Some of the most memorable experiences of my clinical career have come while treating victims of stroke. At times, there were occasions for me to see those young and old who came desperately seeking help after having suffered paralysis to some degree and after having lost vital body functions (walking, getting in and out of a chair independently, etc.). Many were told that there was neither hope nor help for them after sometimes feeble or intense therapeutic measures. However, there were those occasions when I was able to witness what seemed to be the miraculous turnaround of a bed-bound man who began to take steps after a year of immobility or a wheelchair-bound woman who began to eventually walk with assistance. These memorable occasions and others’ made treating the effects of this savage adversary both thrilling, rewarding and most challenging.
A stroke can be a life-threatening medical emergency. It is an attack on the brain (cerebrovascular attack or CVA) that requires immediate reaction to its signs and symptoms. It occurs when blood flow is shunted or cut off (ischemia) from certain areas of the brain. A blocked blood vessel in the brain (thrombosis), plaques or material breaking off of blood vessel walls causing vessel blockage (embolus), loss of oxygen supply to the brain (hypoxia) and ruptured blood vessels spilling blood onto the brain (hemorrhage) are all means of creating ischemia to the brain. Ischemia causes brain cells to die and the brain to become damaged (infarction). The damaged brain translates into losses in body function depending on which part of the brain the damage occurred. The deficits can look like speech impairment, memory, sensation or paralysis/movement deficits, phantom pain and even incontinence. The severity of the infarct determines how severe the loss of physical function will be as well as which functions are lost. Because we humans connect with the world by way of our physical abilities, the oftentimes lifelong loss of them can be truly catastrophic!
Believe it or not, there was a time when stroke was thought to be unpreventable, an “old folks” disease and untreatable. However, these perceptions have evolved. We now know that it is largely preventable through lifestyle choices and controlling risk factors such as high blood pressure, cardiovascular disease, high cholesterol, smoking and obesity (inflammatory diseases). We now know that recognizing signs and symptoms (sudden one-sided numbness or weakness, spontaneous confusion, difficulty speaking, understanding seeing and or walking, sudden loss of balance, dizziness or severe, unexplained headache to name a few) is essential for engaging an immediate response and maximizing the potential for a person’s recovery. The effects of a stroke can be devastating, so it is necessary to protect oneself against potential stroke-related devastation in one’s life: paralysis, pain, balance deficits, swallowing and coordination deficits, intellectual, perceptual or sensory deficits, inability to manipulate objects, to dress/bathe oneself, inability to discern right side up or to drive a car, again, just to name a few. The major losses that a person victimized by stroke may suffer often create confusion and a life of altered abilities in an intimidating world.
In the unfortunate case of a person suffering a stroke, an emergency response to signs and symptoms must be deployed to give the sufferer the best chance at survival and recovery. Secondly, once the person is stabilized, skilled, rehabilitative intervention and treatment must begin right away to assist the person in regaining lost abilities (ambulation, balance, coordination, self-care/grooming, cognition, speech, eating, etc.), however, the goal is to prevent the stroke from ever happening by controlling those risk factors that can be controlled: choices where inflammatory food, beverage and nicotine intake are concerned.
Thoughts and preconceived notions about stroke have evolved over time. We now know that there is hope in prevention and treatment. With consumer and medical management the devastation is often reduced- especially when proper steps are taken to prevent the destructive effects of stroke. Hopefully, modern medicine will continue to make strides toward advancements that will eradicate stroke-related mortality and morbidity altogether.