As such, stroke treatment for children tends to vary depending on the cause of their stroke and any underlying medical conditions they may have. A child whose stroke was caused by a heart defect, for example, may be treated with blood-thinning medication, such as warfarin or aspirin.
Children who suffer stroke have around a 15-18% chance of suffering another stroke. Therefore, many children may receive treatment to prevent stroke recurrence, such as antithrombotic therapy – medication that stops blood clots from forming or growing.
One crucial treatment for the majority children who suffer stroke is rehabilitation therapy, which can involve physiotherapy, occupational therapy and speech therapy.
Sixty percent of children experience neurological problems, such as hemiplegia or hemiparesis cerebral palsy, following stroke. Rehabilitation therapy can really help reduce the neurological effects of stroke, and the earlier treatment is started, the more likely it is to succeed.
Severe delays in diagnosis of pediatric stroke
But as Dr. MacKay’s study showed, many parents either do not consider the possibility that their child is suffering a stroke or are unable to recognize the signs, which can severely delay treatment.
Dr. MacKay’s findings revealed that the average time from symptom onset of pediatric stroke to arrival at the emergency room was 1.8 hours, with some arrivals taking up to 4 hours.
And it is not only parents who may overlook the signs and symptoms of pediatric stroke – doctors can too. Studies have found that in the US, it can often take longer than 24 hours to diagnose stroke in children.
Because of the delay in diagnosis, the boy had to have a part of his skull removed to ease pressure from the build up of blood in his brain.
In a 2008 interview, Dr. Fullerton said she believes a delay in diagnosis of pediatric stroke has fallen into a gap in clinical care. “It is a rare disorder in general, and so most child neurologists will not be very comfortable in caring for children with stroke,” she said, adding:
“Stroke is considered more a disease of adults, but then adult stroke neurologists aren’t familiar of the etiologies of stroke in children or how to manage stroke in children, and so they’re often uncomfortable with caring for a stroke in a child.
It can be difficult to diagnose the etiology of their strokes. It often takes sophisticated imaging studies and studies that are done by very experienced practitioners. It really often does take a team approach to figure out why a child has had a stroke and figure out what is the best way to prevent more strokes in that child.”
While stroke is much rarer in children than adults, it is important that parents, caregivers and health care professionals are aware that children can be affected by the condition and take note of the signs and symptoms that may arise.
Not only is May American Stroke Awareness Month, 2nd-8th May is dedicated to World Pediatric Stroke Awareness Week. Set up by the IAPS and not-for-profit organization Brendon’s Smile last year, the campaign aims to raise awareness of pediatric stroke around the globe and educate communities about how the condition can impact children’s lives.
Visit the IAPS website to find out more about pediatric stroke and how you can help raise awareness of the condition.
Written by Honor Whiteman
By Amy Kraft CBS News April 28, 2015, 1:58 PM
Strange and overlooked signs of stroke in women
Stroke is the third leading cause of death in women, according to the National Stroke Association. Yet few women know some of the subtler, gender-specific signs of a stroke, or that women face some unique risk factors.
Ohio State University’s Wexner Medical Center released a national survey today that found that out of 1,000 women, only 11 percent could identify female-specific stroke risks including pregnancy, migraine headaches, use of birth control pills, and autoimmune diseases such as lupus.
The survey also found that only 10 percent were aware that hiccups along with chest pain are early warning signs of a stroke, when accompanied or followed by classic stroke symptoms such as face drooping or numbness on one side of the body.
“Women have thought of stroke as a man’s disease and have not really been as proactive in understanding their risk for stroke,” Dr. Diana Greene-Chandos, a neurologist and director of neuroscience critical care at Ohio State’s Wexner Medical Center, told CBS News.
Things that put women at greater risk of stroke are related to female hormones, such as estrogen. Estrogen is a coagulant, which means it clots the blood more. Women are at higher risk of stroke when estrogen levels are high in the body, including at the later stages of pregnancy and right after delivery. Estrogen levels can also be raised by birth control pills or hormone replacement therapy medications.
