Brain Awareness: What are Strokes and TIAs?

 “Of 100 people who have a stroke: 10 recover completely, 25 have minor impairment, 40 will have moderate impairment, 10 will require long term care and 15 will die.” David Turkel-Parrella, MD

imgres-1Dr. David Turkel-Parrella, a Neurologist and Neuro-Intervention Fellow at the University of Toronto in Canada, knows about Stroke.  His recent research  investigates factors that contribute to stroke severity and progression.  He serves as a member of the Endovascular-Interventional section of the American Academy of Neurology.  He completed a Fellowship in Vascular Neurology at the New Jersey Neuroscience Institute.

With a clinical background combining the disciplines of neurology and radiology, Dr. Parrella is working to more quickly treat strokes, limit their severity and reduce the disability they can cause.

Ischemic-Strokes-Clots_UCM_310939_Article

“Simply put a stroke is when a part of the brain is deprived of blood and stops working.  Two main ways a stroke occurs: a clot blocks blood flow to a region of the brain, or a blood vessel bursts,” he explains.

Physicians call a clot that blocks blood flow an ischemic stroke.  Blood vessels are clogged by fat and cholesterol that collect to form a plaque.

When a blood vessel bursts, it is called a hemorrhagic stroke.   Bleeding in the brain  “sometimes …[occurs] from untreated hypertension…[or] sometimes

Hemorrhagic-Strokes-Bleeds_UCM_310940_Articlefrom an aneurysm or vascular malformation that ruptures,” Dr. Turkel-Parrella explains.  An aneurysm or vascular malformation is a widening of an artery due to weakness in the blood vessel wall.

Dr. Turkel-Parrella notes that both types of strokes can be equally devastating.  “80 % of strokes are Ischemic (from a blood clot) and 20% are Hemorraghic (bleeding)… on a cellular level, stroke, left untreated, causes irreversible neuronal death,” he says.

 The symptoms of stroke can be sudden and severe:  headache which occurs when the person is lying flat and headaches that wake the person from sleep. “The worst headache of your life is an ominous sign for a possible type of bleeding stroke called SAH.   SAH is Subarachnoid Hemmoraghe, the type of bleeding that occurs when an aneurysm bursts,” says Dr. Turkel-Parrella.  

Other symptoms can be sleepiness, unconsciousness or even coma.  Sudden changes in taste, hearing, balance, vision, coordination and muscle weakness are all signs of stroke.  “If it’s a blockage of an artery, its imperative to give clot busting drugs quickly,“ he explains.

Stroke risk factors include high blood pressure, diabetes, high cholesterol, family history of stroke and being African American.  ”The most vulnerable of society are the most at risk for stroke, ”  Dr. Turkel-Parrella relates.  

Having a stroke is higher among those who are overweight or obese, who eat too much fat or salt, drink alcohol heavily or smokers.  Birth control pills can also increase the risk of stroke in women ages 35 and up.   “Hypertension is a huge contributor to poor cerebrovascular health! But it is a modifiable one!”  Yet “things that cause strokes, hypertension, diabetes, cholesterol all have a genetic underpinning.  Aneurysms also have a familial component.  In Toronto we screen all people with second and first degree relatives with an aneurysm,”  he says.

A Transient Ischemic Attack (TIA) is a warning sign that a stroke may happen soon.  Blood  flow to a part TIA-Transient-Ischemic-Attack_UCM_310942_Articleof the brain stops for a short period of time.     The person has symptoms that are like a stroke.  “A TIA by definition means the symptoms resolve,” says Dr. Turkel-Parrella.

Imaging like  MRI (magnetic resonance imaging), Doppler, CT scans play a large role in diagnosis of stroke.  “Imaging plays a role in the acute phase: what type of stroke is it? That drives treatment decisions in the Emergency Room.  CT is the main modality. MRI is more useful when you are trying to figure out why the stroke occurred,” Dr. Turkel-Parrella relates.

“In acute stroke we give clot busting drugs or use mechanical devices to go in the brains ‘blood vessels and fish out clot.” It is important to get to a hospital, preferably a stroke center, as soon as symptoms arise.  “Time is brain,”Dr. Turkel-Parrella says,  “and if you live far away from a stroke center it can be less than ideal. The percentage of those who survive stroke yet are seriously disabled can be as high as 50 percent….  ”

Dr. Turkel-Parrella has focused his medical career on stroke and he has a very good reason.  “Stroke is the third leading cause of death in the United States, 140K people die each year from url-1stroke in the United States.  Stroke represents a national healthcare crisis, and its a condition that is treatable, but more importantly often preventable.” This is what motivates his work.

“Ischemic Stroke is often caused by modifiable risk factors, social determinants of health and improved health literacy. We need to help people get access to basic primary care.  We need to improve health literacy on a basic level.  Real access to primary care is what will make the biggest impact on preventing stroke,” Dr. Turkel-Parrella says.

Based on #HCHLITSS twitter chat March 14, 2013

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