The Surprising Facts About Stroke with Dr. Shazam Hussain

Podcast Transcript

Nada Youssef:   Hi. Thank you for joining us. I'm your host Nada Youssef and you're listening to Health Essentials podcast by Cleveland Clinic.

Today we're broadcasting from Cleveland Clinic main campus here in Cleveland, Ohio, and we're here with Dr. Shazam Hussain. Dr. Hussain is the director of the Cerebrovascular Center for Cleveland Clinic's Neurological Institute and we are here today to talk about stroke.

Thank you so much for being here today.

Shazam Hussain:  Yeah, thanks for having me.

Nada Youssef:   Please remember this is for informational purposes only and is 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:   Sure thing. So before we jump into topic I want to ask you some more personal questions to get to know you better.

Shazam Hussain:  Sure. Alright.

Nada Youssef:   Alright. So what is the best place in Cleveland or Ohio for beautiful scenery?

Shazam Hussain:  Beautiful scenery, outdoor scenery for Cleveland I really like the lake front especially in the Lakewood area.

Nada Youssef:   Lakewood?

Shazam Hussain:  Yeah, Lakewood area where they have developed right along the edge of the lake right there. It's really beautiful. It's fantastic view.

Nada Youssef:   Yeah, you can see downtown right from there.

Shazam Hussain:  Absolutely.

Nada Youssef:   How about your best travel destination?

Shazam Hussain:  Best travel destination, I really enjoy going to Miami.

Nada Youssef:   Miami?

Shazam Hussain:  Just enjoying the beaches.

Nada Youssef:   Really?

Shazam Hussain:  And having a good time.

Nada Youssef:   Kind of a party setting, right?

Shazam Hussain:  Yeah, not so much the party side, but yeah.

Nada Youssef:   Okay so if you weren't a physician what would you be today?

Shazam Hussain:  If not a physician I was thinking at one time in my live I would have loved to have been in astronomy.

Nada Youssef:   Really?

Shazam Hussain:  Looking up at the stars is really fantastic stuff.

Nada Youssef:   Great. That's amazing. Alright, so I pulled up some facts about stroke that I kinda wanted to start this conversation with.

Shazam Hussain:  Great.

Nada Youssef:   So first of all, stroke kills about 140000 Americans each year. That's 1 out of every 20 deaths and it's the number five cause of death and number one cause of disability in the US.

Shazam Hussain:  Mm-hmm (affirmative).

Nada Youssef:   And someone in the United States has a stroke every 40 seconds. That's every four minutes someone dies of a stroke. And about 185000 strokes, nearly one of four, are in people who have had previous strokes. So today we're gonna talk quite a bit about prevention for those who have already maybe survived a stroke and how to prevent it from happening again. So let's start with what is a stroke?

Shazam Hussain:  Sure. So a stroke, and I'm glad you brought up those numbers 'cause it's really important. I think it's underappreciated how devastating a condition stroke really is and I don't think people really appreciate how impactful it is to all of us in society with the numbers that you mentioned.

It's also important to note that even though in a person who's had a stroke before the American Heart Association through their data shows only one in three people actually know one symptom of the signs of a stroke. That includes people who've had a stroke before.  So thank you for the opportunity to do this podcast.

Nada Youssef:   Sure.

Shazam Hussain:  It's really important that we get this information out there.

In terms of a stroke, a stroke is a sudden neurological event. It's due to a vascular cause. We basically break that up into two big categories. The Ischemic type of stroke, which is one where there's a blood clot that blocks a blood vessel and prevents blood flow from getting to the brain and then the Hemorrhagic type of stroke which is the bursting of a blood vessel bleeding into the brain.

Overall the Ischemic types are more common. It's about 80% of the strokes that occur are the Ischemic type, with the remaining 20% are the Hemorrhagic type.

Nada Youssef:   Okay, great. Is there such thing as a mini stroke?

Shazam Hussain:  Yeah, the term mini stroke really refers to what we call Transient Ischemic Attacks.

Nada Youssef:   Okay.

Shazam Hussain:  Which essentially that falls under the category of the Ischemic type stroke where there is a blood clot or loss of blood flow to a part of the brain but luckily it's transient. It's short lived. The blood vessel opens up again. When that blood flow restores back to the brain then the symptoms will go away.

Nada Youssef:   I see.

Shazam Hussain:  And there's no damage then that occurs from it. That being said, it's still a pretty significant event that needs medical attention right away.

Nada Youssef:   Sure, sure. So what are the main causes of a stroke?

