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Stroke Science.


You think of it as something that can only happen to elderly people, or people who are extremely unhealthy. You think your risk is low because you are under 50 or because you've cut down significantly on that smoking habit. To some degree, you're right, but strokes--while a higher risk to those over the age of 55--can happen to anyone. According to the National Institute of Neurological Disorders and Stroke, there are more than 700,000 strokes each year in the United States, and it is the third leading cause of death in the country. Women are at higher risk than men, but men are more likely to have strokes at a young age than women.

Scary statistics, especially when most of us in the general public have a limited knowledge about strokes and why they happen. But there are risk factors that are important to consider, health changes that can be made, and warning signs that can predict an impending stroke or identify one occurring. Early detection and treatment, as well as preventative care, can not only help those in recovery from a stroke, but also can give us all a chance to keep strokes at bay and maintain a healthier lifestyle.


A stroke occurs when the blood supply to part of your brain is interrupted or reduced, depriving the brain tissue of oxygen and food. Brain cells begin dying immediately making a stroke a medical emergency. According to Catherine McVey, director of Critical Care Services and Stroke Program Coordinator at Alaska Regional Hospital, almost 90 percent of strokes are what are called "ischemic strokes," a result of the arteries to the brain being narrowed or blocked. The strokes can be classified as thrombotic or embolic. A thrombotic stroke is caused by a blood clot forming in one of the arteries that supply blood to the brain, while an embolic stroke occurs when a clot forms in blood vessels away from the brain (commonly in the heart) and is swept through the bloodstream to lodge in the brain arteries.

Sometimes referred to as a "mini-stroke", a transient ischemic attack is yet another type of stroke, caused by a temporary decrease in blood flow to the brain. Mini-strokes are usually caused by a clot or plaque and most last about five minutes. Many people don't find out until long after the fact that the stroke even occurred. These mini-strokes put them at a higher risk for a major stroke.


Chronic health conditions, such as high blood pressure, high cholesterol, diabetes and smoking are all contributors to strokes. "No one is immune," McVey says, "but strokes happen most often to those over age 55 with high-risk health issues."

Symptoms can be subtle, but should never be ignored. "If you notice numbness, tingling, or weakness affecting one side of your body, sudden changes in vision or balance, change in cognition, loss of speech or comprehension, call 911," says Erica Coady, Ph.D., a neuropsychologist with Providence Behavioral Medicine Group. "The thing that makes a stroke so devastating is that brain tissue is exquisitely sensitive to any type of disruption, which is why an individual having a stroke will typically begin showing signs almost immediately."

According to the National Stroke Association, 2 million brain cells die every minute during a stroke, increasing the risk of permanent disability or death. Acting as fast as possible is imperative, in order to minimize damage to the brain.


Providence Alaska Medical Center has a strong team to work with stroke survivors. "I've worked in a number of rehabilitation settings in the Lower 48," Coady says. "I'm impressed with the quality and comprehensiveness of the care Providence offers. The team includes top-notch physicians, a superb nursing staff, well trained occupational and physical therapists, speech and language pathologists, dieticians, spiritual care, as well as my role as a neuropsychologist."

Therapy and treatments vary, based on the severity of the stroke. Depending on the location of the stroke, different functions may be affected. Some strokes affect motor functioning on one side of the body, while others might impact memory and thinking abilities. "Therapy may involve work with a physical therapist to improve strength and coordination in the case of motor function impairment," Coady says, "or speech and cognitive therapists if there are memory issues. A stroke can also cause emotional and behavioral changes, another area of stroke medicine we address."


Providence is a designated site for the Crystal AF (Cryptogenic stroke and underlying atrial fibrillation) clinical trial being conducted internationally by Medtronic Inc. "Previous clinical trials have shown that a heart condition called atrial fibrillation may be the cause of a stroke," said Christie Artuso, director of Neuroscience Services. "The clinical trial randomizes eligible patients to either a control group or a continuous monitoring group. Patients are randomly placed in either group. Those in the continuous monitoring group are monitored for previously undiagnosed atrial fibrillation through a small implanted device that detects cardiac rhythm problems."

Alaska Regional Hospital is also on the cutting edge of stroke treatment and rehabilitation. They were certified as a stroke center in 2007, the first in the state, and recertified in both 2009 and 2011. Alaska Regional's stroke center consists primarily of two units, the Critical Care Unit and the Progressive Care Unit. "All stroke patients go to one of these two units," McVey says. "The nurses there are specifically trained to care for stroke patients."

Alaska Regional is the only hospital in the state to provide endovascular coilings, a minimally invasive procedure to treat aneurysms, and offers treatment for stroke patients from the Emergency Department through the Rehabilitation Department. Other treatments include thrombolytic therapy, which is considered best for those patients treated within a three- to four-hour window. Hemorrhagic strokes sometimes respond to interventional radiology treatments and endovascular coilings.


Both Providence and Alaska Regional emphasize that the proverbial ounce of prevention is the most important way to deal with the issue of strokes. "The most important thing you can do is reduce your cholesterol, watch your blood pressure and treat it if it is high, reduce obesity and stop smoking," McVey says.

"We all have a few bad habits, but it's never too late to modify them." Coady says. "Sometimes even making one or two small changes in your routine can decrease your chance of stroke. Talk to your doctor if you have questions. As a neuropsychologist, the behavioral contributions to disease interest me--there is a lot of research about therapeutic interventions that can potentially reduce the risk of stroke."


Recovery rates depend upon the individual and severity of the stroke. "Our medical team assesses exactly what areas of function have been affected and based on that information, tailor a rehabilitation program to the person's needs," Coady says. "I think it is important for someone who has had a stroke to be evaluated as soon as possible. Our brains tend to recover more quickly in the months immediately following an injury."

While some stroke patients can have almost a full recovery, for others it is a matter of a little bit of recovery and then learning new strategies for living with the impairments caused by the stroke.

"I would add that if a stroke patient or a family member is concerned about any changes in cognition, he or she should ask the doctor about a neuropsychological evaluation," Coady says.

Devastating as they might be, strokes should not necessarily be considered a death knell, and many people go on to live full and active lives.

"In dealing with a stroke," Coady says, "it is important to find a good comprehensive stroke rehabilitation team to help manage your care. It is also important to utilize the support services of one's family and community connections. Social and familial support are known to be some of the strongest predictors of functional recovery after stroke."
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Title Annotation:HEALTH & MEDICINE
Author:Ellis-Knapp, Jody
Publication:Alaska Business Monthly
Geographic Code:1USA
Date:Mar 1, 2012
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