‘TIME IS BRAIN’
Dr Peter Johnson on stroke intervention
FOR YOUR first Doctor’s Appointment in Season 2, we explored an illness that is said to affect someone, somewhere in the world, every two seconds. In fact, it has been listed by the World Health Organisation (WHO) as the second-leading cause of death in Jamaica and third in the United States.
A cerebrovascular accident (CVA), or ‘stroke’, is an acute and sudden dysfunction of the brain that is typically the result of blockage or pre-existing disease in blood vessels, causing bleeding inside brain tissues or around the brain itself. There are three distinct types of stroke that all require immediate medical attention.
1. The first kind of stroke is the ischemic stroke, which is caused by an obstruction within a blood vessel that is responsible for supplying blood to the brain.
2. Meanwhile, the haemorrhagic stroke is commonly created by uncontrolled hypertension or high blood pressure, which is notably prevalent among Jamaicans as well. It may also result from either a weak, bulging area in an artery (aneurysm) or an abnormally or poorly formed vein and artery (arteriovenous malformation) that bursts.
3. The third type is known as transient ischemic attack, or TIA, often called a ‘mini stroke’. It is caused by the onset of a temporary clot in blood vessels and may be a sign of more serious implications.
THINKING FAST
Dr. Peter Johnson, consultant interventional neuroradiologist at the University Hospital of the West Indies and special guest on
Doctor’s Appointment, noted that with this particular health concern, ‘time is brain’. That is to say, the longer a patient takes to get medical attention, the more severe the damage to the brain cells and other parts of the body which are at the centre of a stroke.
Among the reported signs and symptoms of a stroke are:
trouble walking, dizziness or loss of balance;
weakness on one side of the body affecting the face, arm or leg;
difficulty seeing or blurred vision in one of both eyes;
and a challenge in speaking clearly, as well as confusion. However, Dr. Johnson explained that any form of disruption of regular brain function should be taken as a symptom of stroke and a nudge to seek help.
To formally determine if a person is experiencing or has experienced a stroke, practitioners use the acronym, FAST, which stands for face, arms, speech and time. An examination will determine which side of the brain is affected, based on the side of the body that appears to be most impacted.
If the left side of the brain is compromised, the right side of the body will be most impaired, and if the right side of the brain is impacted, controls for functions of the left side of the body will be negatively affected.
Ideally, if a clot can be removed within 3.5 hours from the onset, Dr. Johnson highlighted, a patient who has suffered a stroke can reverse the impacts with greater success in shorter time frame.
Therefore, in case of a suspected stroke, the first course of action is to get to a hospital immediately. Going to a general practitioner or a clinic will only result in the patient being transferred to the hospital where treatment is available, reducing the window of opportunity for limiting long-lasting adverse effects.
TREATING AND PREVENTING A STROKE
A stroke can be cured. With an ischemic stroke, doctors are able to quickly work to restore blood flow to the brain. Emergency treatment may include the use of aspirin or an injection of tissue plasminogen activator (TPA), usually given through a vein in the arm — depending on the individual case. TPA breaks down the obstructing clot, but must be administered within 4.5 hours after stroke symptoms begin, if injected into the vein. Based on the characteristics of the clot and its location, following a CT scan, medication may be delivered directly to the brain or removed mechanically. Surgery is often applied in cases of haemorrhagic stroke.
The truth, however, as Dr. Sara Lawrence reminded viewers, is that prevention is better than cure. It is also cheaper and worthwhile to invest in preventing the deterioration of our health before it responds in ailments such as stroke.
High blood pressure, diabetes, obesity, high cholesterol, smoking, excessive alcohol consumption and living a sedentary lifestyle (general inactivity) are cited as risk factors that make it easier to have a stroke. While it has been found that there is a hereditary component to stroke, it is not a primary disease, in that it is caused by something else. Preventing any of these risk factors is considered effective. Through the adjustment of diet, regular check-ups, and becoming physically active, an individual can begin taking steps in the right direction - away from experiencing a life-threatening stroke.
Join us next week on Sunday at 5:30p.m. on TVJ when we look at Sickle Disease with guest, Dr. Knight Madden. Doctor’s Appointment is a family and health-oriented television programme that is produced by Maverick Communications Limited (formerly Maverick Communications and Associates).