Aging Begins at 30

Stroke 1: Stricken from Apparent Good Health

A stroke is denial of blood to a part of the brain by clot, bleeding, or by an embolus - a clot to the brain from elsewhere in the body.

"Strokes strike suddenly like the blow to pole-axe a steer." Not so. In 9 out of 10 cases, the path to stroke is lined with warnings. First, and foremost, high blood pressure should be a warning to all of us. This is one of the benefits of regular checkups.

A serious warning indeed, a dress rehearsal for stroke with temporary incapacity is called a Transient Ischemic (lack of blood) Attack, or TIA affecting the brain. Mary, in her early 70's, said to me, "I had a numbness in my left hand and had some trouble speaking and a curtain came down over my right eye." James, age 65, had dizziness, a numb tongue, and weakness in both arms and legs. The symptoms in both were maximal in five minutes and gone after 15 minutes. In Mary, there was a brief lack of blood from the carotid arteries to the forebrain. In James, it was lack of vertebral artery blood to the hind brain. About 40% of people with TIAs develop a completed stroke in the next few years. Completed strokes are preceded by TIAs in 10%. Others, because of their unhealthy blood vessels, die of heart attacks. These dire effects can usually be prevented by an aspirin a day to keep the doctor away.

"Call no man lucky until he is dead." A friend of mine, voted most likely to succeed in retirement, was struck down by a massive stroke from an abnormal heart rhythm called atrial fibrillation. This stagnates the blood in the heart with clot formation liable to migrate suddenly to the brain (an embolus). Regular use of heart rhythm drugs and anticoaglulants may prevent this.

A note of optimism. While coronary artery diseases have declined 25%, strokes have declined an amazing 47% in the past 20 years, particularly in people age 65 to 74. So even if many members of your family have died of stroke you need not feel you are automatically doomed to suffer the same fate.

At the same time, strokes still take their toll. The average age for stroke is 61. There are half a million strokes a year and the number of people that are having or have had strokes total 1.7 million in the U.S. Stroke is the third leading cause of deaths over age 65 (11%).

Stroke frequency began declining even before we had treatment for hypertension but have declined faster since we have had effective medicines. People who have had a stroke are more likely to have another than others to have their first. Diabetes, high blood fat and cholesterol, obesity, polycythemia (opposite of anemia), angina, heart attacks, or heart failure all add to risks of developing a stroke. Smoking, excess alcohol (heavy steady drinking or bingeing), and the use of birth control pills add to your risk. Age, race (black more than white), heredity, and poverty increase your predisposition. There are more strokes in the winter than in the summer.

You have been warned. Take care.

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See related Patient Topics Brain and Nervous System, Heart and Circulation, Seniors' Health or Stroke.

See related Provider Topics Brain and Nervous System, Heart and Circulation, Seniors' Health or Stroke.

All contents copyright © 1992-2004 the Author(s) and The University of Iowa. All rights reserved.

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