Women are also at a greater risk than men of developing autoimmune diseases such as lupus, which is associated with inflammation of blood vessels.
“I think we have a ways to go when it comes to educating women about stroke and their unique risk factors,” Greene-Chandos said in a press release.
Some risk factors are the same for both women and men, including smoking, lack of exercise or high blood pressure. Greene-Chandos recommends maintaining a blood pressure level below 140/90. Other risks include having elevated blood glucose levels of more than 7 if you are already diabetic, or 5.7 if not; as well as having LDL cholesterol below 100 without other risk factors, or less than 70 with additional risk factors.
The survey also found that more than half of the women were unaware of the problems that females face after stroke. Many women experience nerve damage, trouble swallowing and depression. Greene-Chandos said that these side effects often keep women from getting the rehab that is vital to their recovery.
“The more you use your brain, the better you’ll do in your recovery after a stroke,” Greene-Chandos said.
Each year, nearly 800,000 Americans suffer a new or recurrent stroke and more than 137,000 people die from stroke. According to the American Heart Association, 60 percent of stroke deaths occur in women and 40 percent in men.
Greene-Chandos believes it’s important for medical professionals to do more to get the message out about stroke in women. “As the population ages, it’s going to become more of a problem,” she told CBS News.
Anyone, male or female, who experiences possible stroke symptoms needs to seek medical attention right away. Currently the only acute treatment for stroke is with a clot-busting drug known as tPA, which must be administered within three hours of the onset of a stroke.
Greene-Chandos advised women not to delay seeking medical help. “We would rather have you in and out of the emergency room quickly than it be missed,” she said.
© 2015 CBS Interactive Inc. All Rights Reserved.
For About and By Caregivers
Hurricane Preparedness for Caregivers
By Angela Medieros, Staff Writer
Hurricane season has made its entrance again. Individuals who are caring for loved ones must plan as far ahead as possible. Regardless of how many hurricane seasons weathered, current knowledge is literally a lifesaver.
The season lasts from June 1st to November 30th. Longtime residents living along the Atlantic and Gulf coasts have the dates memorized, but even those who have been through many cycles should look at each season individually.
If you are in an evacuation zone, your supplies should be portable and manageable. Depending on the health condition of your loved one, you may already have information on where to go. Ventilator dependent patients who must go through storms at the hospital must find out which supplies they have to bring. Supplies like gauze pads and other day-to-day items may not be available, since it is not a regular admission. Loved ones who are told to go to the hospital may only be kept for the duration of the storm. Other facilities will have to be found if a home cannot be returned to immediately.
Time spent in shelters can be trying, especially for caregivers who have loved ones who are memory challenged. Having items that will entertain your loved one will help. In addition, consider “making friends” with as many people as possible to divert both of you. If the loved one has hearing difficulty, bring earbuds or headphones along to allow higher volumes to be used. Shelters can be filled to capacity with a variety of people who are used to different schedules. Even a hurricane cannot deter them from their routines. Patience and tolerance can be your most frequently used “supplies” at a shelter.
Special needs shelters are determined by the county, and registration is also required. As with any shelter, taking along all medications is a must. Prepare a list of medications, dosages and other medical facts like allergies and have it laminated. The list can be kept with the medications for quick reference if needed.
Most special needs shelters require everyone to bring their own supplies, including bedding. Arrive as soon as you are aware you must evacuate to a shelter rather than wait until the last minute. The storm determines when transportation to the shelter or hospital is shut down. Having supplies packed and ready to go will allow you to leave immediately.
Therapy pets are allowed in special needs shelters, but not household pets. If your loved one cannot be separated from their pet, speak to your local Humane Society about qualifying them as a therapy pet. Last minute arguing with shelters or loved ones may keep everyone in an unsafe situation. Storms can turn on a dime, as we saw with Hurricane Andrew. They can also appear to “last forever” as Hurricane Wilma did. Everything you do to prepare is an investment in everyone’s safety.
