Up to 1 out of 3 of you have had a stroke - perhaps without knowing

Have you ever had a stroke? Perhaps you had one but didn't recognize it. Read this link how 1 in 3 Americans may have had warning stroke without knowing it:

 ... [A]bout 35 percent of Americans experience symptoms of a warning stroke. Yet only about 3 percent get immediate medical attention.

Most adults who had at least one sign of a "mini" stroke - a temporary blockage also known as a transient ischemic attack (TIA) - waited or rested until symptoms had faded instead of calling 911 right away, according to the research from the American Heart Association/American Stroke Association (AHA/ASA).

"Ignoring any stroke sign could be a deadly mistake," said ASA chair Dr. Mitch Elkind, in a news release from the organization.

Myth No. 2: Just wait it out, and if you feel better, ignore it

Most of us have heard stories or actually witnessed it - someone is having stroke-like symptoms but instead of seeking immediate help, simply waits.

And sometimes, the symptoms go away and the person never seeks help.

But it's a myth that you shouldn't bother with help after a transient ischemic attack, or a mini-stroke. They can be precursors for something far, far worse.

Read this story, which I cited several before, on how one in eight strokes are preceded by a mini-stroke:

Aspirin and you - reasons to take that lowly pill

Take two aspirin and call me in the morning, the old joke goes.

Now, we're told, aspirin just after a mini-stroke (also known as a transient ischemic attack, or TIA). It might keep you out of trouble. Read about how an immediate aspirin after mini-stroke cuts risk of major stroke:

"A great many people who have (mini-strokes or TIAs) don’t seek medical attention, and don’t feel that it’s an emergency," said lead author Peter Rothwell of the Stroke Prevention Research Unit in the Nuffield Department of Clinical Neuroscience at John Radcliffe Hospital in Oxford in the U.K.

Post-TIA brain scans might yield vital information

Nobody likes to hear bad news - but sometimes, bad news might save a life.

Many people have transient ischemic attacks, or mini-strokes, before a larger stroke occurs. Now, imaging after a mini-stroke can help map a plan of treatment and, potentially, preventing a more serious stroke.

You can read here about how brain scans yield clues to future stroke risk:

Brain scans taken shortly after a mild stroke can help identify patients at risk of suffering another stroke within three months, a new study suggests.

Dr. Groucho got it right

Groucho Marx might have said it best: "I intend to live forever, or die trying."

I can connect with Groucho after a hole in my heart was closed back in 2007. Click on this link for info about my patent foramen ovale (PFO) closure and why.

The short story version is that the hole between the upper two chambers in my heart apparently allowed a blood clot to circumvent the clot-filtering mechanism in the lung, leading to a stroke in 1998 and a mini-stroke in 2007.

Since then, I've seen lots of studies indicating that this procedure might or might not be the best way to treat stroke survivors, looking at procedure vs. blood-thinning medication. My concern about warfarin (also known as Coumadin) was that as a fairly active person, taking pills that make you bleed easier might not be a good idea. Plus, pills and the related monthly blood tests cost money. I ditched the pills six months after the procedure.

That's more of a long-term concern instead of the relatively short-term outcomes in most studies. However, a recent study suggests that PFO closure may be cost-effective over long term:

PFO closure reached the incremental cost-effectiveness threshold of  < $50,000 per quality-adjusted life-year (QALY) gained in 2.6 years. Moreover, the treatment met the threshold of < $50,000 per life-year gained in 4.9 years. The per-patient mean cost of medical therapy surpassed that of PFO closure after 30.2 years of follow-up.

Now, I was in my 40s when my PFO closure occurred, so I plan to live 30.2 years (and more, I hope!) afterward.

Don't just shrug off a mini-stroke

TIAs - or transient ischemic attacks - are too often shrugged off as unimportant. However, that's wrong.

Even if the person can move and speak with no difficulty after a mini-stroke, that doesn't mean the patient and professionals should walk away and do nothing. A recent study showed that many patients with TIA have long-term cognitive impairment:

"Our findings confirm what we experience in daily practice: While motor and language disturbances recover within 24 hours after a TIA, long-lasting cognitive complaints are a problem for many patients. There needs to be more clinical awareness of this issue," lead investigator Ewoud J van Dijk, MD, from the Radboud University Nijmegen Medical Centre, the Netherlands, told Medscape Medical News.

He suggested that a TIA affects complex networks that are involved in cognitive functioning. "These networks are likely more vulnerable than those involved in motor and language function. Further study is needed to confirm this, but physicians should be aware of these cognitive dysfunctions because it potentially affects quality of professional and daily living," he said.