Shazam Hussain:  There's a lot of different what we call risk factors or reasons why strokes can occur. Probably one of the most common reasons are related to blood vessels and blockages, for example, a blockage of the carotid artery. That can limit the blood flow and also where clots can form and then go off and cause a stroke to occur.

The other common, for the Ischemic type of stroke, the other common place is from the heart from a rhythm problem called atrial fribillation, where the heart goes into a certain rhythm that increases the risk of having a stroke, a blood clot form and a stroke occurring for that reason.

On the Hemorrhagic side, there's different causes there. The more common reasons we see there is related to high blood pressure. That's probably the most common reason. Of course we really others significant types are when they have brain aneurism or other malformations of blood vessels.

Nada Youssef:   Alright, so there's also I read about a silent stroke. So what is a silent stroke and does it cause the same damage to the brain as other types of strokes?

Shazam Hussain:  A silent stroke or so called silent strokes, we talk about those when we see on pictures that there's evidence of damage to the brain from a prior stroke but the person doesn't recall any specific symptoms related to that.

Because they haven't caused any symptoms oftentimes a person wouldn't obviously go seek medical attention 'cause they haven't felt anything, although if you really delve into the history sometimes you can get clues about something that happened. The person felt a little bit off. Oftentimes the symptoms will be a little bit more vague, that they felt just suddenly just very, very tired or that their thinking wasn't as clear.

But we do worry about silent strokes because if they do end up accumulating to too much then that can also cause significant impact to a person's life, in particular causing things with memory or thinking problems.

Nada Youssef:   I see. Now if there's somebody that feels like they just went through a stroke or may have went through some sort of stroke, silent or mini stroke, when they go to the doctor is there a blood test that could be done or what do you do to figure out if they did have a stroke?

Shazam Hussain:  Yeah, unfortunately there's no specific blood test that we have to diagnose a stroke but certainly bringing up their symptoms with their physician is really, really important and then as health care professionals we really need to be attuned to these type of symptoms and make sure we're properly evaluating them and getting the person to medical attention.

Nada Youssef:   Sure.

Shazam Hussain:  So getting proper pictures of the brain with either an MRI or CT scan and then certainly if a stroke is found or the symptoms sound very worrisome for a mini stroke or a TIA, then making sure we get full evaluations of the blood vessels and of the heart to make sure we reduce the risk as much as possible.

Nada Youssef:   Okay, and TIA, is that the same thing as a mini stroke?

Shazam Hussain:  Yeah, Transient Ischemic Attack or TIA is the abbreviation. So TIA or mini stroke is what people will commonly call them.

Nada Youssef:   Okay. Great.

Now let's talk about some of the common warning signs of a stroke, and what to do as soon as you see someone or if you feel that you're going through that as well.

Shazam Hussain:  Right, absolutely. We like to teach our patients an acronym called BEFAST. The "B" stands for balance, if there's any sudden change in your balance. "E" for eyes, if there's any changes in your vision, particularly loss of vision either in one eye or the other or part of the visual field.

Then we get to the FAST portion, "F" standing for face, if there's droopiness in the face on one side or the other. "A" standing for arms, so weakness to the arm which can also apply to the leg as well, if there's any weakness or paralysis to the arm or leg. Then "S" standing for speech, any kind of difficulty speaking, difficulty getting your words out or understanding what's being said.

Then the "T" reminds us all about the time element. That really again, stroke is a very, very time sensitive condition and so the "T" stands for time and time to call 911.

It's estimated that we lose somewhere in the order of about 2000000 brain cells a minute in the situation of acute strokes.

Nada Youssef:   Wow!

Shazam Hussain:  So it really is a situation where every second counts and the faster you can get to medical attention then the more options there are in terms of treatments that can be given to limit the problems from a stroke.

Nada Youssef:   So these are common symptoms of a stroke. Are there any early warning signs that you can detect before these kind of symptoms start showing?

Shazam Hussain:  Yeah, unfortunately the way that strokes work it is really a very, very sudden event. Usually without any warning. The word stroke actually comes from Latin words "to strike" so it really strikes a person down out of nowhere.

That being said, sometimes you will hear people have described that they've had some kind of more minor event that they just tend to ignore. For example, they may have felt a little bit of problems picking up objects with their hand which lasted maybe just a couple of minutes and then went away and they say well, nothing to worry about. I'm just going to keep watching it.

Whereas really when you have any of those symptoms that, especially in that list of BEFAST, really important to seek medical attention right away.

Nada Youssef:   So if I witness somebody having a stroke with these symptoms that you just mentioned, I call 911. Is there anything else I should do physically for the patient to keep them safe?

