Steps Toward Reducing Risk: Controlling Blood Pressure, Learning the Warning Signs and Acting Immediately

Dr. Walter J. Koroshetz, deputy director of the National Institute on Neurological Disorders and Stroke, lists five things everyone should know about strokes:

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Dr. Walter J. Koroshetz.

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Dr. Walter J. Koroshetz, deputy director of the National Institute on Neurological Disorders and Stroke, is answering readers' questions about stroke this week. Submit a question

A KILLER Strokes can cause permanent brain damage and are the leading cause of permanent disability in adults. They are the third-leading cause of death in the United States. There are two main types of stroke: ischemic, caused by blockage of a blood vessel in the brain, and hemorrhagic, caused by bleeding into or around the brain.

PREVENTION The best way to prevent most strokes is to keep blood pressure in the normal range.

WARNING SIGNS A number of conditions place people at high risk for stroke and should lead to intensive investigation and therapy.

¶The most dangerous warning sign is a transient ischemic attack, sometimes called a T.I.A. or a ministroke. The symptoms usually go away after a few minutes, but are otherwise identical to stroke symptoms. People suddenly cannot speak or move an arm or leg or they cannot see. Many go on to have a stroke in the next few hours to weeks.

¶Atrial fibrillation, a heart condition that results in an irregular heartbeat and that occurs in millions of elderly Americans, is a common cause of severe strokes in patients over 65, or in younger patients with other vascular risk factors.

¶A severe headache that occurs so suddenly that it is often described as a “clap of thunder” can be a sign of bleeding around the brain, called a subarachnoid hemorrhage. Immediate medical attention is necessary to treat the weakened blood vessel, an aneurysm, before it bursts, causing a hemorrhagic stroke.

REDUCING RISK There are ways to reduce stroke risk when these warning signs occur.

¶People who have had T.I.A.’s or strokes or whose carotid arteries are partly obstructed can protect themselves by taking low doses of aspirin (81-milligram tablets) and a cholesterol-lowering statin even if their cholesterol level is not high.

¶People with atrial fibrillation can substantially decrease their stroke risk by taking warfarin, a drug that inhibits blood clotting.

¶Some people with obstructed carotids may reduce their risk of stroke by having the obstruction surgically removed. Stents to hold back the obstruction may help patients who cannot have the surgery and have had symptoms of a stroke.

URGENCY Patients with stroke symptoms should get to a hospital immediately. The brain damage from acute ischemic stroke can sometimes be halted by medications that dissolve the clots blocking blood flow to the brain. But for this therapy to be successful, treatment must be initiated as soon as possible. Minutes count, and therapy may be futile as soon as three hours from the onset of symptoms.