Stroke Symptoms and Risk Factors Everyone Should Know with Dr. Shazam Hussain

Podcast Transcript

Nada Youssef: Hi, welcome. I'm your host Nada Youssef. Thank you for joining us today. Today we have the director of the Cerebrovascular Center, Dr. Shazam Hussain. Before we get started, please remember, this is for informational purposes only and not intended to replace your own physician's advice. Thank you so much for being here today.

Shazam Hussain: Thank you for having me.

Nada Youssef: Well, before we begin, is there anything, you want to introduce yourself to our viewers, that maybe I didn't touch on?

Shazam Hussain: No. I'm one of the stroke neurologists here at the Cleveland Clinic, and I also do stroke intervention. Stroke is a very interesting area now, a lot of very interesting developments, which I'm hoping we can touch on over the next half an hour.

Nada Youssef: Sure thing. All right. Well, strokes affect nearly 800,000 Americans every year, and women at a higher risk than men. We'll get to that in a point, but first I want to talk about what is a stroke exactly, and what different types of stroke are there?

Shazam Hussain: A stroke is a sudden onset of neurological dysfunction attributed to the brain or the eye or the spinal cord. Basically, the actual word stroke actually is a Greek word that comes to strike, because it really does strike people out of nowhere and causes them to have these disabilities. Overall, from strokes we actually have two major categories. We talk about the ischemic type strokes and the hemorrhagic type strokes.

Ischemic type strokes are a type of stroke where a blood clot comes from somewhere in the body and blocks off a blood vessel to the brain that deprives it of that blood that it really, really needs and therefore causes its problems, whereas a hemorrhagic type stroke is when there's actually a bursting of the blood vessel causing bleeding in the brain.

Nada Youssef: Okay. So the blood clot could be anywhere in your body, and that could cause that stroke.

Shazam Hussain: Usually, on the arterial side. The most common locations, they either come from the carotid arteries, or they can originate in the heart and then come up to the brain.

Nada Youssef: I see. Why are women at a higher risk? Why is that?

Shazam Hussain: Women can be at a higher risk. It's usually related to hormonal factors that occur in women. So especially as women age and there's changes in the estrogen levels as time goes on, that seems to increase the risk. Actually, estrogen is protective, so at a younger age they seem to be a little bit better protected from stroke, but unfortunately as women get older and lose that protection that puts them at a higher risk.

We also know that women generally don't recover necessarily as well as men, and this is thought to be more actually a social issue that oftentimes women are actually taking care of the men who have the stroke. Whereas because they're later in life, maybe their husbands have passed away or family members have passed away, women when they have their strokes don't necessarily have the same kind of support that the men do and sometimes will have a little tougher time recovering because of that.

Nada Youssef: Oh, interesting. Major risk factors and causes, is it different, first of all, for women than men or is this kind of equal?

Shazam Hussain: In general, the risk factors are generally pretty similar between men and women. Overall, we talk about the risk factors that we can control and the ones we can't control. Unfortunately, the biggest risk factor for stroke is age, which none of us have a solution to yet, but hopefully someday. Otherwise though, there are many risk factors that we can control when it comes to stroke, particularly the biggest one is actually high blood pressure. If we were able to control everybody's blood pressure in the United States and keep it normal, we'd actually eliminate half the strokes that occur in the country.

Nada Youssef:   Wow.

Shazam Hussain: Really, if you had to pick one, really blood pressure's the big one you want to control.

Nada Youssef: Blood pressure's the biggest one.

Shazam Hussain: Otherwise, we talk about other risk factors like having high cholesterol. If you have diabetes, that puts you at higher risk. If you smoke, really I don't know why anybody smokes nowadays, but if you do smoke, you got to quit because that really puts you at high risk of not only stroke but many other diseases. Leading a sedentary lifestyle, all of these factors are really also incorporated and can cause increased risk of having a stroke.

Nada Youssef: Sure. Now, I know we have our right and left brain hemispheres, and the strokes usually happen on one side versus another. Does that change things? Because I know on the right side is more creative, on the left is more language, and there's all this stuff to go into the factors. How does that affect a stroke in a patient that has a right versus left stroke?

Shazam Hussain: Right, absolutely. When someone has a stroke, the type of symptoms they have is dependent upon where in the brain that actual stroke is occurring. We talk about, yeah, the left side of the brain, the right side of the brain. Also, the back of the brain has a little bit of different symptoms compared to those two areas.

