Shining the Light on Stroke Symptoms

Posted: May 9, 2016

Questions ranging from how to spot signs of a stroke to the effectiveness of cholesterol-lowering drugs were the focus during the latest #OurDocTalk live chat on NorthBay Healthcare’s Facebook page.

The May 4 chat featured two NorthBay experts answering questions: neurologist Dr. Ameer Almullahassani and Beth Gladney, R.N., NorthBay’s Stroke Program Manager.

May is Stroke Awareness Month and both Dr. Almullahassani and Gladney spent the half hour chat educating on what has become the fifth leading cause of death in the United states and a major cause of adult disability in the country.

Visitors who posted questions in advance of the chat immediately turned to the issue of drug treatments, including one who queried on an “alternative” type of “treatment.”

“Speaking long term, for a heart attack survivor who ingests cannabis multiple times a day, what can the expected effects in preventing a stroke?” the Facebook follower asked.

NorthBay’s two stroke experts agreed.

“Cannabis for stroke prevention is a controversial topic. We do not recommend it as of now, but this could be a conversation with your primary care provider,” Gladney replied, adding that patients should be aware that there are differences between medical cannabis and “street” cannabis.

Other Facebook followers wanted to know about more “traditional” drugs, in particular the use of statins (cholesterol-lowering medications).

“The anti-inflammatory effect of statins help with the recovery from an acute stroke, decrease the edema,” noted Dr. Almullahassani, explaining that lowering  LDL (bad cholesterol) is important.

“In addition to medications for lowering cholesterol, dietary changes can also be made that will help decrease LDL,” added Gladney. “Fish oil has also been proven to lower LDL or ‘bad’ cholesterol and increase HDL which is the ‘good’ cholesterol.”

Asked about recovery times for stroke, Dr. Almullahassani said much of it depends on the patients age and where the stroke is located, but that “most of the recovery happens between 3-6 months” after a stroke.

Gladney explained that stroke impacts everyone differently.

“Each person has a different recovery time after a stroke depending on how severe the stroke was, what area of the brain was affected and if there were any complications as a result of the stroke,” she noted. “Some stroke survivors recover very quickly, but most can take months to years to recover after a stroke and require some form of short or long term rehabilitation.

The full text of the chat can be found on NorthBay Healthcare’s Facebook page (Facebook.com/NorthBayHealthcare). Here is an edited transcript of the chat:

Q.: Speaking long term, for a heart attack survivor who ingests cannabis multiple times a day, what can the expected effects be in preventing a stroke?

Elizabeth Gladney: Cannabis for stroke prevention is a controversial topic. We do not recommend it as of now, but this could be a conversation with your primary care provider. There is also a difference between medical Cannabis and street Cannabis.

Q.: What do you recommend as far as statin for stroke patients? I know someone who's rehab Dr. prescribed 10 mg. Lipitor 1x per day. GP changed to 40mg per day. They say their joints ache. Their cholesterol is good.

Dr. Almullahassani: The anti-inflammatory effect of Statins help with the recovery from an acute stroke, decrease the edema Lower LDL to a goal of <70 is the goal on patients with vascular path

Q.: What are your thoughts on the prescribing of statins to patients that have high cholesterol, however possess no other risk factors, i.e. high blood pressure, weight problems, or heart issues. In light of the fact that taking statins has not been proven to reduce the likelihood of a stroke in these patients, why take them especially when the side effects they cause have been an issue?

Dr. Almullahassani: Even with no risk factors for strokes the goal for LDL is < 70.  LDL is the bad cholesterol

Elizabeth Gladney: In addition to medications for lowering cholesterol, dietary changes can also be made that will help decrease LDL. Fish oil has also been proven to lower LDL or "bad" cholesterol and increase HDL which is the "good" cholesterol.

Q.:  Is there is a typical recovery time for stroke or does it vary based on how severe the stroke is and what part of the brain was impacted?

Dr. Almullahassani: It depends on the patient's age stroke location and size. Usually most of the recovery happens between 3-6 months

Elizabeth Gladney: Stroke affects everyone differently. Each person has a different recovery time after a stroke depending on how severe the stroke was, what area of the brain was affected and if there were any complications as a result of the stroke. Some stroke survivors recover very quickly, but most can take months to years to recover after a stroke and require some form of short or long term rehabilitation. Stroke recovery can be a lifelong process and is different for every individual. For more information on stroke recovery you can visit the following website: http://www.stroke.org/we-can-help/survivors/stroke-recovery

Q.: Since we are beginning this chat, let me ask you Dr. Almullahassani: and/or Beth, can you tell us what is a stroke exactly and what causes it?

Elizabeth Gladney: A stroke or “brain attack” occurs when a blood clot blocks an artery or a blood vessel breaks, interrupting blood flow to an area of the brain. When either of these things happens, brain cells begin to die and brain damage occurs. That is why a stroke should be treated as an emergency.

Q.:  How long after a stroke has been diagnosed does TPA be administered?

Dr. Almullahassani: Up to 8 hours.  For IV TPA 4.5 hours. If it is intra-arterial it is up to 8 hours.

Elizabeth Gladney: It is important to note the time the stroke symptoms began, as the time window for the administration is from the individual’s last known well, or the time they were last seen normal. The optimal time window for IV TPA is within the first 3 hours of symptom onset but can be administered up to 4.5 hours.

Q.: What's the difference between a TIA and a stroke? Will having a TIA increase my chances of having a stroke?

Dr. Almullahassani: TIA is a stroke like symptoms last less than 24 hours and leaves no damage in the brain VS ischemic stroke is a clot closing an artery in the brain and cause permanent damage in the brain

Q.: Dr. Almullahassani, can you talk about the reason a fast response is so important with stroke?

Dr. Almullahassani: Each minute with a stroke you lose 1.9 million brain cells. The sooner you start the treatment with TPA, the better outcome will be best outcome will be when you get the treatment with the first hour. Beyond 8 hours there is no acute Therapy

Q.:  Could you share some of the signs and symptoms of stroke?

Dr. Almullahassani: Facial drop. Slurred speech. One- side weakness or numbness. In general pain is not a sign of stroke

Q.: So if a patient had a stroke and now has stiffness on one side and spasticity, what treatments are available?

Dr. Almullahassani: Yes we have and oral medication called Baclofen can help it. the best treatment which we have it available now at NorthBay is an Intrathecal Baclofen Pump (ITB) which is a pump pushes the Baclofen into the spinal area

NOTE: If you have more questions or concerns about stroke, Call (707) 646-4034 and Beth, who heads up our NorthBay Stroke Program, would be happy to chat with you further!

 

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