From Shruti Sonni, MD
CHA Neurologist,
Instructor in Neurology at Harvard Medical School
According to the National Stroke Association, stroke is the 4th leading cause of death in America. However, the good news is that 80% of strokes are preventable by managing risk factors and adopting a healthy lifestyle. here is a short Q&A of questions I'm often asked about strokes. I hope this information is beneficial to you and your clients.
How does a stroke occur?
A stroke, also known as a "brain attack," is caused by a sudden blockage in blood flow to the brain due to a clot in a blood vessel (an ischemic stroke) or a brain bleed (an intracranial hemorrhage). 
The clot that causes an ischemic stroke can form within the blood vessel or originate anywhere between the heart and that blood vessel. For instance an irregular heartbeat (such as atrial fibrillation) can cause clots to form in the heart which can travel up to the brain and cause a stroke. An intracranial hemorrhage is caused by the bleeding of blood vessels inside the brain and is often a result of uncontrolled high blood pressure.
I have heard of a "TIA" before - what exactly is that?
A TIA stands for 'Transient Ischemic Attack' - some people might call it a "mini stroke". It is essentially the same as a stroke but the symptoms resolve within a few minutes to a few hours, as the blood vessel closes and then opens again or blood supply is not completely cut off to that part of the brain. A person who has a TIA is at high risk for having a full stroke, so it is important to seek medical attention right away, no matter how quickly the symptoms subside.
How can I tell if my patient or client is having a stroke?
Just remember the acronym, FAST:
(photo credit from the American Stroke Association)
F - Face Drooping. Is one side of the face drooping?
A - Arm Weakness. Is one arm weak or numb? Does it drift downward?
S - Speech Difficulty. Is speech slurred?
T - Time to call 911. If your patient or client has experienced any of these symptoms, call 911 right away - even if the symptoms subside.
(note: as CHA is a designated primary stroke service, you can get expert care at the Cambridge, Somerville, or Whidden Hospital emergency rooms, 24 hours a day)
Are there risk factors that I should be aware of? Yes. As 80% of all strokes are preventable, it is important to understand common risk factors and other healthy habits so we can share with patients or clients. Many of the risk factors are related to heart health, including:
- high blood pressure
- high cholesterol
- diabetes
- atrial fibrillation (abnormal heart rhythm)
- smoking
Healthy eating habits can also help lower your stroke risk:
A diet low in sodium, carbohydrates, and sugar are especially important. Excessive alcohol intake is also a risk factor, but that doesn't mean alcohol is all bad! Many studies have shown that having 1 glass a day can be beneficial to your health.
Are there any treatments for a stroke? Yes! If detected early, strokes can be treated with excellent recovery.
If a patient is having an ischemic stroke, an intravenous medication known as tPA can be given to help to dissolve the clot. If given within 4.5 hours of the symptoms, it can help improve the chances of full recovery. For an intracranial hemorrhage, an urgent trip to the hospital is important so blood pressure can be controlled, or an aneurysm can be detected and treated to prevent further damage.
We want to do all we can to prevent strokes from recurring, so hospital admission, monitoring and workup is important for the stroke patients who do not fall into the above categories. 
Anti-platelet agents and anticoagulants decrease the risk of future strokes significantly. More than 50% of all strokes are caused by uncontrolled hypertension, which can be treated with blood pressure management. Diabetes can be diagnosed and treated appropriately. If a carotid artery is found to be narrowed, patients can be considered for a procedure (carotid endarterectomy) to reduce the risk of stroke from that vessel being blocked. Appropriate lifestyle changes can be recommended. Physical therapy and speech and swallow therapy can be initiated in appropriate situations to speed up and improve stroke recovery.
The biggest take home message from this Q&A is don't wait. Never brush off possible stroke symptoms. If you have any questions about strokes, please do not hesitate to contact me. I can be reached by email at ssonni@challiance.org.