Starting with the left side of the brain, this side of the brain usually is what controls ... Strength and power function of the body is crossed, so left side of the brain is what's going to control the right side of the body. So you can have drooping of the face, weakness of the arm or leg on that side.

Nada Youssef: On the right side?

Shazam Hussain: On the right side if it's the left side of the brain. Then language function, as you said, is also controlled on that left side, so ability to both express and receive language can be affected in the midst of having a stroke on the left side of the brain. Versus the right side, which we would expect then the left side of the body would have the weakness, but also we can have other things we come to, attention to the world.

We have a syndrome of neglect, for example, where someone would have a tendency to ignore one half of the world. Oftentimes with strokes on the right side of the brain, in fact, people will actually not even recognize they're having a stroke because they just tend to ignore everything that's going on with that side of the body.

Then the back part of the brain, this can be a really dangerous area to have a stroke. This can sometimes even control our consciousness, so people can present with a coma. People can also present with double vision or balance difficulties or other types of visual problems.

Nada Youssef: Now, if I'm witnessing someone having a stroke, do I drive them to the hospital? Do I call 911? What's the first step to do?

Shazam Hussain: Yeah. Recognizing the stroke is really, really important, because actually it's estimated only 36% of Americans even know one symptom of a stroke, so glad we're having the opportunity to review these symptoms. We use an acronym called BE FAST to help people remember the symptoms. So if you go through the BE FAST, B stands B for balance; E standing for eye, so if there's any kind of trouble with the vision; F standing for face if there's droopiness on one side of the face or the other; A for arm, so arm strength, and you can extend that to the leg as well if there's any weakness of the arm or leg; S standing for speech if you're having any kind of speaking difficulties; then that T is in there as a time, it means time to call 911.

So in answer to the question about what to do in that situation, it's really, really important actually to allow the medical professionals to handle that situation. Best thing to do is as soon as you see, if you yourself are experiencing these symptoms or if you see someone with these symptoms, best to call 911. Let the EMS professionals get out there, assess the situation. Because it's really, really, there's a lot of factors that could influence what we can do with a person, and one of the biggest ones is actually time, how quickly they can get to the hospital and come to medical attention.

Nada Youssef: Then in Cleveland Clinic here we do have a mobile stroke unit. Do you want to talk a little bit about that?

Shazam Hussain: Yeah. This is an innovative new approach to things. As a standard rule around the country again, calling 911, the paramedics, EMS professionals will pick up a person and then get them to usually the closest hospital or the hospital that can best take care of that stroke situation. We've developed technology here, an innovative approach, where we've actually taken a CT scanner and have the ability to put that into an ambulance.

Nada Youssef: Oh, wow.

Shazam Hussain: The reason that's important is that unfortunately there's no way to tell the different types of strokes we were talking about before, the ischemic type of stroke and the hemorrhagic type of stroke. Unfortunately, there's no way to tell the difference between those unless you have the CAT scan. That's really limited us. Before, that person really had to be in the hospital. Unlike other diseases where sometimes we can start treatment in the field, we need that CT scan before we can do anything.

CT scanners now have come into such a technology that they've actually become small enough where you can fit them inside an ambulance. We also now have the ability virtually to be able to beam into the vehicle using telemedicine.

Shazam Hussain: It allows us basically when a 911 call is placed, this ambulance can go to the scene of where the person's having their stroke, whether it be at their home or at their work or at another location. We can get them into our ambulance, take a CAT scan, and the doctor can then beam in via telemedicine, assess the situation. We can actually start treatments right there in the field.

Shazam Hussain: We're saving on average about 40 minutes of time. Just to put that in perspective, every minute in a situation of stroke you're losing about 2 million brain cells a minute, and so really it's a situation every minute counts. That 40 minutes can really, really add up to a lot of impact for that patient.

Nada Youssef: Sure. That's excellent. Then now I always go to diet. Does your diet affect the risks of a stroke? Is there something we should stay away from? Is there a kind of food we should eating? What kind of diet do you recommend?

Shazam Hussain: Absolutely. This comes back to the risk factors, and absolutely, stroke is a preventable problem. I think that's really, really important to emphasize. We usually advocate for a good diet that will be so-called a good diet for blood vessels. It's very similar to what people recommend for the heart.