Drug combo may reduce risk of second stroke

I was on aspirin and Plavix for several years to prevent a second stroke. I eventually had a mini-stroke (or a transient ischemic attack) anyway. Still, more info to discuss with your own doctor. Check out this article about how a study shows this drug combo may reduce risk of second stroke:

After suffering a stroke or a mini-stroke, patients are usually given aspirin to prevent clots that can cause another stroke. Now a new study suggests that adding the drug Plavix (clopidogrel) to the mix can reduce the risk of a second stroke by nearly a third over aspirin alone. ...

"Giving two drugs that block platelets works a lot better than aspirin alone in people who have had a minor stroke or TIA," said researcher Dr. S. Claiborne Johnston, a professor of neurology at the University of California, San Francisco.

The trial was done in China, so whether the results would be the same in the United States isn't known. "They probably are, but we would like to see them confirmed," Johnston said.

Shuffling gait might be clue of mini-stroke history

We all see people shuffling rather than walking, often associated with older people. Now, a study showed how transient ischemic attacks - or TIAs, may cause the shuffling gait of old age:

The small strokes may impair their ability to walk, balance and function just the same.

Scientists examined the brains of 418 priests and nuns after they died. The researchers found that one-third of the brains that had seemed normal using conventional tests while the people were alive actually had damage to tiny blood vessels. The damage was so slight it was impossible to see without a microscope.

The people whose brains had these tiny signs of hardened arteries and stroke were most likely to have had shuffling gait and other movement problems while they were still alive.

What good is this info? Well, a mini-stroke is a warning that a bigger one is on the way. So an unexplained shuffling gait might mean the person should take precautions - watching blood pressure, for example, and seeing a doctor about this - to perhaps prevent a more devastating stroke.

One more reason to get help fast!

If you've visited this blog before, you've heard this line before: If you are having any stroke sign or symptom, even one, call 911 and get to an emergency department that is a stroke center quickly.

Even a mini-stroke - a transient ischemic attack, or TIA - can be a harbinger for a full-blow stroke. Now, we find that according to one study, 'mini strokes' are linked to doubled heart attack risk:

Although TIA symptoms may last only a few minutes, they are a warning of coronary heart disease that may be unrecognized, said Dr. Larry B. Goldstein, a professor of medicine and director of the Duke Stroke Center at Duke University Medical Center, who was not involved in the study.

The study confirms that "people who have had a TIA or stroke should also be evaluated for coronary heart disease," said Goldstein.

Live TV lesson about stroke signs

The chilling video of  Los Angeles TV reporter Serene Branson was played over and over the last few days. She began stumbling over slurred words on live television. Her face appeared not quite symmetric - class stroke signs.

Turns out, as U.S. News and World Report reported, her severe migraine mimicked a stroke:

Doctors at the University of California, Los Angeles, who performed a brain scan and blood work on Branson, said she suffered a type of migraine - often called a complex or complicated migraine - that can mimic symptoms of a stroke, the Associated Press reported Friday.

Dr. Ralph L. Sacco, president of the American Heart Association and chairman of neurology at the University of Miami Miller School of Medicine, explained that "a complicated migraine can often masquerade as a stroke or TIA (transient ischemic attack, sometimes called a mini-stroke)."

The symptoms can look just like a stroke, Sacco said, including loss of vision, blurry vision, paralysis on one side of the body, trouble speaking and trouble walking. "All kinds of things we associate with a TIA or stroke can be part of a complicated migraine," he said.

For people whose first experience with a migraine is a complex migraine, Sacco advises that they assume it is a stroke, however.

"If people have these classic symptoms, we should treat them as the emergency we think they are, which is a possible stroke," he said.

Branson did the right thing: Even though her symptoms subsided, she sought follow-up care. Too often, people don't see a doctor after a mini-stroke, setting themselves up for full-blown strokes. The lesson we can all take away: When you detect these signs, get help right away. It might just save a life.

From ABC News, a video of a good discussion of stroke signs:

Window widens - but still, don't wait

Treating stroke patients with the powerful clot-buster tPA has a wider window:

Last year, European clinical trials found that selected patients still benefit from tPA up to 4 1/2 hours after a stroke.

Now, an advisory from the American Heart Association formally spells out which patients might benefit from later tPA treatment. But the chairman of the committee that issued the advisory -- Gregory J. del Zoppo, MD, professor of medicine and adjunct professor of neurology at University of Washington, Seattle -- warns patients not to misinterpret the statement.

"The message is that stroke patients still need to come in for treatment as soon as possible. There is no benefit in waiting," del Zoppo tells WebMD. "Despite the fact that patients who come in even 3 to 4 1/2 hours after stroke can benefit, they should not wait."

Good words - "should not wait." As someone who was able to receive help right away, I can attest: Even if you think you or someone is showing stroke signs or symptoms, even for the mini-stroke variety, listen to what the doctor said, and don't wait.

