Stroke: Overview of Ischemic Stroke
Guest: Dr. Raymond Turner - Neurosciences, MUSC
Host: Dr. Linda Austin – Psychiatry, MUSC
Dr. Linda Austin: I’m Dr. Linda Austin. I’m interviewing Dr. Raymond Turner, from the Department of Neurosurgery and Radiology, as well as the Center for Neuroscience, here at the Medical University of South Carolina. Dr. Turner, in this podcast, let’s focus on stroke. What is a stroke?
Dr. Raymond Turner: Thanks for having me again, Dr. Austin. There are two kinds of stroke. The first kind is when the brain doesn’t receive enough blood and nutrients. The second kind is when there’s a bleeding episode in the brain. I think the best thing to do is focus on when the brain’s not getting enough blood and nutrients. That’s called an ischemic stroke, and it’s the number one cause of disability in the United States.
Dr. Linda Austin: So, the word ischemic means, what?
Dr. Raymond Turner: The word ischemic means lack of oxygen, so, essentially, starving the brain of what it needs for nutrients and oxygen to survive.
Dr. Linda Austin: What are some of the common causes of an ischemic stroke?
Dr. Raymond Turner: The common causes of ischemic stroke can either be embolic, when a blood clot travels from either the heart or the neck and goes up to the brain, or it can be from a narrowing of a blood vessel; either in your neck or your brain. So, you can have hardening of the arteries in your neck. You can have hardening of the arteries in the blood vessels within the brain. And those can all lead to a stroke.
Dr. Linda Austin: I’ve heard strokes referred to as a brain attack, kind of like a heart attack. Is it the same mechanism as a heart attack?
Dr. Raymond Turner: That’s exactly right. A stroke is a brain attack, where there’s a sudden loss of supply of blood and nutrients to the brain; just like in the heart. A heart attack is a sudden loss of blood and nutrients to the muscle of the heart.
Dr. Linda Austin: And this is, of course, a very common, sadly enough, but very common occurrence.
Dr. Raymond Turner: Yes, it is, especially here in South Carolina where we’re considered the stroke belt of the United States; it’s extremely common.
Dr. Linda Austin: Why is that? Why do we have so many strokes here?
Dr. Raymond Turner: Well, strokes in general, you’re risk of having one, I should say, has to do with multiple factors. One is genetics. One is your diet; your personal habits, such as smoking and drinking. These all play a role in your risk of developing hardening of the arteries, problems with your heart, and other blood vessels; including the blood vessels that go to the brain. It’s a little bit unclear to me exactly why we have such a high incidence of stroke here in South Carolina. But, I suspect, it’s a combination of all those factors.
Dr. Linda Austin: Not just one thing?
Dr. Raymond Turner: Exactly. I think it’s genetics, diet, smoking, and
sedentary lifestyle. I think everything plays a role.
Dr. Linda Austin: I just saw a study in which smoking in public places was banned in a city in Colorado. And they found, within three years, the rate of cardiovascular death drop by 40 percent, relative to surrounding cities where that ban was not in place; indicating that even second hand smoke can be just so incredibly dangerous for people.
Dr. Raymond Turner: Most people think of smoking as being bad for your lungs, and can give you lung cancer. But what a lot of people don’t realize is that smoking is very bad for all parts of your body. It increases your risk of having a stroke. It increased hardening of your arteries. It increases your risk of having a heart attack, and even other things that you don’t typically associate with it, such as your bone strength; smoking weakens your bones.
Dr. Linda Austin: What are the warning signs that a person may be at risk for having a stroke?
Dr. Raymond Turner: Most people, if they have warning strokes for stroke, will have a temporary loss of function; either an inability to speak, or to feel on side of the body, or an inability to move one side of the body. Typically, it only lasts for several minutes. We call that a TIA, or transient ischemic attack. It’s like a mini stroke. However, when these symptoms last for longer periods of time, they can result in permanent disability; so, inability to regain function of an arm or a leg, or vision.
Dr. Linda Austin: It sounds as if you have even one of those very brief episodes, it’s really critically important to get treated.
Dr. Raymond Turner: That’s exactly right. I think if you’re having warning signs of a stroke, it’s imperative that you seek medical treatment immediately, because that may be a warning sign of something more serious to come.
Dr. Linda Austin: And, if it is a full blown stroke, it’s really important to get to an emergency room as quickly as possible. Why is that?
Dr. Raymond Turner: Well, typically, we think of stroke in several phases. In a full blown stroke, you want to get to the emergency room as quickly as possible; we want to open up that blood vessel as quickly as possible. One option for opening up the blood vessel is to use medication through an IV in the arm that will break up the clot and open it up the blood vessel so you can get blood back to your brain. The other option is to go into the blood vessel and physically get the clot and pull it out of the brain and, therefore, restore blood flow. Typically, most patients need to be seen and treated within minutes to hours for treatment to be effective.
Dr. Linda Austin: The sooner, the better?
Dr. Raymond Turner: That’s exactly right. Time is brain.
Dr. Linda Austin: How much progress have we made over the last decade in our ability to prevent some of the really tragic consequences of stroke?
Dr. Raymond Turner: I think we’ve made some good progress, but we clearly haven’t made the same progress as in other areas, such as cancer and heart disease. But, we have new medications that have come out that help to thin the blood and, therefore, reduce the risk of having a stroke. We have endovascular techniques; techniques through the blood vessel, to go up and get the blood clots out and open up blood vessels. Ten years ago, we didn’t have any good devices to remove a blood clot. Now, we have several devices, and we have more on the horizon, that help to open up the blood vessels and restore blood sooner, and easier. So, I think we’ve made good strides from that standpoint. I think we’ve also made strides in understanding stroke, and understanding the different types of stroke.
So, there’s stroke due to narrowing of the blood vessels in the brain. We’ve done large studies and found that this is not an uncommon problem. And, over the last five years, we’ve developed; not just medical treatments, stents that can travel into the brain and help to open the blood vessels much like we open up the blood vessels in the heart. So, I think we’ve made a lot of progress, but we certainly have a lot of work to do ahead. And, the biggest thing, for us, is educating the population, making sure people know that if they have a sign of stroke, they need to seek medical attention immediately. And they need to get themselves; not to any hospital, to hospital that can actually offer them treatment. We’re privileged here, at MUSC. We’re the only hospital in the Charleston area, and one of only two hospitals in the entire state of South Carolina, that can offer treatment to open up the blood vessels for both medication as well as through the blood vessel using endovascular devices.
Dr. Linda Austin: Dr. Turner, thank you so much for talking with us today.
Dr. Raymond Turner: Great. Thank you.
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