You want to make sure you're watching the amount of salt that you're taking into the diet, because of course high salt can lead to high blood pressure, which as we mentioned is one of the biggest risk factors for stroke. Watching the amount of saturated fats and trans fats in the diet. If you like fish, fish a couple times a week is usually good for people. Because of the type of oils that are in there, it promotes good cholesterol in the body. If you have diabetes of course or just in general, probably watching the amount of carbohydrates and sugars that your body is taking in would be important as well.

In addition to diet, again I always like to emphasize again the exercise portion of things, that really it's really important. We usually recommend either 30 minutes to an hour a day of some kind of good physical activity, because that really also, it really helps you keep those blood vessels nice and healthy.

Nada Youssef: Sure. Now, is there an age that your risk for stroke goes significantly increased at a certain age, or can this happen to younger people?

Shazam Hussain: Generally speaking, it's always been thought to be a condition of older individuals, and so in general your risk starts to really start to go up after the age of 60, 65. However, unfortunately as many of us know, in the United States, especially because of our bad diets and lack of exercise and other risk factors, that we're seeing that age getting younger and younger and younger. Unfortunately, also, there's other types of strokes that can even present, other reasons to have a stroke that can present at a very, very young age.

We really do see it throughout the spectrum of all the age ranges, which is why it is again very, very important to be vigilant about these symptoms. Even if someone's at a younger age, in their 30s or 40s, for example, and has these symptoms, it's important not to just brush it off and think that they couldn't have a stroke, because they very well could be. It's really, really important to get these people to the hospital right away.

Nada Youssef: Very good information. Thank you. Well, I'm going to jump onto some live questions. I have Patricia. "Can epidurals that were difficult to place cause seizures and strokes?"

Shazam Hussain: I think we're talking about epidural catheters. In general, we usually don't attribute an epidural catheter. I guess it would depend a little bit on the specifics of the situation, but in general, with an epidural if there was a bit of bleeding or something that might've occurred, then it's possible that could track around and maybe, but it's a very, very unusual reason to have a stroke.

Nada Youssef: Okay. Then I have Sidneya, "Does fish oil help stop strokes?"

Shazam Hussain: As we mentioned, eating fish a couple times a week, and that's thought to be related to the oil in the fish, that does seem to help promote good cholesterol, and so from a dietary perspective could be effective. When they look specifically at the fish oil capsules, there's never been a study that actually shows that that has a significant impact on prevention of strokes. But I think in general if this is something that your physician recommends, obviously you talk to your physician and discuss this with them, can be effective part of the treatment in certain cases.

Nada Youssef: Speaking of healthy oils, Rodrigo, "What is your opinion about ketogenic diet in relation to stroke?"

Shazam Hussain: A ketogenic diet certainly has its place in certain aspects. We typically use it more so in the situation of seizures, and particularly in bad or very, very hard to control seizures. In the situation of stroke, it's never been really proven to be effective in promoting good health, and there can be a lot of challenges to the body when you're using a ketogenic diet. Again, this is something you really want to talk to your physician, have a good discussion with them about the pros and cons of being on a ketogenic diet before you employ or use that as a strategy.

Nada Youssef: Sure. Looks like we're getting a lot of questions regarding seizures and strokes. Can you tell me the relation? Does every stroke patient, do they have a seizure at the end of the stroke, and why is that?

Shazam Hussain: No, not necessarily, but certainly stroke can be a risk for having seizures. What happens with stroke is that it can create a scar, a little bit of a scar on the brain from the injury that happens to the brain. That scar then can be a site from which a seizure, which essentially is an electrical storm in the brain, extra electrical activity, that scar can be the factor that predisposes or launches the seizure.

Nada Youssef: The seizures.

Shazam Hussain: It's not seen very commonly though. It's only about 10% of strokes that have seizures associated with them.

Nada Youssef: Oh, okay. Then Sarah, "If you have an embolic stroke, do have less of a chance to have another if your heart rhythm is back to normal?"

Shazam Hussain: Embolic strokes are one of the major causes of stroke, and certainly many of those can come from the heart, which is why when we're doing an evaluation for stroke it's really important to do a good evaluation of the heart. We usually like to do a good ultrasound of the heart, also to get a monitor of the heart rhythm, as she mentions here. There's certain heart rhythm problems, particularly atrial fibrillation, that does increase your risk of having strokes, and so there's definitely in treatment strategies that you and your doctor will want to discuss to make sure you're keeping yourself at as low a risk possible.

