Stroke

The Best Stroke Treatment is Prevention

Author: Jeffrey Thomas, MD​
Specialty: Neurosurgery

In the United States, stroke affects more than 795,000 people each year. Of that, around a quarter of these individuals have had a stroke or multiple strokes in the past. In addition to being one of the leading causes of death, stroke is also a leading cause of long-term disability and reduced mobility.

With the serious, long-lasting effects that stroke presents, knowing the causes, risk factors, and how to decrease risk can be a matter of life and death.

What is stroke?

Stroke is a disease in which the blood supply within the brain is interrupted or obstructed. This disruption causes brain cells to die, presenting as sudden muscle paralysis and loss of motor function.

There are two main types of stroke: ischemic and hemorrhagic. Hemorrhagic stroke refers to a ruptured blood vessel that causes bleeding inside the brain. In addition to interrupting normal blood flow, this creates swelling and pressure that further damages the surrounding brain tissue. Ischemic stroke occurs when a clot blocks blood flow in an artery going to or from the brain. By far the most common variety, between 80 and 85 percent of strokes are ischemic.

Both are life-threatening medical emergencies.

Who’s at risk for stroke?

There are many factors that increase one’s risk for stroke – some can be controlled and some cannot. Of those that are beyond one’s control, age, race, and sex are significant risk factors.

Age – It’s estimated that your likelihood of having a stroke doubles every 10 years after the age of 55. However, while your risk of stroke increases with age, strokes can occur at any age. In fact, a third of those hospitalized for stroke were less than 65 years old.

Race and Ethnicity – Some populations are more predisposed to stroke than others. This may be due to genetics (like sickle cell disease or heart disease), socioeconomic or cultural factors, or lack of education on stroke warning signs and risks. Although stroke death rates have generally declined over the past couple of decades, Hispanic populations have seen an increase of death due to stroke since 2014. African-Americans still have the highest rate of death due to stroke and their risk of having a first stroke is almost twice as high as their Caucasian counterparts.

Sex – Although stroke is the fourth leading cause of death among all Americans, it’s the third leading cause of death among American women. Women carry certain risk factors that may increase their overall risk for stroke – particularly if they’re under the age of 55. Among them are pregnancy or a history of miscarriage, estrogen-based birth control pill use, hormone replacement therapy, and a history of migraines with aura.

Behavior-Related – While some of these factors have a genetic component, many can be attributed to lifestyle. Smoking, alcohol consumption, obesity, unhealthful diet, and inactivity increase the likelihood of high blood pressure, high cholesterol and diabetes – some of the leading controllable causes of stroke.

How do I decrease my risk?

One in four strokes are recurrent, meaning the patient has had at least one stroke in the past. So decreasing the risk of stroke has as much to do with reducing future strokes as it does preventing a first one.

Risk factors are cumulative, meaning that if you remove even one of them, you dramatically reduce your overall risk for stroke (and a lot of other related conditions). While there’s not much you can do about genetics, you can focus your energy on correcting behaviors that put you at an increased risk.

Stop Smoking – Breaking any habit is easier said than done, but this single change can significantly improve heart, lung and brain health.

Reduce Alcohol Intake – Drinking increases blood pressure and diabetes risk, can make maintaining a healthy weight more difficult, and interferes with medications that may be controlling other risk factors. The American Stroke Association recommends limiting alcohol intake to 14 units per week, or the equivalent of consuming six pints of regular-strength beer or six glasses of regular-strength wine over the course of a week.

Eat Healthy – In addition to affecting weight, your diet can impact your stroke risk. A good stroke-healthful diet should focus on reducing sodium, fat, and cholesterol intake with whole grains, fruits, vegetables and lean proteins. The consumption of red meats, which has been associated with increased risk of stroke as well as heart disease, should be greatly limited.

Get Active – Heart health and stroke health are inextricably linked. And, because the overwhelming majority of strokes are due to blood clots (ischemic stroke), it makes a lot of sense. Maintaining an active lifestyle improves heart health and can positively affect your body’s ability to manage conditions that increase stroke risk like high blood pressure, diabetes and obesity.

Manage Weight – Weight loss can be a natural byproduct of proper diet and exercise – and that’s good news for managing your stroke risk. Maintaining a healthy weight helps your body better regulate ancillary factors like blood pressure and diabetes.

Stating that the best stroke treatment is prevention isn’t just opinion, it’s fact. An estimated 80 percent of all strokes are preventable.

Here at the Stroke Program at Washington Hospital, we see around 40 patients per month. While I’m not wanting to put anyone out of a job – myself included – the prospect of preventing 30 of those strokes is a goal worth striving for. And knowing what risk factors you may have and taking steps to mitigate those risks is the first step to helping yourself live a longer, healthier, stroke-free life.

Posted July, 2018

About Jeffrey Thomas, MD
Dr. Thomas is one of fewer than 120 board-certified and fellowship-trained neurosurgeons nationwide who perform both microneurosurgical and neurointerventional techniques for complex cerebrovascular brain lesions (aneurysms, AVM, and stroke), and who employ both techniques on a regular basis. Practicing at Washington Hospital, Dr. Thomas has access to one of the most sophisticated surgical facilities available today to treat both aneurysm and stroke.

Dr. Thomas obtained his medical degree at Columbia University College of Physicians and Surgeons in New York. He did his medical internship at Columbia Presbyterian Medical Center at New York Presbyterian Hospital – Cornell. His residency took place at Los Angeles County/University of Southern California Medical Center. Dr. Thomas did his fellowship training at Thomas Jefferson University Hospital in Philadelphia, Pennsylvania, and additional fellowship training at the Cardiovascular Research Center of the Massachusetts General Hospital. He is board certified by the American Board of Neurological Surgery. In addition to English, he also speaks French and Spanish.

The philosophy of care that guides Dr. Thomas’ practice is about treating his patients in a very personal and profound manner that forms very unique relationships with them and their families. He believes that treating patients goes beyond performing surgical or technical procedures, as they are human beings who should always be treated like family or longtime friends.