Mini-stroke can be a major warning

A "mini-stroke" can be anything but, according to this mention from Forbes.com:

About half the people who have a major stroke soon after a less serious brain event, such as a transient ischemic attack or "mini-stroke," do so within 24 hours of the minor event, a new study finds.

The message here for people who have a TIA is to "seek medical attention immediately, particularly if you have either weakness or speech disturbance that lasts more than 10 minutes," said the study's senior author, Dr. Peter M. Rothwell, a professor of clinical neurology at the University of Oxford in England.

"Don't wait until the next day - it may be too late," he said.

Good advice. Remember that often, time = recovery.

(Drawing from the National Library of Medicine)

Prompt care means better outcome

Fewer lasting effects, shorter hospital stays, lower costs.

Not a bad deal.

A recent study in The Lancet Neurology spells out that it seems prompt treatment of transient ischemic attack (TIA, or mini-stroke) patients means fewer problems, including additional strokes.

Now, that's good news.

From a MedPage Today article:

Urgent care was associated with an estimated savings of about $890 per patient, which, if extrapolated to the entire population of the U.K., could yield savings of nearly $100 million in acute care costs per year, the researchers said.

"In addition," they said, "the reductions in disability rates at six months might lead to a reduction in the long-term usage of the health service in the community."

So, as stated: prompt, good care means less change of another stroke, fewer patients becoming disabled, lower costs. It follows that it's important if you are in a position to help a stroke victim, you must help that person to get proper care.

A special no-more-hole-in-the-heart story

Like mother, like son?

More than a year ago, this blog featured a posting about how a certain type of hole in the heart could raise the risk of stroke among elderly people. The study hit home the other day.

My mother, who is 81, has had a series of mini-strokes in recent years, including slurred speech and other symptoms. It turned out that, like her son, she had a couple of holes between her upper heart chambers. "Had" is an important term.

Like mine, this condition can cause unfiltered blood shunt from the right side of the heart to the left, then pumped out, perhaps with a clot, to cause a stroke or transient ischemic attack. The holes were not exactly the same variety of mine, but the danger was similar.

So on Dec. 29, 2008,my mother went throught the same catheterization procedure I went through, by the same doctor at the same hospital!

She's just over two weeks out and recovering well. An implanted device called an Amplatzer sealed the holes, which should mean reduced chances of stroke.

As I've said before, this blog is not really about me. Today, it's about my mother. As you read this, say a little prayer for her.

One stroke is enough

Sometimes, a picture says it all.

This is from the Stroke Update Web site, a United Kingdom-based Web site chocked with stroke-related links, articles, news, studies, books and events.

At this writing, its lead articles were about younger adults returning to work after strokes and the June 2008 Welsh Stroke Conference. Another article explores the connection of a stroke with the combination of patent foramen ovale and atrial septal aneurysm.

Often, one stroke, or even a transient ischemic attack - also known as a mini-stroke - increases the risk for another. That's one reason why research is so vital - finding ways to prevent that second event that can be deadly.

Stroke sign and prevention tips

Another Web site with some stroke prevention tips: Signs and tips for prevention from familydoctor.org. A snippet:

Risk factors for a stroke

* Atherosclerosis (hardening of the arteries)
* Uncontrolled diabetes
* High blood pressure
* High cholesterol level
* Smoking
* Previous transient ischemic attack (TIA)
* Heart disease
* Carotid artery disease (the artery that carries blood to your brain)

Many of these risk factors are treatable - so if this list sounds like you or one of your loved ones, get to a doctor if you haven't already!

Anniversary and awareness

Stroke Awareness Month stories will come and go, with phrases to help you recognize stroke symptoms. We should all pay attention.

But any month, any day, any time, the bottom line: If things don’t seem right, don’t hesitate. If speech is slurred, get some help. If someone’s face becomes off kilter, call 9-1-1. If a limb gets weak or numb, stop what you’re doing and get to an Emergency Room. Vision blurred or sudden confusion? Don’t take a chance. Quick onset of a severe headache? Don’t take two aspirin and call the doctor in the morning. Get to the doctor now.

I was certainly blessed to receive help 10 years ago today, May 8, 1998, when my stroke occurred. Details are here.

My personal – and apparently final – resolution came last summer. In April, I had a mini-stroke, what doctors call a transient ischemic attack. A trip to the emergency room – hey, I learned my lesson - led me to some Columbia, Mo., specialists. A test involving a camera dropped down my throat to get an echo image of my heart confirmed what I was told 10 years ago, that the apparent cause was a misshapen wall and a hole between the two upper chambers of my heart.