In general, if the heart rhythm is back to normal, and we have to be cautious when calling it normal, it can't be also flipping in and out of normal because that can also be risky, but if it's truly back to normal, then overall that risk should be fairly low of having repeat strokes.

Nada Youssef: Okay. Then when we say stroke, and let's say a heart attack, because I know with heart attacks you are to chew on an aspirin. That's what we know from Hearth Month in February. We talked a lot about that. What about stroke? Do we chew on an aspirin? Is there a relation between the two at all?

Shazam Hussain: For stroke, we actually don't recommend chewing an aspirin. If you do, I don't think it's detrimental. It's not going to hurt anything, but certainly there's no evidence that it actually helps in that situation. Again, the really critical thing there is call 911. Let the EMS professionals come and pick you up, get you to a hospital that can take care of strokes. That offers you your best chance. Because there are really good therapies for stroke that are available now, particularly we use a clot buster medicine through the intravenous called TPA, tissue plasminogen activator, or TPA. This is a clot busting medication that we can give within four and a half hours of the start of stroke, so a really, really effective medication.

Then also for the special type of stroke called ELVO-type stroke, or emergent large vessel occlusion, this is where a large blood clot actually goes from some location and blocks off a major artery to the brain. Sometimes we'll actually have to do a catheter-based technic called thrombectomy where we thread a catheter through the arteries to get up to where the clot is and remove it out of the blood vessel.

Shazam Hussain: That can be actually administered even up to 24 hours in certain patients, but all of these are very, very time dependent. That's why you want to get to a hospital right away to give yourself the best chance of being able to receive those treatments if you're eligible.

Nada Youssef: Okay, great. Then I have to ask, just because you said the back part of your brain can have you unconscious, correct?

Shazam Hussain: Sure.

Nada Youssef: So if I see someone unconscious in front of me, I'm thinking chest compressions. Does that hurt any, or is that okay?

Shazam Hussain: No. Certainly, it wouldn't hurt in a situation of stroke. In particular again, if you've gone through your BCLS, your life support training, and you're checking for a pulse, you're not feeling a pulse, obviously important to get that CPR administered right away. It wouldn't cause any problems or issues.

Nada Youssef: It wouldn't, in a negative way.

Shazam Hussain: If anything, it's helpful.

Nada Youssef: Sure, great. Misty asks, "Why can evidence of stroke on CT be occurred for up to 24 hours? What about the patient who cannot have an MRI?"

Shazam Hussain: A CT scan, it's a good test for stroke. It often shows changes that show up, but unfortunately it is a test that it sometimes takes a bit of time. Usually, we estimate usually it takes about six to 12 hours for the changes to first start showing up on a CT scan.

Shazam Hussain: That's why sometimes it is helpful to have an MRI scan, which is just a much more detailed picture of the brain. It can identify stroke much, much earlier than a CT scan will. Now, usually in that situation where a person can't get an MRI scan, then there are other strategies where we can repeat CT scans down the line to see evidence of the stroke or not.

It's important to remember also when we're talking about using these acute therapies, the intravenous TPA or the clot removal or else identifying blood, really the CT scan, the importance of that CT scan isn't so much to really absolutely see the stroke. It's really to make sure that there's no blood in the brain. Because the treatment, if you're imagining giving an intravenous clot buster, if you had bleeding in your brain, that could be very dangerous. That's why we really need that CAT scan early on. As long as that CAT scan doesn't show any blood, that opens up the options for different kinds of treatment.

Nada Youssef: Great. Then Shawna wants to know, "Is whooshing in your ears always a sign for issues coming later?"

Shazam Hussain: Whooshing in the ears can come from a variety of different causes. The most common reason we see it for is when there's some little bit of turbulence in the blood flow. Normally, blood flows in the blood vessels like a quiet stream, but sometimes it can be like water in rapids and swirling around. That's thought to be related to sometimes when you hear this whooshing sensation, and also there can be other causes for it. Those are the more vascular causes.

Nada Youssef: I see.

