Brain Attack: Stroke Prevention and Treatment

by Food and Drug Administration (FDA)

As a physical therapist, Dina Pagnotta, 33, has helped more than 100 people recovering from stroke. So when she had a stroke on a May morning in 2002, she had an idea of what was happening.

First, she felt dizzy during a Pilates class in New York City. One moment, she had been laughing with a friend. Then she took a sip of water but couldn't swallow. She choked and the water came right back out of her mouth. Seconds later, she couldn't move her left leg or arm, the left side of her face went limp, and her speech was slurred. "It felt like I got a shot of Novocain in the whole left side of my body," Pagnotta says.

Her friends lowered her to the ground, and someone called 911. "The next thing I knew, I was in an ambulance with the sirens screaming and a paramedic calling it in: '30-year-old female, CVA,'" which stands for cerebrovascular accident, also known as stroke.

A stroke occurs when blood flow to part of the brain is interrupted, which is why it's sometimes called a "brain attack." Pagnotta had an ischemic stroke, the most common kind. It occurs when a blood clot blocks a blood vessel or artery in the brain. Ischemic strokes account for 80 percent of all strokes. Hemorrhagic strokes, which account for the other 20 percent, occur when a blood vessel in the brain ruptures and causes bleeding.

According to the National Institute of Neurological Disorders and Stroke (NINDS), about 700,000 people have a stroke each year — 500,000 first strokes and 200,000 recurrent strokes. Stroke is the leading cause of long-term disability and the third-leading cause of death for Americans after heart disease and cancer.

Time Is Brain

When blood flow to the brain stops, brain cells are deprived of oxygen and nutrients. "A stroke is a medical emergency because brain cells start dying quickly," says John R. Marler, M.D., a neurologist and associate director for clinical trials at the NINDS. And treatment is most effective when given promptly.

Activase (alteplase), a genetically engineered version of tissue plasminogen activator (t-PA), is the only drug approved by the Food and Drug Administration for treating the sudden onset of ischemic stroke. The drug dissolves blood clots that block blood flow to the brain, improving the chance for recovery and decreasing disability. But the drug must be given within three hours after stroke symptoms begin. It has not been shown to be effective beyond three hours.

"The longer blood flow is cut off and the longer treatment is delayed," Marler says, "the more likely it is that the patient will suffer permanent damage." Stroke experts commonly refer to the sense of urgency in stroke treatment with this expression: "Time is brain."

Marler says, "This is why it's so important to recognize the symptoms of stroke and call 911 right away." The most common symptoms of stroke are

• sudden weakness or numbness in the face, arms, or legs, especially on one side of the body
• sudden confusion, or difficulty speaking or understanding speech
• sudden vision problems, such as blurry vision or a partial or complete loss of vision in one or both eyes
• sudden dizziness, trouble walking, or loss of balance and coordination
• sudden severe headache with no known cause.

Other symptoms that are less common, but still important, are sudden nausea, vomiting, brief loss of consciousness, or decreased consciousness, such as fainting and convulsions.

Sometimes, people experience a transient ischemic attack (TIA), also called "mini-stroke," which also requires prompt medical evaluation. When a TIA occurs, stroke symptoms may last only temporarily and then disappear. Most TIA symptoms disappear within an hour, but they may persist up to 24 hours.

"About 1 in 4 people who have a TIA go on to have a bigger stroke within five years," says Ralph L. Sacco, M.D., associate chairman of neurology and director of the stroke division at New York Presbyterian Hospital at Columbia University. "Stroke may have been prevented if the TIA had been detected and appropriately treated," he says. Doctors may recommend drugs or surgery to reduce the risk of stroke in people who have had a TIA. "For us, TIA is to stroke what chest pain is to heart disease. It's a warning sign that shouldn't be ignored," Sacco says.

The effects of a stroke depend on which area of the brain is affected and how extensive the damage is. One side of the brain controls the opposite side of the body. So a blood clot on the right side of the brain limits function on the left side of the body and vice versa.

At the hospital, Pagnotta recalls that a doctor kept lifting up her left arm. "Each time, it flopped back down," she says. Pagnotta didn't receive treatment with t-PA. Two hours after her symptoms began, she could move her fingers again, then she could move her whole arm, and her speech improved. After conducting tests, her doctors concluded that there had been a blood clot that temporarily blocked an artery on the right side of her brain, but it dissolved on its own.

"I was lucky," says Pagnotta, who ran the New York City Marathon in November 2004. She is among the roughly 10 percent of stroke survivors who recover almost completely. According to the National Stroke Association (NSA), 25 percent recover with minor impairments, 40 percent experience moderate-to-severe impairments that require special care, 10 percent require care in a nursing home or other long-term care facility, and 15 percent die shortly after the stroke.

About the Author

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