“When symptoms start showing up, you have to respond immediately,” says local stroke survivor Ron Brinson, pictured here with his wife, Peggy.
Written by Dustin Waters
Photographs by (Ron Brinson) Mira Adwell & (Dr. Smock) Samantha Jean Becker
Early detection and fast action are vital in treating stroke, a condition that kills someone in the U.S. every four minutes. Read on to learn more about this all-too-common condition
On April 26, 2019, 74-year-old North Charleston resident Ron Brinson awoke feeling strangely unrested. As he got dressed and ready for the day, he felt foggy-headed—he couldn’t articulate his thoughts as well as usual or find the right words. Brinson, a North Charleston City Councilman, brushed those odd but subtle symptoms off as the result of a poor night’s sleep and headed to a city budgetary meeting. Once there, additional symptoms cropped up over the course of just 30 minutes.
“I couldn’t see what my colleagues saw: my droopy face, a cold sweat. I just remember that I couldn’t talk,” says Brinson, who, over the course of the morning, had become one of the nearly 800,000 Americans who suffer a stroke each year. A colleague dialed 911. Time was of the essence—and Brinson’s life was on the line.
According to Roper St. Francis Healthcare Stroke Program medical director and vascular neurologist Dr. Alison Smock, stroke can manifest in a variety of ways (see sidebar at right). In most cases, a stroke occurs when an artery leading to the brain is either narrowed or blocked, resulting in a loss of blood flow and oxygen to the brain—a condition known as ischemia. “It’s that ischemia, or lack of blood flow, that produces symptoms,” explains Dr. Smock, who notes that ischemia can be caused by a blood clot or by atherosclerosis—a gradual build-up of plaque or fatty tissues in the arteries’ inner walls.
“When someone starts showing symptoms of stroke, they are in a period where the brain tissue hasn’t died, it’s just sort of starving,” explains Dr. Smock, who notes that symptoms can vary depending on where the blocked blood vessel is located. “That’s why it’s so important for a person get treated as quickly as possible. The faster we can restore blood flow to the brain, the less likely a person is to experience permanent brain damage, long-term disability or death.”
Treating the Condition
When Brinson arrived at Roper Hospital via ambulance, doctors ordered a CT scan to check for brain hemorrhaging. “Treatment varies based on the type of stroke, so a CT scan is the first course of action when a patient arrives,” says Dr. Smock. They found no signs of a hemorrhagic stroke, so, after evaluating him and determining that he was a good candidate for treatment, they immediately administered tissue plasminogen activator (tPA)—a one-time dose of clot-busting medication given via IV that’s considered the gold-standard treatment for ischemic stroke.
According to Dr. Smock, tPA needs to be administered within four and a half hours of when the patient last seemed well. If the patient is not a tPA candidate, they will be evaluated for a procedure called mechanical thrombectomy, which involves running a catheter to the large vessels of the brain and sucking out the blockage.
In the case of hemorrhagic stroke, doctors focus on controlling bleeding within the brain and reducing pressure caused by the excess fluid. If the patient takes blood thinners, treatment will likely include a blood transfusion. Other treatment options include use of medications (to lower blood pressure and prevent seizures) and surgery (during which they can remove excess blood in the brain and/or the enlarged area of the blood vessel, known as an aneurysm). “Treatment for hemorrhagic stroke varies for each patient, but most hemorrhagic strokes do not require any surgical intervention and can be medically managed,” says Dr. Smock.
In the Wake of Stroke
By the time Brinson was moved to the intensive care unit after receiving tPA for his ischemic stroke, he had regained his ability to speak. Within hours, his other symptoms had faded, as well. Unfortunately, this isn’t the case for all stroke victims.
According to the American Stroke Association, only about 10 percent of stroke patients recover completely. A quarter of survivors recover with minor impairments, while 40 percent experience moderate to severe impairments, making stroke the leading cause of long-term disability in the nation. Approximately 140,000 of the nearly 800,000 Americans who have a stroke each year die from the condition.
“The cruel thing about stroke is that, if it doesn’t kill you, it can leave you severely disabled,” says Dr. Smock. “But the faster we’re able to treat patients, the more we can minimize any lasting side effects.” These can include difficulty walking or using extremities, making it difficult to brush teeth, open jars and dress and feed oneself. Strokes can also lead to other, less obvious, conditions. “One of the most common long-term side effects is depression. A lot of that is situational, because a big event has just happened to you, but stroke can also alter the chemistry in your brain,” says Dr. Smock. For those who do suffer disability after stroke, occupational therapy, speech therapy, physical therapy and counseling can help improve motor strength, coordination, mental health and independence.
Know Your Risk
Certain vascular conditions can increase a person’s chances of experiencing stroke. These include hypertension, hyperlipidemia (a high concentration of fats in the blood), diabetes and heart disease. Other controllable, or modifiable, risk factors include smoking, a sedentary lifestyle, obesity and untreated sleep apnea. “Once identified, exercise, a healthy diet and medication can help mitigate these risk factors,” says Dr. Smock. “In fact, approximately 80 percent of strokes are preventable.”
Other risk factors are non-modifiable, such as genetics, age, gender and race. Research shows that risk for stroke doubles with each decade after age 55; stroke is more prevalent among men until age 80, at which point women become at higher risk; and African-Americans are close to twice as likely to suffer a stroke than white Americans. Another risk factor is having had a stroke in the past. “One in four survivors will experience another stroke,” notes Dr. Smock.
For Brinson, regular exercise and healthy eating have always been a part of his daily routine, making his stroke even more of a shock. But thanks to his general healthful lifestyle and quick medical intervention, Brinson is once again active. “My message is that wellness and fitness really do count,” he says. “My doctors have told me that being physically fit probably served me very well. Having said that, healthy living doesn’t make you bulletproof,” he notes. “When the symptoms start showing up, you have to respond immediately.”