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Stroke

Stroke

May 31, 2011
12:00 p.m. – 1:00 p.m. (EST)

  • Efrain Salgado, MD – Neurologist

Stroke is the third largest cause of death, ranking behind "diseases of the heart" and all forms of cancer and can happen at any age. Nearly 1/4 of strokes occur in people under the age of 65 and is also a leading cause of serious, long-term disability.

Cleveland_Clinic_Host: Today's Live Web Chat, "Stroke" with Efrain Salgado, MD will begin at 12 noon EST. Please submit your questions by typing them below and then clicking 'Ask'.

Cleveland_Clinic_Host: Welcome to our Online Health Chat "Stroke" with Efrain Salgado, MD. We are thrilled to have him here today for this chat. Let’s begin with the questions.

Falpa: Is it possible that an ischemic stroke can repeat despite all the controls I have over my risk factors?

Efrain Salgado_MD: Yes. Most important risk factor for stroke is age, which is non-modifiable. However, one can substantially reduce risk by up to even 60-70% by controlling hypertension, diabetes, high cholesterol, by exercising, treating obstructive sleep apnea if you have it, and avoiding tobacco and excessive alcohol consumption. Many patients with atrial fibrillation, which is a particular irregularity of the heart rhythm, also need to be on a blood thinner to substantially lower risk.

Jonnyboy: Is a mini stroke and a TIA the same thing?

Efrain Salgado_MD: Yes. The mechanism of TIA and stroke are very similar. With TIA or "transient ischemic attack" the stroke symptoms typically last no more than minutes and totally resolve. Furthermore, there is no brain damage left as typically occurs with stroke.

Jonnyboy: I know that a stroke occurs when the blood supply to a part of the brain is blocked. Why / how does this happen?

Efrain Salgado_MD: Most common reason for this is atherosclerosis or "hardening of the arteries" or the deposit of cholesterol inside the arteries narrowing them to the point that blood flow is compromised. Most of the risk factors for stroke accelerate this process.

Carmicat17: Does having a TIA leave you at a greater risk to have a full blown stroke?

Efrain Salgado_MD: Yes. TIA should be considered a medical emergency requiring evaluation ASAP because it is a warning that a stroke may occur soon.

Sonny145: What was the age of the youngest person you know to have had a stroke or TIA?

Efrain Salgado_MD: Children and babies can have a stroke. Stroke can happen to anybody at any time; although the older you are the higher the risk. However, young children with sickle cell anemia could have a stroke, an adolescent can have a stroke from drug abuse, a young woman on birth control pills who also happens to have migraines with aura and who smokes could also have a stroke, and a young person who suffers trauma to the neck could develop injury to the carotid artery leading to dissection of that vessel and stroke.

MissLyss: When you see someone with the first signs of a stroke, I know you dial 911 first, but after that is there anything you can do before the paramedics get there?

Efrain Salgado_MD: Have him or her lay down and keep him or her comfortable. We do not recommend that you try to give them Aspirin, because we do not know what type of stroke they are having whether ischemic due to lack of blood or hemorrhagic due to bleeding. The CT scan we do when they arrive in ER helps to sort this out. If you give aspirin and the stroke is hemorrhagic, it could make things worse.

Cleveland_Clinic_Host: We are receiving many great questions so far! Please remember that this chat is for general questions regarding stroke. If you have a medical question not related to this condition, or that is diagnostic in nature, please follow-up with your personal health care provider or use our contact link clevelandclinic.org/webcontact to submit your questions.

Bruce: I have had two TIAs in last four months and take Coumadin for my artificial heart valve with recommended PT/INR of 3-3.5 and baby aspirin. What else can I do lower my risk/prevent a stroke under these conditions?

Efrain Salgado_MD: Make sure that all of the other risk factors for stroke are well controlled, namely, hypertension, diabetes, high cholesterol, smoking, excessive alcohol consumption, obstructive sleep apnea, etc. Dipyridamole is another medication that can be added to Coumadin to lower the risk of stroke in patients with certain heart valves instead of aspirin, but this needs to be discussed with your doctor.

Sam345: Can you experience only one of the many symptoms of stroke? For example, if you just feel dizzy, without any other signs, could that still mean you are experiencing a stroke?

Cleveland_Clinic_Host: We have approximately 15 minutes left in the chat. We received a large amount of questions and we will continue to answer as many as possible. We apologize if we did not get to your question. If you have additional questions after the chat, please use our contact link clevelandclinic.org/webcontact to submit your questions.

Efrain Salgado_MD: Dizziness is a very nonspecific symptom and by itself is rarely a stroke symptom. You need to discuss exactly what you mean by dizziness with your doctor so that he or she can decide how best to evaluate it and treat it.

Maryann4fun: Once someone experiences signs of a stroke, the paramedics have been called and the person reaches the hospital, what happens? What do the doctors do to prevent any damage that could be done if the person doesn't receive medical attention?

Efrain Salgado_MD: When patients arrive we make sure that their vital signs are stable and order some rather simple blood tests and a head CT. If the stroke is determined to be of the ischemic type (lack of blood flow) and if they meet the criteria to be treated with the clot busting medication TPA, the drug is administered intravenously. This drug increases the chances that patients will have little or no disability from the stroke by 30%. Sometimes the improvement can be very dramatic and occur within minutes or hours after the administration of the medication.

Cmd2002: My friend's husband went through a stroke just a short time ago and is now being verbally abusive. Could this be from the stroke? He was never like this before.

Efrain Salgado_MD: Yes.

MissLyss: If a second stroke occurs, will it likely be more severe than the first?

Efrain Salgado_MD: Not necessarily so.

Sam345: Is it true that some people go completely paralyzed from a stroke? Is there anything you can do to prevent that?

Efrain Salgado_MD: Yes. Keeping your stroke risk factors optimally controlled, as previously noted in this web chat, significantly reduces your risk of future stroke.

Nutzy:

Efrain Salgado_MD: An infarct may be symptomatic (with symptoms) or asymptomatic (without symptoms), so it is possible to have an area of brain damage (infarct) without symptoms. The most important thing to prevent infarcts whether symptomatic or not is to make sure that your risk factors for stroke are well controlled.

Cleveland_Clinic_Host: I am sorry to say that our time with Efrain Salgado, MD is now over. Thank you again Dr. Salgado for taking the time to answer our questions today about Stroke. To make an appointment with Efrain Salgado, MD or any of the other specialists in our Stroke Center / Neurological Science Institute at Cleveland Clinic Florida, please call 877.463.2010. You can also visit us online at vanity clevelandclinicflorida.org.

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