Shazam Hussain:  Yeah, in general the most important thing is as you said call 911. Get the ambulance on the way because the paramedics are trained in how to deal with this type of emergency and they'll know which center to take the person to.

In the meantime usually we'll have the person lie down.

Nada Youssef:   Okay.

Shazam Hussain:  And really no other medications that they should be taking. In terms of information though, that'll be important for the paramedics or, and once they get to the hospital the team that's treating the patient. The physicians and nurses and everybody else taking care of them, they'll want to know particularly something called a "last known well time." So we really like to know when was that person last 100% normal self.

The reason for that is a lot of the treatments we use are time limited and we have to take the time last seen 100% well as the time as when the stroke started for safety reasons.

Nada Youssef:   I see. And if you're not sure of the time or if there's nobody there, do you have to stop giving some certain medications that could be harmful after a certain time?

Shazam Hussain:  Yeah, unfortunately the different medicines that we can use, we can use a clot buster medication called tPA, Tissue Plasminogen Activator to clot bust. You can give through the intravenous, and we can use that up to four and a half hours.

Then we do have other techniques where we can go with catheters to remove clots out of the blood vessels where we can have up to 24 hours to use those. But in particular the clot buster medication in that four and a half hours. It can be dangerous to give it past that window.

Nada Youssef:   I see.

Shazam Hussain:  So sometimes we do have situations. A lot of times we have people that are with somebody and we know exactly when that stroke started. But unfortunately there are other situations where they're not with somebody or, for example, if someone's gone to bed and is okay and then wakes up in the morning and already has their symptoms. For safety reasons we have to take that last known well time as the time when it started.

Nada Youssef:   Sure.

Shazam Hussain:  Now that being said, it doesn't have other options 'cause we do have ways now with pictures like MRI scans or CT scans to pick out the people that may still benefit from different treatments.

Nada Youssef:   Sure, sure. So if you previously had a stroke, are there things you can do to prevent from having another one?

Shazam Hussain:  Mm-hmm (affirmative), absolutely. That's a really important message, is that stroke is a very preventable disease.

So what we do when we evaluate people who've had a stroke before, we really try to get to the bottom of exactly why the stroke has occurred. For example again, blockages of an artery, is there some kind of heart block problem or some other issue that drove why the stroke happened.

Otherwise, we also focus then in on risk factors. So making sure that person is on the proper blood thinners, making sure the blood pressure is controlled, that their cholesterol is okay, if they have diabetes that that's well controlled, if they're smokers they should stop smoking and then life style measures like diet and exercise are really, really important to making sure you stay as healthy as possible.

Nada Youssef:   Okay, great. Then what tips do you have for us to manage those risks of having another stroke? I know you mentioned smoking is probably one of the big ones, but is there anything to do like life style management that you can do differently to prevent a stroke from happening again?

Shazam Hussain:  Yeah, yeah absolutely. There's lots of great ways to take care of yourself. The number one preventable risk factor for stroke is high blood pressure. So if we controlled everybody's blood pressure in the United States we'd eliminate half the strokes that are happening.

Nada Youssef:   Wow!

Shazam Hussain:  So really important again that you work closely with your physician. Keep track of your blood pressure. There's many different ways now. There's different machines you can even buy to at home be able to take your blood pressure and monitor them.

So really important to know what your blood pressure is, and if it is high then work work with your physician. Sometimes that will be a matter of certain medications you can take, but otherwise eating a good healthy diet, particularly watching salts.

In general in the United States in particular, we eat too much salt in our diets. American Heart Association recommends that we eat less than 1500 mg of salt and most of us are about 3000.

So it's really something where we need to, all of us should be trying to reduce the amount of salt. Particularly when you're eating a lot or processed foods or you eat out a lot, you have to be really careful about that salt intake.

Besides high blood pressure though, eating a good healthy diet, otherwise to watch the amount of saturated fats and trans fats which also are ... They're eliminating them from a lot of processed foods but they can still be there. You gotta be careful.

Nada Youssef:   Yeah.

Shazam Hussain:  If you are a diabetic of course, you know, the carbohydrates, eating a lot of starchy foods, you've just got to be very, very mindful of that.

Then exercise wise really it's between 60 to 90 minutes now a day that everybody should be having some good physical activity. Something that will get your heart rate moving.

Sometimes people are a little bit limited, for example, if they have problems with their legs. It doesn't mean that you can't still do some kind of exercise. We tell people to use their arms when they're sitting watching TV.

Nada Youssef:   Yes.

Shazam Hussain:  Maybe using weights and just kind of get your body moving.

Nada Youssef:   Sure, sure. Excellent.