Shazam Hussain: It's not necessarily though a sign of issues that are going to be coming per se. It just means that there may be a little bit of turbulence to the blood flow. Important to probably talk that over with your physician, but I don't anybody panicking and starting to run to the emergency room because they hear this. It's not necessarily a sign of a big issue coming up.

Nada Youssef: Okay, great. Then Pam, "My husband has right," is it carotid?

Shazam Hussain: Mm-hmm (affirmative).

Nada Youssef: " ... carotid 100% blocked. We were told nothing can be done. Is there anything he can do to prevent the stroke?"

Shazam Hussain: The most important thing actually when you have 100% blockage, it's interesting that when your artery's 100% blocked, you're actually in a safer situation than when it's 90% blocked. You can imagine this like having a dam on a river. If you had a dam on a river and it blocked up the water all the way, even if there was garbage in that river, it's not going anywhere. It's just staying right there. Whereas if there's a little bit of a channel, you have a little bit of water going through, then all of a sudden that garbage can flow downstream, and then your town below can get garbage in it.

Similarly, when you talk about stroke, if that artery's actually blocked up 100%, there's no way anything's getting through there to get debris or anything up to cause a stroke. Now, that doesn't mean that you're completely out of the woods though because it is indicative that there is problems with your blood vessels. Again, we come back to the issue that you got to take care of your blood vessels, so that means working with your doctors to make sure you're on the right medications.

Particularly, the cholesterol medications can be very effective because they help promote and heal up the blood vessels, in addition to good diet and exercise and taking care of making sure if you lose one of your carotid arteries, normally we have four arteries to the brain, two carotid arteries in the front, two vertebral arteries in the back. If you're down a carotid artery, you only have three going to the brain, you really can't afford to lose another one, so very important to make sure you keep blood vessels nice and healthy.

Nada Youssef: Cindy, "Are red rice yeast capsules beneficial?"

Shazam Hussain: It's an interesting question. Now, there's no strong evidence per se. We don't have a study, for example, that shows us that red yeast capsules are, but as with any of these things, I think anecdotally people will sometimes feel that they're effective. As long as it's not interfering with your usual treatment plan, discuss it with your physicians, as long as there's no concern about it, I don't think there's any detriment to taking it.

Nada Youssef: Okay, great. Sue, "My husband has a post-valve A-fib and has about 40 to 60 episodes per month. He has had two ablations and gets dizzy and spinning occasionally. He still drives, but as you can tell, he cannot run into the ER every time one of those episodes happen. He's on warfarin. Is there anything else that we can do?"

Shazam Hussain: I think for this kind of situation it's really important to consult with your physician. Certainly, for example, in our center we would ask our cardiology team to assess this patient, because there certainly are very useful treatments that can be available to a person in that situation. I think from a stroke perspective, we have someone in atrial fibrillation, really the most important treatment is to be on strong blood thinners like warfarin, and there's also newer ones that are out there.

From our standpoint, the being in the atrial fibrillation itself isn't necessarily an issue, but it's really being on the blood thinners to prevent clots from forming and going and causing stroke. Even if you're in atrial fibrillation, as long as you're on those blood thinners, you should be in good shape.

Nada Youssef: You should be okay. Great. Gabby asks, "What happens when a stroke patient is admitted to the hospital?" Basically, why is so important to find the source of the stroke or how?

Shazam Hussain: Getting to the bottom of why the stroke happens I think is really, really important, because we really tailor our treatments based on what kind of process we find. Really, the most important things we sort out while you're in the hospital is to get a good look at your blood vessels, make sure there's no blockages or narrowing that we may have to worry about in terms of treating. Then the second place is to focus in on the heart, as we mentioned, looking at a good ultrasound of the heart as well as getting a monitoring of the heart rhythm, as well as then again in specific situations there are a series of other tests that could be employed to get to the bottom of why the stroke happened.

Depending on what the source is, then there's different treatments. For example, if you have a blockage in your carotid artery, this may require some kind of either surgery or stent to fix it. Also, going again back to the medications, there's certain medications we want to use in that situation to help treat the stroke. If it's coming from the heart, if we find atrial fibrillation again, for example, we're going to be going on stronger blood thinners. Really, trying to get to the bottom of why the stroke happened really helps us to tailor the treatment towards what's going on and protect that person hopefully best from having a stroke in the future.

Nada Youssef: Sure. Because treatments are all different based on what you're having, right?

