Stroke
Heart attack’s just-as-evil twin

Michele Sponagle

It began as another ordinary day for MaryAnn Luff, a mother of four children. As usual, the 47-year-old from Belleville, Ont., dropped off her daughter at school, but the intense headache she experienced that morning was unlike anything she had ever felt before. It came on fast and strong and was soon followed by blurred vision. As MaryAnn stepped out of her minivan, her body felt very weak and she collapsed. She knew she was having a stroke because, just a few days before, she had read a news story about Walter Gretzky, father of Wayne, and his recent encounter with stroke. “It’s strange,” she says, “because a week earlier, I would not have known what the signs were.” (See “Know the Signs of Stroke”).

Fortunately, the ambulance attendants immediately recognized her symptoms as those of a stroke (also known as a cerebrovascular event) and transported her to a Kingston hospital. There she received tPA (tissue plasminogen activator, a clot-dissolving drug) after a CT scan determined there was a blood clot lodged in her brain. Lying in her hospital bed, MaryAnn could not feel the left side of her body at all, and her climb back to wellness took about five months. Physiotherapy helped get her on her feet again, at first with a walker, then with two canes. Now MaryAnn’s on the move without assistance. The only residual effect of the stroke that occurred seven years ago is a lingering paralysis in three fingers on her left hand. “That I can live with,” she says with a laugh. Today, she volunteers with the Heart and Stroke Foundation to raise awareness of this scourge.

MaryAnn’s stroke came as a surprise; having none of the typical risk factors, she was not considered at high risk (see “Recipe for a Cerebrovascular Event”).

Trends

As the body of knowledge about stroke and its prevention grows, two disturbing trends have emerged. First, younger Canadians are increasingly at risk, according to a study released by the Heart and Stroke Foundation. Blame smoking — a strong risk factor — in part. The majority of today’s puffers are 15 to 29 years of age. Add to this that one fifth of Canadians in their 20s are obese. In 2000, 18,000 men and women between the ages of 30 and 60 were hospitalized for stroke.

Equally bleak are the statistics on women and stroke. According to the Heart and Stroke Foundation’s 2007 Annual Report on Canadians’ Health, a woman’s odds of dying following a stroke are higher than a man’s; in the first 30 days, she is 11% more likely to die from a stroke.

The reasons for this have puzzled researchers, but they have their suspicions. Dr. Antoine Hakim, scientific director of the Canadian Stroke Network in Ottawa, explains: “A woman experiencing a stroke can present differently than a man; a woman’s symptoms can appear more vague and may not be the classic ones” (see “Know the Signs of Stroke”). Women do not seek help as quickly, and 30% are unfamiliar with the symptoms. Women can take up to 46% longer than men to get to the hospital after stroke symptoms appear.

Men are equally in the dark when it comes to their female partners and strokes: according to the Heart and Stroke Foundation, only 24% of men consulted thought their partners or spouses would suffer a stroke. Clearly, there’s a major role for public education in stroke prevention and treatment. The faster the warning signs are recognized, the faster a patient can receive life-saving treatment. Sadly, women often ignore the signals and delay treatment. “It’s tragic when a woman doesn’t want to bother her doctor or go to the hospital,” says Hakim, “Time is of the essence when a stroke happens.”

Photo by Masterfile

What’s new?

Researchers are examining the impact of thermal stimulation on stroke survivors who experience impairment in an upper limb. With the application of hot and cold packs, patients have had significantly higher rates of recovery.

New cardiovascular guidelines suggest that women age 65 and over should consider taking a low-dose multivitamin-mineral supplement, regardless of their risk levels. Research suggests that supplementation may prevent both strokes and heart attacks in this age group.

Stroke’s two fists

There are two main types of stroke: ischemic (accounting for more than 80% of strokes) and hemorrhagic. In an ischemic stroke, the blood supply is cut off from brain tissue, usually by a blood clot lodged in the brain or the internal carotid artery, which supplies the brain with blood-borne oxygen and nutrients. Like cardiac muscle in a heart attack, some brain tissue may be starved and can die. Then there are ministrokes (also known as TIAs, or transient ischemic attacks). The symptoms are the same as with a full-blown ischemic stroke, but they may disappear after a few minutes or hours. TIAs often indicate that a full-blown ischemic stroke is on the way.

Photo by Masterfile

In hemorrhagic stroke, a vessel in the brain bleeds and puts pressure on cerebral tissue. Both types produce similar symptoms, and their after-effects vary according to the part of the brain they target. Ischemic stroke may cause possible lasting paralysis or speech difficulties. Hemorrhagic strokes are more often fatal, but those who survive them frequently make good recoveries since the injuries are due to pressure on the brain from bleeding, not from lack of blood. Hemorrhagic stroke is more common among women than men, particularly among women who smoke. And while moderate alcohol consumption may have some preventive advantage against ischemic stroke, alcohol increases the risk of hemorrhagic stroke. Women who suffer from migraines with aura may have a higher risk of hemorrhagic stroke

Taking control

High blood pressure, or hypertension (HPT), is a key risk factor linked to 65% of all strokes. “Hypertension is the most modifiable risk factor,” explains Dr. Robert Côté,

a Heart and Stroke Foundation spokesperson and an associate professor of neurology at McGill University Health Centre in Montreal. “We can all do a better job by having our blood pressure checked at doctor’s visits.”

A cuff device called a sphygmomanometer measures the force of blood against the walls of your arteries in terms of millimetres of mercury (mm Hg). When high blood pressure is caused by an external factor (ranging from kidney disease to drug side effects), it’s called secondary hypertension. When tied to an individual’s genetics or lifestyle, it’s called essential hypertension. Both types are dangerous.

About 22% of Canadians ages 18 to 74 have high blood pressure (defined as consistently more than 140/90 mm Hg in non-diabetic people (the target is lower for people with diabetes). Equally worrisome is that 42% in this group are unaware of their condition and are not receiving treatment. In adults with high blood pressure, 18% are women and 26% are men. As age climbs, so does the prevalence of hypertension: 58% of women between the ages of 55 and 74 have HPT. Canadians visit their doctors 20 million times a year for HPT, a leading risk factor for death worldwide. 

Over time, hypertension can scar blood vessel walls. These scars promote the buildup of fatty deposits called plaque, which can burst and snag blood clots. Very high blood pressure may cause blood vessels in the brain to burst, resulting in a hemorrhagic stroke, in which bleeding damages brain tissue. Your doctor may prescribe medication and suggest lifestyle changes. These include quitting smoking, maintaining a healthy weight and eating a diet high in vegetables, fruits and fibre. Other steps are reducing salt and saturated fat intake, boosting exercise, cutting back on alcohol and lowering stress.

What’s new?

Adults at elevated risk for stroke may be screened using an eye exam that checks for signs of hypertensive retinopathy. This is a condition that causes small ruptures in the blood vessels of the eye. Scientists at Australia’s University of Sydney found that those who had retinopathy were three times more likely to suffer a stroke.