Well some studies I've read say that consuming more than two alcoholic drinks per day may increase your stroke risk by 50%. Is that true, and can you talk about that a little bit?

Shazam Hussain:  Yeah, so alcohol's an interesting subject. We certainly know that above a certain amount there is an increased risk of both heart attack and stroke. So it's usually about one to two drinks. The drink that they measure things by is wine, a glass of wine a day.

So above that, that can start to increase your risk. So certainly if you're drinking more than a glass of wine a day that's something you want to reconsider, especially if you have a history in your family or personal risk factors for stroke or heart attack. It's something you'll really want to consider cutting back on.

Lower amounts of alcohol, there's a bit of controversy. There's been conflicting studies, some that have shown benefits, others that have shown harm.

Nada Youssef:   Right.

Shazam Hussain:  So again, it's something to maybe talk over with your physicians about in your particular situation whether that's something to be cautious of or not.

Nada Youssef:   Sure, and I know they also talk about alcohol effects women and men differently. So does your stroke risk, is it specific also to gender?

Shazam Hussain:  Stroke risk in terms of alcohol?

Nada Youssef:   Just in general. We can talk about alcohol as well.

Shazam Hussain:  In general, it's an interesting nuance. Men are generally thought to be higher risk than women, but if you look at the numbers actually more women have strokes every year than men do.

That's mainly related to the fact that women live longer and their number one risk for stroke unfortunately is age which none of us have a cure for yet. Hopefully one day.

Nada Youssef:   Yeah, I want to live forever. So are there unique risks that women have that men don't?

Shazam Hussain:  Yeah, so in general the common risk factors women also need to watch out for. But in otherwise, especially when you're talking about young women having strokes, we worry about if they are on any kind of either hormone replacement or birth control. Because particularly the estrogen component of those does increase,  somewhat increase stroke risk. And that especially is exaggerated if someone's a smoker and is on those kind of hormone replacement or birth control.

So coming back to the same point that you made earlier, that really if you're smoking there's no good reason to do it. You should just stop smoking.

Nada Youssef:   Sure, sure.

Shazam Hussain:  Otherwise when women are pregnant there is a slightly increased risk. I don't want people panicking over that. It's not like there's a very, very high risk. But if you looked at the numbers there is a slightly higher risk there as well.

Nada Youssef:   For a pregnant woman?

Shazam Hussain:  Yeah, women in pregnancy. But overall the risk is so low that even if it's a little bit higher it's not like a very high risk, so we don't want people panicking if they're pregnant thinking that they might have a stroke.

But in general the risk factors otherwise they should be monitoring just the same way. Blood pressure, cholesterol, not smoking.

Nada Youssef:   Food, Exercise.

Shazam Hussain:  Foods and exercise, yeah.

Nada Youssef:   Sure. Okay, so I pulled up some more stroke statistics when it comes to race and ethnicity.

Shazam Hussain:  Sure.

Nada Youssef:   So stroke is the fifth leading cause of death for Americans, but the risk for having a stroke varies from your race and ethnicity, and the risk of having a stroke is nearly twice as high for African Americans compared to Caucasians. Minorities in general have a higher risk for stroke and at an earlier age. Can you talk about that and why that is?

Shazam Hussain:  Yeah, definitely. We know that many of the minority populations in the United States are at higher risk. Actually if you look worldwide, it's African Americans, Hispanics, South Asians and Asian populations as well.

For that reason actually stroke in the world is actually the second leading cause of death.

Nada Youssef:   Wow!

Shazam Hussain:  Because it's the number one cause in China, and with the population in China being so high it drives it up worldwide. So again, underappreciated how big an impact world healthcare problem it really is. Part of that is genetics in those populations.

Nada Youssef:   Okay.

Shazam Hussain:  They genetically are predisposed to be more prone to stroke. In addition, there's probably other life style from a cultural perspective.

For example, in South Asian cultures there a lot of sometimes oily foods or fatty foods, and the diets are not particularly great. Plus lack of exercise and things, other factors that can contribute to that. So a combination of both the genetics and the environment.

Nada Youssef:   So life style modifications can somewhat decrease the risk a little bit? Like you mentioned, the food could be high fats.

Shazam Hussain:  Absolutely, including in minority populations as well. May be even more impactful to make sure that exercise, regular exercise, eating a good diet, staying away from those potentially harmful foods.

Also in general minority populations we really try to advocate to really to work closely with your physicians 'cause there is a tendency in those populations maybe not to be as closely connected with their physicians.

Nada Youssef:   I see.

Shazam Hussain:  We certainly want to promote and help them get to seek medical attention appropriately.

