Diary of a Stroke

It was January 18, 2011. I woke up in the morning and seemed a bit dizzy.  I thought it might be my Ménière’s syndrome [a disorder of the inner ear that affects balance] acting up.

I walked down the hall and twice caught myself from falling. I said to myself, “You are acting like a drunk.”  Then I said, “No, you are acting like your dog Gingy when she has had too much morphine.” She is being treated for congestive heart failure with morphine, and I wondered if it could have transduced to me, either from my handling her pills or from skin to skin contact.

I took a shower and leaned on the wall to stabilize myself.  Dried my hair and went to the kitchen to get some breakfast.  When I picked up a plate with my left hand, I couldn’t make it horizontal. I had the passing thought that I might be having a stroke, but dismissed it, because my speaking was not impaired, and the three colleagues I have known who had had stokes all lost speech.  My left foot also seemed to be dragging, but I wasn’t quite sure if it was true or if I was making it up.  My dog walked up to me in an uncharacteristic way with a very unusual quizzical look on her face, and it made me think that she knew I was in trouble.

I returned to the thought that maybe I was having a stroke and decided to do a brief neurological test on myself. I decided to see if I could touch my nose with each hand with my eyes closed.  With my eyes closed I put my right index finger on my nose instantly. When I tried to put my left index finger on my nose, I was in for a surprise. I had no mental representation, no visual image, of any part of my body whatsoever.  I could not begin to find my nose. There was a total blank, just darkness. Everything was black.

I remembered that it was important to take baby aspirin if you were having a stroke, so I took 4 baby aspirin in case it was a stroke and called a close friend of mine who was a physician and asked her what she thought.  Mind you, I had almost no anxiety about the results of my mini neurological test. I was simply intellectually curious about it. (I now know that my lack of anxiety was a part of the syndrome of neglect that goes along with this kind of stroke.) My friend was alarmed, rushed out from her luncheon engagement, and told me she was coming to pick me up in a taxi to take me to the hospital immediately.

I put on some sturdy shoes to help stabilize me, canceled my patients, and went downstairs to get a taxi.  I saw the concern on my friend’s face and realized that maybe this was more serious than I understood. She wondered out loud if she should have called an ambulance, and my thought was, “Why in the world would we need an ambulance?” I asked her if she thought my left foot was dragging, and she said yes.  We went directly to the Cornell emergency room.

Susan Coates, Ph.D.
Clinical Professor of Psychology in Psychiatry
College of Physicians and Surgeons, Columbia University

Dr. Andersen responds: Dr. Coates, a patient of mine, was indeed having a stroke. She got prompt medical attention, did remarkably well, and has made a full recovery.  She is back taking care of the many patients who need her.

Not everyone fares so well.

Image: WebMD

Strokes can be deadly, and they can strike like lightning. Strokes are the third leading cause of death (behind heart disease and cancer) and the No. 1 cause of disability in the United States.  According to the American Stroke Association, 137,000 Americans a year die from stroke. Strokes are more common in women, who account for 60 percent of stroke deaths in this country, and who are more likely to die from them (60 percent of women who have a stroke die from it, compared with 40 percent of men).

A stroke is like a heart attack of the brain.  It occurs when the brain, deprived of blood flow and oxygen delivery, begins to malfunction and die.  There are two types of stroke:

“Ischemic” strokes are the most common; they occur when there is disruption of blood flow within a blood vessel from an embolus. [Dr. Coates's stroke was an embolic stroke.] The two most common causes are a tiny blood clot or a piece of a ruptured atherosclerotic plaque from an artery that supplies the brain with blood.  Atherosclerotic plaque is the fatty, cholesterol-filled substance that can build up within the blood vessel wall and cause narrowing.  (If this plaque ruptures in an artery supplying the heart, it can cause a heart attack.)

The second type of stroke is a “hemorrhagic” stroke.  This occurs when a blood vessel in the brain bursts and bleeds.  This most commonly occurs when there is uncontrolled high blood pressure or a weakness in the artery wall (aneurysm).

A “mini-stroke,” or “TIA” (transient ischemic attack), occurs when blood flow to the brain is interrupted for only a brief period of time and there is no associated brain cell death.  Stroke-like symptoms do occur, but they are transient, lasting for only a few minutes to two hours. A TIA is a warning sign that you are at a heightened risk for stroke.  TIAs are diagnosed by history—or, if witnessed by a doctor in time, a physical exam.  TIAs will not be detectable on a brain scan.

The most common symptoms of a stroke include sudden trouble speaking or understanding speech, sudden numbness or weakness of the face, arm or leg—especially if on one side; sudden trouble seeing in one or both eyes; sudden trouble walking from weakness, dizziness, or balance.

Although stroke rates are dropping for older Americans, the latest reports from the Centers for Disease Control found the incidence of stroke in younger Americans to be increasing at an alarming rate.  Stroke hospitalizations rose sharply among men and women age 15 to 44.

Furthermore, the rate of stroke among pregnant women and new mothers has increased dramatically. The Centers for Disease Control reported in July that over the past 12 years the rate of stroke hospitalizations increased by 47 percent for expectant mothers and 83 percent for women who had recently given birth. The most likely explanation is that pregnant women are increasingly likely to have more risk factors for stroke such as obesity, high blood pressure, and diabetes.

Prevention
The public needs to know more about stroke and stroke prevention. Being informed can significantly help you reduce your risk of stroke; indeed, it could potentially save you or someone you love from dying or being significantly disabled.

The risk factors for having a stroke are much the same as those for heart attacks—high blood pressure, high cholesterol, diabetes, obesity, family history, and a sedentary lifestyle.  Interestingly, we now know that a history of migraine headaches—which are much more common in women, especially with aura—also increases your risk of stroke.  Other risk factors include the presence of some heart arrhythmias (most notably atrial fibrillation), illicit drug use (particularly cocaine), some congenital conditions of the heart or blood vessels, and hereditary conditions which increase the propensity to form blood clots.

A diet lacking in fruits and vegetables will also increase your risk.  We have known for quite some time that eating a diet replete with fruits and vegetables can lower your blood pressure, but a large study published in December 2011 in the premiere journal Stroke showed that it can also significantly reduce your risk of hemorrhagic stroke.

If You See Any of These Signs, Call 911!

If you think you or someone with you may be having a stroke, act F.A.S.T. and do the following:

F-FACE: Ask the person to smile; does one side of their faced droop?
A-ARMS: Ask him/her to raise both arms. Does one drift downward?
S-SPEECH: Ask him/her to repeat a simple phrase. Is the speech slurred or strange?
T-TIME: If you observe any of these signs, call 911 immediately.

Life-Saving Treatment
With heart attack and stroke, getting treatment quickly is the key.  We now have a potentially life-saving, clot-busting medication called tPA that can be used within the first three hours of when symptoms appear.  This medication can significantly improve one’s outcome with the most common type of stroke.  So if your symptoms suggest stroke, don’t call your doctor, call 911.  Your doctor and family can be notified later. Time is of the essence.