ITEMS ON HAND
Take a look at your pantry. People who are not accustomed to canned food will keep little of it around. The familiar hurricane phrase “We’ll just eat sandwiches” is unrealistic. By the time the storm is over, everyone will look for meals to return to normal. If power is on, it’s not a problem. When there’s no power, caregivers must use a creative hand to keep themselves happy and distressed while feeding loved ones.
Consider adding a canned dish to meal offerings before it is necessary to use them. Corned beef hash, canned chicken or tuna and other “hurricane foods” as a temporary part of normal diet will help everyone get used to them. This cuts down on those refusing to eat until the power goes on. Every couple of weeks, have a “hurricane meal night.” It can help keep the season in the “memory loop” of all concerned, but still be a fun experience. Caregivers will be able to determine which types and brands of canned goods will be eaten by everyone.
EXTRA HINTS FOR CAREGIVERS
Consider purchasing caregiver and loved one medallions from the Alzheimer’s Association to wear in the event of emergency. You may do everything you can to avoid separation from your loved one, but the information that can be obtained via the service’s 800 number is a backup.
Precautions are taken in shelter facilities to ensure safety for everyone. However, keeping valuables out of sight and on your person is the first safety measure. A checklist of the items you are carrying will prevent you from worrying about loss, but the list should remain in your possession at all times.
Examine whether a safety deposit box would be a useful investment versus a “home safe.” Papers and other valuables should be plastic sealed in either case.
Websites and printed information on quantities of food and water are excellent guidelines. You can overstock if you choose, but keep the recommended amounts on hand until the season is fully over. To prevent expiration, rotate your supplies within hurricane season.
Don’t wait until the last minute to check and buy batteries or any other items. If you need to make a last minute trip to the store, focus on items that will keep. Buying perishable foods when a storm is imminent will waste money and food reserves if the power goes out. Although you may buy a gallon of ice cream for the “lights out party,” make sure you have non-perishable fun foods when the fridge should be kept closed.
Thinking ahead will offer you a sense of comfort and give your loved one a feeling of security.
All publications are reviewed by National Stroke Association’s Publications Committee. © 2011 National Stroke Association.
African Americans and Stroke
What is stroke?
Stroke is a “brain attack” that occurs when blood, which brings oxygen to your brain, stops flowing and brain cells die. For all racial groups, stroke is the third leading cause of death in the U.S. and a leading cause of adult disability.
How does stroke affect African Americans?
African Americans are twice as likely to die from a stroke as whites. The rate of strokes in African Americans is almost double that of whites, and strokes occur earlier in life for African Americans than whites. In addition, African American stroke survivors are more likely to become disabled and experience difficulties with daily living and activities.
The statistics are staggering. African Americans are more impacted by stroke than any other racial group.
African American women have a lower one-year survival following ischemic stroke (a stroke caused by a blood clot) compared with whites.
Among those aged 20 to 44 years, African Americans are 2.4 times more likely to have a stroke compared with whites.
African Americans are significantly less likely to receive tissue plasminogen activator (tPA), the only FDA-approved treatment for stroke, compared with whites.
Not all of the reasons are clear why African Americans have an increased risk of stroke. However, risk factors certainly play a major role in the risk of having a stroke.
There are some stroke risk factors that cannot be controlled, such as age, gender, race, family history and previous stroke or transient ischemic attack (TIA). But if you have one or more of the following controllable risk factors, you should learn about changes you can make to prevent a stroke.
Many controllable risk factors are either lifestyle or medical risk factors. Lifestyle risk factors, such as smoking, excessive alcohol use and being overweight, can often be controlled by quitting smoking, managing exercise/diet and limiting alcohol consumption.
Medical risk factors, such as high blood pressure, high cholesterol, diabetes and atrial fibrillation, can often be controlled by surgery, medication and a healthier lifestyle. Talk with your healthcare professional about risk factor management.