Nada Youssef:   Sure. Now stroke is also on the rise among younger adults. There's a 44% increase in the number of young Americans hospitalized due to stroke over the last decade. Do we know the reason behind this?

Shazam Hussain:  Yeah. Unfortunately you're correct. We're seeing younger and younger patients with stroke, so it's becoming to a point where actually younger age ranges between say age 40 to 65 are almost equal numbers to over age 65 which in the past it was thought to be a condition of the elderly. It's really not now. It can hit you at really any age.

Part of that has to do, again in general, our population isn't healthy. We're seeing earlier onsets of things like high blood pressure and diabetes and lack of activity in the population. So in general the life style, particularly in the United States, we're not a healthy population in that way. Getting the population as a whole to be addressing risk factor and eating a better diet and exercising more would certainly help to reverse that trend.

In addition, there are specific things in younger patients that make us a little more concerned are different types of strokes that we have to think about. For example, dissections or little tears in the blood vessel. When you have a younger patient that's something to be more attuned or aware of 'cause that can certainly be a different type of treatment that you might have to give to that type of patient.

Nada Youssef:   Sure. A 44% increase is huge.

Shazam Hussain:  Yeah, absolutely.

Nada Youssef:   So do you think something like the SAD diet, the Standard American Diet, is nutrition probably a really big one? You mentioned fats, you mentioned salts. Lack of exercise, I can see people exercising or not exercising for the past few years but with the 44% increase do you think diet has the biggest impact on this one?

Shazam Hussain:  Yeah I think a lot of it has to do with the risk factors that we're seeing in the population, and that younger and younger people are just unfortunate. We see even as early as ten years old now we're starting to see sometimes disease in blood vessels.

So we really, as a whole, we really need to be looking at this and just trying to be healthier in general. The life style here, certainly the diet, isn't fantastic. There's a lot of lack of activity, especially even the way our cities are built. We end of driving everywhere as opposed to other countries where people walk around and things like that.

So it's going to require a big effort in multiple levels to do it. But as an individual I think what you can do is make sure that you are being physically active yourself. That your family members are. Even instilling in children from an early age that really being outside, being active is a really important part of being healthy.

Nada Youssef:   Sure, sure. And even I've read somewhere statistics that smoking has decreased in the years, but you see vape and all of a sudden everybody's vaping.

Shazam Hussain:  Yeah.

Nada Youssef:   You don't have to answer if you don't know the answer to that, but is vaping as bad as smoking when it comes to these risks for these diseases?

Shazam Hussain:  Yeah, in the stroke literature at least we haven't necessarily seen any real difference between vaping and smoking.

Nada Youssef:   Okay, same.

Shazam Hussain:  Although it's thought in stroke to be the nicotine component that's really what drives a lot of the stroke risk when it comes to smoking.

Nada Youssef:   Okay.

Shazam Hussain:  So although with vaping maybe you're missing out on some of the other chemicals.

Nada Youssef:   Tar.

Shazam Hussain:  And tars and other things that might be in there, it's still the nicotine that's still the problem.

Nada Youssef:   Okay, so this is very important information. So just to reiterate, before I let you go. Stroke is preventable. Right? It's preventable.

Shazam Hussain:  Correct. Yes, absolutely, 100% preventable.

Nada Youssef:   Up to 80% of strokes could be preventable through healthy life style changes and working with your health care team to control health conditions that raise your risk for stroke. And these healthy life style changes that you mentioned, we talked about healthy diet and exercise, physical activity, quitting smoking and limiting alcohol intake.

Is there anything else you want to end this podcast with, steps or information for stroke?

Shazam Hussain:  I know as I said, I think it's really important that people understand that it is a preventable condition, that there are things that all of us can do to decrease our risk of both stroke, and actually those things that decrease stroke will decrease risk of heart attack, which is also something we want to prevent.

The only thing again, blood pressure, blood pressure, blood pressure. If you monitor, know what your blood pressure is and if it is high get it treated.

Nada Youssef:   Okay. Thank you so much for your time. It's been a pleasure.

Shazam Hussain:  No worries, thanks. Thanks for having me.

Nada Youssef:   And if you'd like to make an appointment with a neurologist, please call 216-636-5860. And for more information on strokes make sure you visit clevelandclinic.org/strokeguide.

Thanks again for our listeners and viewers for joining us today. And to listen to more of our Health Essentials podcasts from Cleveland Clinic experts make sure you go to clevelandclinic.org/hepodcast, or you can subscribe on iTunes.

And for more health tips, news and information, make sure you're following us on Facebook, Twitter, Snapchat and Instagram @clevelandclinic just one word. Thank you and we'll see you again next time.