Shazam Hussain: Yeah. Stroke is a very, very broad term that encompasses many, many, many conditions. Unlike when we talk about the heart, for example, we know that almost 90, 95% of that is related to blockage of the blood vessel. In stroke there's a huge variety of different causes, and so finding out the exact type of stroke and what that underlying cause is really helps us to tailor that treatment to that individual.

Nada Youssef: And pinpoint it, sure. Elaine, "If family members have A-fib, how likely will it be for another female member to also have it?" I guess, is it hereditary?

Shazam Hussain: Yeah. Atrial fibrillation can have ties to family, so certainly if a family member has atrial fibrillation, other family members should be on the watch for it. The number-one risk for atrial fibrillation is actually age, so everyone as they get older also has this risk of atrial fibrillation. If someone in the family has it, other family members are at higher risk and probably it's worth making sure your physicians know about that so they can properly watch out for that.

Nada Youssef: And lower your risk. Sure. Michael, "What is the difference between a hemorrhagic stroke and an aneurysm?"

Shazam Hussain: Good question. Hemorrhagic stroke again is a bit of broad term, and so within hemorrhagic stroke we have something called subarachnoid hemorrhage. The main reason we see that is from a brain aneurysm, which essentially is a weak spot on the blood vessel that can then leak or break that causes bleeding around the brain.

We also run into the situation where we have brain aneurysms that haven't leaked, and so important that we do an evaluation in those cases to understand what the person's risk for that potentially breaking is. It's actually an interesting statistic that if you did scans on everybody walking on the street, about 1 in 20 people actually have a brain aneurysm.

Shazam Hussain: Most of them though are very, very tiny, never going to cause a person a problem. They'll never know they have it, never have an issue. But they break at a rate of about 1 in 10,000 to 1 in 100,000. If they do break, they can be a dangerous situation. If one is found, again not something that you necessarily need to panic over, but important to get it checked out by a specialist that really understands brain aneurysms, usually which will be either an interventionist of some kind, which can be a neurologist, neurosurgeon or radiologist or otherwise neurosurgeons that deal with brain aneurysms.

Nada Youssef: Now speaking of symptoms, is there any way that you don't know that you just had a stroke, like if you have a mini-stroke? Because I've read a little bit about how people maybe don't know that they just had a stroke.

Shazam Hussain: Certainly, the term mini-stroke really people tend to use that more if someone has had symptoms of a stroke that were temporary. So you have some kind of difficulty speaking, maybe a little bit of weakness in your arm, but it goes away after 10, 15 minutes. People call that a mini-stroke.

There also are those silent strokes, as you mentioned, where someone may not know. That's reflective of that there are sometimes strokes, depending on where it hits you in the brain, if it hits a very strategic part of the brain, you're going to end up with a lot of symptoms. But if it ends up hitting a part of the brain that maybe doesn't necessarily produce direct symptoms, you can take a stroke in that area and really not experience much in terms of symptoms.

However, it's important still to be able to do those assessments for patients because we know that if silent strokes really do start to accumulate that that can also start to affect things like memory and thinking. Coming into the broader topic of how stroke can affect other things, we know that there's a whole subset of dementia called vascular dementia, which is a huge proportion of the number of people who have dementia, and it's really related to these silent strokes that are occurring in the brain.

Nada Youssef: Let's see. Then we have Jan, "Once you had a factor V done and it is negative, will it ever change?" What is a factor V? I guess that's the next question for you.

Shazam Hussain: Factor V is a type of factor that's in the blood that looks at clotting basically. In general, from a stroke perspective, really it more so comes to the vein side of the circulation, so we worry more with factor V about people developing blood clots in their legs or in their lungs as opposed to stroke, although it can occasionally be related to strokes as well. It is thought to be related to genetics, so that if your factor V is negative, it should be negative for life.

Nada Youssef: Okay, great. Vanessa's asking, "What is the most common treatment of stroke?"

Shazam Hussain: We mentioned, talked about the acute treatments for stroke, which is one type. I think she's probably more so getting at more how do you prevent strokes, a longer term thing.

Nada Youssef: Right.

Shazam Hussain: Again, most common reason for stroke is related to blockages of arteries, and so we tend to focus mostly in on those risk factors, so making sure someone's on a bit of a blood thinner, which usually involves aspirin or medication like aspirin to thin out the blood a little bit, which prevents against both stroke and heart attack and other vascular problems. We also want to then focus on high blood pressure, making sure a person's blood pressure gets under control.