With the combination of those heart defects, blood comes in on the vein side laden with clots and other debris - as normal - and instead of being pumped through the lungs and get filtered, sometimes debris collected along the wall, then shunted through the hole and pumped out, unfiltered, into the arterial system, a stroke waiting to happen.

Last June, a doctor in St. Louis snaked a tube through an artery and placed a quarter-size patch, made of nickel-titanium, over the hole. Six months later, my risk of a stroke became no more than the rest of the population in general. To celebrate my 10 years, I plan to run 10 miles, as usual, on Saturday morning.

Many stroke survivors do not have such an outcome, I know. But more awareness and faster treatment can save or improve a life. Perhaps even yours.

There's a hole in my heart

A word to the around-40-year-old set: It can happen to you, too. Strokes are not always confined to the elderly.

I post this not to encourage pity, but rather to issue a warning: Be aware of stroke symptoms, even if you're young and in the best of health. A lurking birth defect can cause trouble, and it's important to act promptly when you even suspect stroke symptoms.

The above video is an experiment, so please forgive my amateur presentation. But considering the information below, it might save the life of someone you love -- or your own.

For nine years, I've had the nagging information that there is a small hole in my heart (more information to follow) that, in all likelihood, contributed to my stroke in 1998. A minor transient ischemic attack in April 2007, though, put that hole back on my radar. And with it, a hope to drastically reduce my stroke risk. Permanently.

Thus the video. It's from a transesophageal echocardiogram, big words to describe a camera that goes down your gullet to capture images of your moving heart. It was conducted at the Missouri Heart Center in Columbia, Mo. This is one snippet and it's my best guess of the location of the hole. At one point of the video, you see no color, then a burst of blue then red, appearing to pass through a small hole. If it's wrong, I'll correct the video. Again, it's my amateur's best guess.

The hole is between the two top chambers of my heart. This is a common birth defect. There are a few complicating physical factors -- based on the characteristics of the wall between the two chambers -- that places me at relatively high risk of stroke. So a doctor in St. Louis will snake a tube through some arteries to the heart and apply a patch device, comprised of two quarter-size pieces of nickel-titanium mesh. This is the same procedure done on Tedy Bruschi, a current New England Patriots linebacker.

The heart procedure is set for Monday, June 25. Dr. John LaSala will conduct this procedure at Barnes-Jewish Hospital.

Warning: This is written by a non-doctor. So please, don't take this as actual medical expertise. It's the best I can do, and it's probably 'way too simplified. If you think you're having or have had stroke or TIA symptoms, see a doctor. Now.

I offer these details to illustrate how it can happen to a relatively young, relatively fit person.

The small hole between the two atrial chambers is called a patent foramen ovale. Everyone is born with the hole and, depending on who you ask, somewhere between 75 and 80 percent of the time, it seals up shortly after birth. That means about 1 out of 4 or 5 people actually have a foramen ovale, which is not a huge problem. For most.

There are exceptions to that statement, though; my particular problem centers on the muscular wall between the two chambers, called the atrial septum. It should be smooth and flat. If so, the vast majority of people with a foramen ovale never know and no problems ever develop. In some instances, though, the atrial septum is misshaped, called an atrial septal aneurysm. That's where the problem arises.

Normally, the right atrium receives blood from the vein side of the circulatory system, then passes it along to the lungs. In addition to processing oxygen for the blood supply, the lungs also use a filtering mechanism to remove debris, such as clots. From the lungs, the blood is moved back to the other side of the heart and pumped out to the arterial system, supplying oxygen-rich filtered blood to the body. However, if the atrial septum has a divot, if you will, then debris can collect. When pressure builds up in the chest -- say, from coughing or sneezing -- then blood and debris can move through the foramen ovale from the right atrium to the left atrium, circumventing the lung's filtering system. Unfiltered blood is pumped out into the body, including the brain.

Because of this, nine years ago I experienced a cryptogenic stroke -- that is, a stroke with no obvious cause. Last April, a much more minor episode occurred, which triggered a round of tests recently completed. As long as the current conditions remain, my risk of stroke is several percentage points higher than the rest of the population, despite the fact that I don't smoke, have low cholesterol levels, excellent blood pressure readings and, being a distance runner going on 20 years, am generally quite fit.

Dr. LaSala will use an arterial catheter to insert a metal-mesh object that, once in place, will expand into shapes that look like two small umbrellas and cover the hole, one on one side and one on the other. Over time, scar tissue should cover the patch and permanently seal it against the atrial septum.

The final result: My stroke risk will fall dramatically and should actually be lower than the general population. I anticipate a complete recovery and, in fact, to be in better health than ever.

That, at least, is the plan. What will happen? It's not up to me. But I trust the one who is in charge.