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An Ounce of Prevention is Worth a Pound of Cure: Fighting Stroke

By Dr. Richard Wilkerson, The Vascular Center at Mercy

We’ve all heard the expression, “an ounce of prevention is worth a pound of cure,” and it very much applies to the management of stroke.

In 2006, it was estimated that more than 700,000 persons in the nation would suffer a stroke, with approximately 150,000 dying, making stroke the third leading cause of death. Of the 5 million U.S. stroke survivors, upwards of 30 percent are permanently disabled.

There are two principal types of strokes, ischemic and hemorrhagic, with the former accounting for more than 80 percent of all cases. Ischemic stroke usually occurs due to small blood clots or bits of debris which blocks a small blood vessel in the brain. These blood clots or debris usually arise from a diseased, partially blocked blood vessel in the neck. Hemorrhagic strokes occur when a weakened blood vessel ruptures and bleeds into the surrounding brain tissue.

Fortunately, medical science continues to advance the treatment of stroke with the development of powerful new medicines to limit or even completely reverse acute stroke.

Nevertheless, prevention of stroke all together should continue to have our highest priority. This can be accomplished in a straight forward manner through patient awareness of stroke symptoms and simple, noninvasive ultrasound testing of the carotid arteries.

Most individuals suffering an acute stroke will experience:

• Weakness or numbness, heaviness, clumsiness, and/or paralysis on one side of the body (e.g. the hand, arm, face, leg, or even the entire half of the body)
• Vision impairment (fog, haze, double vision, etc) or vision loss in one or both eyes
• Slurred speech
• Trouble speaking or understanding what others are saying or confusion

Patients who feel that they may have experienced any of the above symptoms should see their doctor for an examination and assessment of their major risk factors. These risk factors include high blood pressure, diabetes, high cholesterol, and smoking. The patient should then undergo testing by ultrasound on the neck blood vessels. This test is rapid, painless and easily identifies the amount of blockage or narrowing in the neck vessels. It is well accepted that blockages over 80 percent leave the patient at high risk for stroke. It is also believed that patients with symptoms should have blockages of 50 percent or greater repaired.

These days, two options are available for correction of a dangerous blockage in the carotid artery. The traditional way is through surgery to remove the plaque that blocks the artery. This is called a carotid endareterectomy. Some patients are now candidates for a second option for repair known as CAS, or carotid angioplasty and stenting. This treatment consists of opening the blockage by balloon angioplasty and stabilizing the plaque with a metal stent. Your doctor can counsel you on which method is best for you.

May is National Stroke Awareness Month, a perfect time to see your doctor and determine if you are at risk for stroke. By controlling risk factors and through appropriate testing, many patients at risk for stroke can be identified and the stroke can be prevented. Stroke is second only to dementia as the reason for long-term institutionalized care, and the costs from stroke in the U.S. top $40 billion dollars. As our nation ages, we can expect the number of people at risk for stroke to rise as well. Fortunately, through medical and surgical treatments, we are making strides to prevent and treat this debilitating disease.

Richard Wilkerson, M.D. is a Board Certified Vascular Surgeon who sees patients at The Vascular Center at Mercy Medical Center and at Overlea Personal Physicians.. For more information, call 410-410-663-8100, 410-332-9696 or visit www.overleadocs.com.