THE BLOG
01/05/2013 03:07 pm ET Updated Mar 07, 2013

My Insights Into Stroke Prevention

Watch the TEDTalk that inspired this post.

Even after caring for hundreds of stroke patients as a geriatrician, I found Dr. Jill Bolte Taylor's TEDTalk, "My Stroke of Insight" compelling, and will urge colleagues to see it. Her detailed first-person account of what it's like to have a stroke is all the more vivid, coming from a Harvard neuro-anatomist who wryly describes thinking, as her stroke was occurring, "This is so cool! How many brain scientists have the opportunity to study their own brain from the inside out?"

The answer is, sadly, practically none, since survival from massive intra-cranial hemorrhage (ICH) is uncommon, and survival without permanent severe disability is even more uncommon. When a rare congenital malformation of blood vessels in her brain burst, she certainly came close to death. The fact that she did not die or become permanently disabled defies odds I would place conservatively at a hundred to one. She is not only a charismatic speaker, a remarkable survivor, and a courageous individual, but also an incredibly lucky woman.

I would also suggest that one of the most important aspects of Dr. Taylor's advocacy is the attention she has focused on this awful disease. Because there are so few stroke treatment options, because recovery is so long and arduous, and because so many stroke victims never make it to the recovery phase at all, one of the most important take-aways from her riveting story has to be the importance of stroke prevention.

Stroke is the fourth leading cause of death in America and the leading cause of long-term disability, yet public awareness and prevention efforts are poor. For the sake of the 600,000 people who will have a stroke this year, I'd like to offer a short overview of how you can "make your own luck" by improving your odds of avoiding a stroke.

Stroke happens when blood flow to the brain is interrupted. This interruption is caused either by a blockage (usually a blood clot) or, more rarely, by a hemorrhage (usually a burst blood vessel, as in Dr. Taylor's case). Blockage (known as thrombosis) causes "ischemic" stroke, and can be caused by diseased or hardened arteries (atherosclerosis), high blood pressure, diabetes, smoking, or high cholesterol. Stroke caused by bleeding is known as "hemorrhagic" stroke, and can be made worse by many of the same factors, as well as clotting disorders, certain medications, alcoholism, and head trauma. (Explore the background on all types of stroke in greater detail here)

The first line of defense in stroke prevention is good blood pressure control. Undiagnosed and under-treated hypertension is far too common in people of all ages, and elevated stroke risk is one of the most serious consequences. Please, get your blood pressure checked and get it under control. The same is true of atrial fibrillation, or irregular heartbeat, which increases the chances that a blood clot will form in the heart then migrate to the brain, causing a stroke. There are anti-clotting medicines that work very well; almost all "a-fib" patients should be taking such drugs, since the benefits far outweigh the risks, as I describe here. Finally, you can greatly reduce your risk of stroke by:
  • Quitting smoking
  • Avoiding excessive alcohol use
  • Getting some exercise, eating right, and, if necessary, losing some weight
  • Improving your blood lipid levels (which include both "good" and "bad" cholesterol, and triglycerides)
  • Controlling your diabetes or congestive heart failure, including faithfully sticking to medications

For more detailed information on the science of stroke diagnosis, prevention strategies and treatment options, you can refer to the American Federation of Aging Research's guide to stroke.

No one having a stroke can hope to be as lucky in their final outcome as Jill Bolte Taylor was. Fortunately, scientists at the National Institute of Neurological Disorders and Stroke (NINDS) predict that good prevention, wise use of existing therapies, and ongoing discovery of new ones have the power to prevent 80% of all stroke. Let's celebrate Dr. Taylor's luck, but also resolve to make some of our own in the new year.

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