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Behind the scenes of the American Academy of Neurology's newest book for patients and their care partners.
Every 40 seconds, someone in the United States has a stroke, which is caused by bleeding in the brain or blockage of a blood vessel supplying the brain. At any one time, there are up to 2 million stroke survivors in the United States; sadly, 150,000 people each year die from stroke. But with specialized care, advances in treatment, and better public education about the signs and symptoms, neurologists hope not only to reduce the number of strokes but also to increase the survival rate and improve quality of life for survivors.
With these goals in mind, the American Academy of Neurology (AAN) recently published Navigating the Complexities of Stroke by Louis R. Caplan, M.D., professor of neurology at Harvard University, senior neurologist at Beth Israel Deaconess Medical Center in Boston, and Fellow of the AAN. This is the latest installment in the AAN's Neurology Now™ Books series for patients and their care partners. Other books in the series include Navigating Life with Parkinson Disease and Navigating Life with a Brain Tumor. Books on multiple sclerosis, dementia, epilepsy, and spinal cord injury are also in development. (See box, “To Order Navigating the Complexities of Stroke.”)
Beginning September of 2013, Navigating the Complexities of Stroke will be available in bookstores and from Internet retailers including Oxford University Press (http://bit.ly/157OuTP ) and from the AAN Store (aan.com/view/PatientBookSeries ).
“Stroke is a unique neurologic condition in that it is very common and highly disabling, but it is also preventable in many cases. Greater understanding can clearly reduce stroke risk and improve outcomes in case stroke does occur,” says Lisa Shulman, M.D., professor of neurology at the University of Maryland, Fellow of the AAN, member of the Neurology Now Editorial Advisory Board, and editor-in-chief of the Neurology Now Books series. Dr. Shulman sees Navigating the Complexities of Stroke as an important tool in raising awareness about the signs and symptoms of stroke and in helping patients be proactive in their post-stroke care. (See box, “A Sneak Peek at Navigating the Complexities of Stroke.”)
“Why Stroke Is So Important,” gives a brief overview, including what strokes are and what causes them, how many people experience strokes each year, and why having a stroke is a complex medical problem.
“What Does the Brain Look Like and How Does It Work?” focuses on the various functions of each part of the brain, and how those parts work together.
“How Does the Body Bring Blood to the Brain?” explains how the heart pumps blood to the brain. This chapter also details what happens when a blockage prevents blood from getting to the brain, causing one kind of stroke.
“What Is a Stroke? What Are the Different Kinds of Stroke?” explains the mechanics of a stroke in the brain and the various types of stroke that can occur.
“What Are the Medical Conditions that Cause a Stroke?” focuses on the various medical conditions that can cause a stroke, including untreated heart disease, hypertension, and blood vessel abnormalities.
“Strokes and Cerebrovascular Conditions in the Young,” provides insight into the causes of strokes in infants, children, and young adults.
“What Are the Different Symptoms of a Stroke?” outlines the key symptoms a person may experience during a stroke.
“What Are the Risk Factors for a Stroke and How Can They Be Reduced?” addresses the various risk factors that increase stroke risk and provides information on how to reduce the controllable risks.
“How Can the Doctor Tell What Caused the Stroke?” provides specific information on the various diagnostic tools, including brain imaging, that are used to pinpoint what caused a stroke. This is often key information in coming up with post-stroke plan of action.
“What Treatments Are Available to Treat an Acute Stroke Patient?” explains the available treatment options, including medication and surgery, based on what caused the stroke. This chapter also addresses treatment strategies to reduce the risk of a second stroke.
“Complications” focuses on the physical and neurologic complications that can occur while a patient is in the hospital or in rehabilitation.
“What Are Some of the Dysfunctions and Disabilities and Handicaps That Remain After a Stroke?” outlines the challenges that stroke patients may face while they recover and over the long term, including memory loss and impairment of speech and movement.
“How Does Recovery from Stroke Occur?” gets to the heart of recovery once a stroke has occurred. While recovery is unique to each patient, this chapter addresses strategies both in the hospital and at home that are used to help stroke survivors recover as much function as possible.
“How Does One Person's Stroke Affect Others?” gives information on the ways that family members and others are impacted when someone has a stroke.
“What Does the Future Hold?” addresses the changing field and how training of healthcare providers, development of more precise imaging, and other tools are making an impact on improving patient outcomes.
“Case Summaries” shares some stories of patients who have had strokes and how their care was handled from diagnosis to treatment and rehabilitation.
“Planning for Your Future” sheds light on the nonmedical aspects of stroke management, including legal and financial issues. Written by two lawyers, this chapter contains important information for more than just stroke patients.