In general, we want people from a stroke perspective, we like people under the target of 140/90. That's really the highest we'd ever want to see someone's blood pressure. Then working with their cholesterol, working with if they have diabetes, getting their sugars under control; if they're smoking, getting them to stop, so quit smoking. That's usually vascular health is the biggest thing.

Nada Youssef: All right. Then Cynthia, "I had a mini-stroke four years ago. No physical problems, thank goodness, but I am not the same mentally. How can I improve? It's very frustrating." I'll piggyback on this and maybe talk a little bit about recovery once you answer that question as well. We haven't talked about recovery.

Shazam Hussain: Certainly, after a stroke or a mini-stroke, it's actually very common for people to describe that they don't feel they're thinking is quite the same as it used to be. Oftentimes they'll feel their energy level is not the same, and they feel a lot more fatigued and don't have the wind in their sails, so to speak.

Fortunately, this is something that generally does get better over time in the majority of people. Unfortunately, there's no magic pill or something for that. It's a matter of trying to get back into your routine, keeping active in terms of mental activities especially. The worst thing we can see people do is when they feel tired or rundown that they end up just lying on the couch.

Nada Youssef: Giving in to that. Yeah.

Shazam Hussain: Because that actually then starts a vicious cycle where you just get more deconditioned and you feel worse and worse and worse. Yeah, from a mental perspective, again trying to do what you can to make sure you're really working very hard. Sometimes this is where the therapist can also be helpful with cognitive therapy, which is either done by occupational therapists or speech therapists. They can often give exercises to help continue to exercise the mind, so to speak, when it comes to mental tasks.

Recovery is a huge area in stroke. Again, there's often a lot of pessimism when it comes to stroke that people say, well, people who've, for instance, had a stroke, it's a very devastating event, and they'll never recover from it. The truth is of course is a stroke is very treatable, preventable and treatable, as we've discussed. Also, from the recovery side, a lot of great work is being done. We usually talk about stroke recovery mainly in the first three months after a stroke, but even to a year or more we see people that have improvements.

There's a lot of work with the therapists, all the different types of therapists, physical therapists, occupational therapists, speech therapists, are really doing great work and great research to develop those areas. We have all kinds of also new devices now that are available and different kinds of clinical trials and other things that are going on, really trying to enhance how people can recover from stroke.

Nada Youssef: Sure. Then I have just one more question for you before I let you go. Beth wants to know, "Do I have permanent brain damage from this stroke?" Is the damage permanent? I guess it all depends on how it was handled maybe, how bad it was.

Shazam Hussain: If we're talking stroke, and usually when we're talking about stroke, we mean that on the MRI scan there's some evidence of injury, injury or damage to the brain. Unfortunately, yes, the answer is yes, that the damage from a stroke is permanent. The good news though about stroke is that the brain has a lot of capacity to recover. The areas that are normal surrounding the damaged part can actually take over for that area that's permanently injured.

Shazam Hussain: This is where we see a lot of recovery, which again comes back to if someone has had a stroke, working hard with those therapists, because they're essentially, it's like an athlete training for an event. You've got to get your brain and body retrained after a stroke occurs, and with that therapy we really see people make great recoveries to the point that really you won't even know they had a stroke.

Nada Youssef:  That's awesome.

Shazam Hussain: Definitely, there's always this great potential for having a stroke, so really important, if you can get early treatment, that's really, really effective to improving your outcome, and then also getting good therapy, good rehabilitation can help people recover.

Nada Youssef: And noticing your symptoms, right?

Shazam Hussain: Number-one thing, if you notice your symptoms, get to the hospital. That's going to give you your best chance of getting better.

Nada Youssef: Sure thing. Well, that's all the time that we have for today. Is there anything else that you wanted to add to this conversation?

Shazam Hussain: No. This is great. Thank you for having me. I really appreciate the opportunity to be able to talk about stroke.

Nada Youssef: Sure, great. For more health tips and information, please follow us on Facebook, Twitter, Instagram and Snapchat, @ClevelandClinic, one word. Thank you. I'll see you next time.

This concludes this Cleveland Clinic Health Essentials Podcast. Thank you for listening. Join us again soon.