Carolyn D. Brockington, MD
Director, Stroke Center
Mount Sinai St. Luke's and Mount Sinai Roosevelt
Think Stroke Can't Happen to You? Think Again
Thirty-six hours before I met model, actress, and author Claudia Mason, she was enjoying the exhilaration and challenge of her regular Tuesday night jazz dance class. On her way to an acting audition the next morning, she was struck by the worst headache of her life, along with sudden partial vision loss. She thought it must be a migraine, though she'd never had one before. What else could it be?
The next morning, Claudia still had a partial visual field deficit, and she knew something was seriously wrong. What she didn't know, and was stunned to discover in the Mount Sinai Roosevelt emergency department where I met her, was that she'd had a stroke caused by a cervical dissection, or injury, to an artery in her neck. This injury probably occurred during her jazz class when she whipped her head around "à la Beyonce," as she calls it.
It Can Happen to Anyone
Claudia's experience illustrates an important fact about stroke that many people don't realize. While one's risk of stroke does increase with age (the majority occur in people age 80 and older), stroke can happen to anyone, at any age -- even to young, healthy adults like Claudia.
Most strokes occur when a clogged artery or clot interrupts blood flow to the brain. According to the American Heart Association (AHA) and American Stroke Association (ASA), cervical artery dissections are among the most common causes of stroke in young and middle-aged adults. The cervical arteries, lined with three layers of muscle, run through holes at the base of the skull, carrying blood to the brain. Moving the neck in an abnormal way can cause a cervical artery to shear against bone, tearing the innermost lining of the artery. This can lead to clotting and restriction of blood flow to the brain. If the part of the brain supplied by that artery is deprived of blood and oxygen, a stroke occurs, causing brain cells to die.
It takes a "perfect storm" for a cervical dissection to occur, with the position of the neck and mechanical forces aligned in a very specific way. One of my patients with cervical dissection had thrown her head down and up suddenly while blow-drying her hair. Another patient had held his neck in an unusual position while painting a ceiling all day. Sometimes you never know what caused it, because you don't even realize you were injured.
Recognize the Signs of Stroke
The key is not to worry about moving your neck in an unusual way, but rather to recognize the symptoms of stroke, and call 9-1-1 immediately if you think you are having one. Stroke is a major cause of serious long-term disability and the fifth leading cause of death in the United States, but quick treatment can save lives and prevent further damage.
- F = face: does one side of the face droop or is it numb? If you ask someone to smile, is the smile uneven?
- A = arms: is one arm suddenly weak or numb? If you ask the person to outstretch the arms, does one lag behind or not rise at all?
- S = speech: is speech suddenly slurred? Is the person unable to speak or hard to understand? Does he or she comprehend what you are saying?
- T = time: if you or someone you see shows any of the above symptoms, even if the symptoms go away, call 9-1-1 and get to the hospital immediately.
- Sudden problems with vision, like double vision or sight loss
- Sudden problems with gait, such as walking as if drunk or losing one's balance
- A sudden headache unlike any other you have experienced, or the worst headache of your life, as Claudia described it
Time Is Brain
Neurologists have a saying: "Time is brain," meaning every moment that passes after a stroke increases the potential for irreversible brain injury. For strokes caused by a blockage of blood flow to the brain (called ischemic stroke), emergency treatment with the clot-busting drug tPA, or tissue plasminogen activator, to reestablish blood flow gives patients the best chance of recovering from a stroke. However, tPA must be given within three hours of symptom onset: a very tight window of time. The faster people get to the hospital, the faster we can evaluate them, run a series of diagnostic tests, and potentially identify them as candidates for tPA.
Even if symptoms started more than three hours before, it's still critical to get to the hospital for urgent evaluation and care. Although Claudia missed the window of opportunity for tPA, we treated her for several months with a strong blood thinner to reopen the artery and reduce the risk of blood clots. She is fortunate that her stroke didn't cause cognitive or muscular deficits; instead, blood flow was interrupted to the part of her brain responsible for vision, resulting in the loss of some peripheral (side) vision on her left.
"The visual field deficit, although shrinking, is still there, but it's not an issue in my life and never has been," she says. "I was so grateful that I could continue my career as a model and actress... I was totally lucky." Not everyone is so lucky, however. "Stroke can happen to anyone at any time, no matter what age or state of health one is in," she rightly notes. "Learn to recognize the signs of stroke. Don't think it's a migraine, as I did, or low blood sugar or something else. If you're having these specific signs, please go to the hospital immediately."
A Word About TIA
If you have symptoms of stroke, but they resolve after only a few minutes, you may have had a TIA, or transient ischemic attack, also known as a "mini stroke." Blood flow was interrupted, but not for long enough to cause injury. When this happens, it is still an emergency, so call 9-1-1 or get to a hospital immediately. TIAs are thought to be warning signs for major stroke. Coming to the hospital opens the opportunity for us to investigate the cause of blood flow interruption and treat it before a stroke occurs.