Researchers are becoming increasingly interested in the impact of stroke, according to Dr. Caplan. “At least five or six medical journals dedicated to stroke are available now,” he says. Nevertheless, not all healthcare providers or medical centers are equipped to handle the challenges of stroke care, he notes.
“The emergency system is designed to take patients to the closest treatment center, not necessarily the best treatment center,” Dr. Caplan says.
In the case of many traumatic injuries, the best place and the closest place may be one and the same, according to Dr. Caplan. Plus, time is of the essence when it comes to stroke. But in some cases, he says, accurate diagnosis and treatment depend on getting to a specialized stroke center with the experts and technology available to quickly diagnose stroke, 24 hours a day, seven days a week.
The best time to look for a center is before you need one. The Joint Commission certifies stroke centers based on established best practices, in coordination with the American Heart/American Stroke Association. Most large cities have such a center; people who live in rural areas or cities without a certified center should look for hospitals connected to a certified stroke center through 24 hour telemedicine programs, allowing physicians to connect with stroke experts for consultation via computer.
For more information on stroke center certification, go to http://bit.ly/10WtgZL , http://bit.ly/HqH0QI , and http://bit.ly/13JJ2EM .
“There is no panacea for preventing or treating stroke. Each stroke is different, and no single therapy will work for everyone,” Dr. Caplan says. Statins, which are cholesterol-lowering drugs, may work to reduce the risk of stroke for one patient, while aspirin or anticoagulants may prove effective for others, he notes.
That's why it's so important for patients and their care partners to have an informed conversation with their doctor. “The prepared patient can engage in a shared decision-making process with his or her physician,” Dr. Shulman says. And that often translates into better outcomes: being educated about how stroke recovery occurs, for example, can help motivate people to participate fully in the rehabilitation process and take the medications that prevent a second stroke.
In addition, it is crucial for people to know and reduce their stroke risk, Dr. Caplan says. He urges patients to discuss their family health history with their doctor.
“People should understand the links between certain conditions and stroke risk,” Dr. Caplan says. (See box, “Stroke: The Basics.”) “I discovered I had very high cholesterol when I was in my early 40s and quickly had my six children tested. We found out that five of them had high cholesterol for their age, so we started watching our diet much more carefully.”
What is a stroke? Ischemic stroke is caused by blockage of a blood vessel supplying the brain. Hemorrhagic stroke is caused by bleeding into or around the brain.
What are the warning signs of stroke?
* Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body
* Sudden confusion, trouble speaking or understanding
* Sudden trouble seeing in one or both eyes
* Sudden trouble walking, dizziness, loss of balance or coordination
* Sudden, severe headache with no known cause
Call 911 immediately if you or someone you are with shows signs of having a stroke.
What are the risk factors for stroke? Risk factors that can be treated, changed, or controlled include high blood pressure, cigarette smoking, diabetes, carotid or other artery disease, peripheral artery disease, atrial fibrillation (irregular heartbeat), heart failure, sickle cell anemia, high cholesterol, poor diet, physical inactivity, and obesity.
The following risk factors cannot be changed:
* Prior stroke, transient ischemic attack (TIA), or heart attack: The risk of stroke for someone who has has had a prior stroke, TIA, or heart attack is higher than that of a person who has not.
* Age: The chance of having a stroke approximately doubles for each decade of life after age 55.
* Sex: Stroke is more common in men than in women. However, more than half of total stroke deaths occur in women. Use of birth control pills and pregnancy pose special stroke risks for women.
* Race: African-Americans have a much higher risk of death from a stroke than whites do, partly because African-Americans have higher risks of high blood pressure, diabetes, and obesity.
* Family history: Stroke risk is greater if a parent, grandparent, sister, or brother has had a stroke. Rarely, strokes may be symptoms of genetic disorders such as cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL).
What treatments are available for stroke?
* Prevention: The best treatment is treating risk factors for stroke, such as high blood pressure, atrial fibrillation, and diabetes.
* Acute stroke therapies try to stop a stroke while it is happening. This means quickly dissolving the blood clot causing an ischemic stroke or stopping the bleeding of a hemorrhagic stroke. The most popular classes of drugs used to prevent or treat stroke are antithrombotics and thrombolytics.
* Post-stroke rehabilitation: This helps a patient prevent or overcome disabilities that can result from stroke damage.
While Dr. Caplan would like to see even more research into stroke prevention, diagnosis, and treatment, he says that a great deal of exciting work is being done. For example, ultrasound technologies are improving the way strokes are diagnosed. Other research highlighting the role of genetics in stroke risk and how individual patients might respond differently to different stroke treatments is ongoing.
For all the articles Neurology Now has published on stroke, go to http://bit.ly/zOSdde .
To listen to a podcast from Neurology®, the medical journal of the American Academy of Neurology, go to http://bit.ly/130dSbj .