Know the signs of a stroke

A stroke is a brain attack and, just like a heart attack, it is a medical emergency. Although stroke is the most common serious neurological disorder in our midst, most Canadians are unaware of the warning signs and don’t know someone having a stroke urgently needs treatment.

Brain cells need a constant supply of oxygen and die when delivery is suddenly interrupted by either a rupture or a blockage of a blood vessel. Ischemic strokes, where blood flow is restricted by a clot or particle, represent 80 per cent of strokes; hemorrhagic strokes, or bleeding into the brain, make up 20 per cent. The loss of function that occurs indicates which the part of the brain has sustained tissue death.

An ischemic (blockage) stroke can be treated with tissue plasminogen activator (tPA), a clot-dissolving drug, but the stroke must be diagnosed and the drug administered within three hours of onset.

A costly affliction
Every 10 minutes, a Canadian suffers a stroke. And, according to the American Heart Association, a North American dies from stroke every three minutes. It’s the fourth leading cause of death in Canada, killing women more frequently than men. fact, the Heart and Stroke Foundation of Canada reports women experience 60 per cent of the 50,000 strokes that occur annually here. Stroke leaves 300,000 patients struggling to cope with its aftermath – a range of physical impairments, personality and behavioural changes, communication difficulties and cognitive changes. Stroke costs our economy an estimated $2.7 billion. Families suffer economically, too; fewer than half of stroke survivors are able to go back to their jobs.

Don’t ignore warning signs
Patients and even physicians underestimate the danger of transient ischemic attacks (TIAs), according to a recent study done by the Institute for Clinical Evaluative Sciences (ICES) in Ontario. Sometimes called mini-strokes, TIAs indicate blood flow has been interrupted temporarily, causing stroke symptoms such as sudden weakness, blurred vision, difficulty speaking or understanding speech, dizziness or headache, which can last moments or up to 24 hours. Because these symptoms seem to resolve and don’t have the dramatic pain of angina or a heart attack, someone undergoing a TIA may not recognize the need for immediate medical attention.

“Don’t ignore the symptoms,” warns neurologist Dr. David Gladstone, research fellow at ICES and director of inpatient stroke services at Toronto’s Sunnybrook and Women’s College Health Sciences Centre. “If in doubt, call 911 immediately,” he advises. “It’s better to be safe than sorry.”

Mini-strokes a maxi-menace
The ICES study revealed TIA patients were less likely than those with a full-blown stroke to receive a full diagnostic workup before being sent home; many were not given preventive prescriptions for drugs to combat clot formation, to lower cholesterol or for high blood pressure. Many were not able to undergo diagnostic investigation as outpatients within 30 days. (Recently, Ontario’s government established a number of district stroke centres and prevention clinics to alleviate this situation.)

Gladstone says the study showed risk of a subsequent stroke is front-loaded; half of the strokes that followed within three months happened within two days of a TIA, nine per cent of them fatal.

What can be done
You can’t change some risk factors: advancing age; family history of stroke, high blood pressure or diabetes mellitus; a prior stroke; female gender; race (blacks, First Nations, Asians and Hispanics have higher rates). You can treat high blood pressure (the No. 1 risk factor) and diabetes, quit smoking, lower cholesterol levels, exercise, control weight and drink alcohol in moderation.

Although Aspirin has been in use for years, new antiplatelet drugs can also be prescribed to keep clots from forming.

TIA patients whose carotid arteries (in the neck leading to the brain) are significantly blocked with plaque are at the highest risk of future strokes. A carotid endarterectomy, which surgically removes plaque from the carotid artery, effectively lowers stroke risk in this vulnerable group, Gladstone says.

Where to get help
The Heart and Stroke Foundation
Phone toll-free 1-888-473-4636
Do the risk assessment questionnaire at
and get a personalized action plan.

American Stroke Association

Canadian Stroke Network