Tag Archives: stroke

Pandemic provides reminder of importance of recognizing signs of stroke

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Because of limited contact with family due to COVID, more people fell victim to strokes, a leading cause of death and disability. (Pxhere.com)

By Jamie Allen
Metro Health – University of Michigan Health

When COVID-19 kept families apart, it meant fewer opportunities for loved ones to notice the signs of stroke. And so, more people fell victim to one of the leading causes of death and disability.

The pandemic contributed in several ways to an increase in fatal strokes in the United States last year, said Dr. Jeffrey Fletcher, who specializes in neurocritical care, neurology and vascular neurology for Metro Health – University of Michigan Health.

Despite the complications of COVID-19, the most important aspect of stroke treatment has never changed, he said: Every second counts to limit the risk of brain damage and death.

“It is essential to recognize the signs of stroke and call 911 to get to the hospital as soon as possible,” he said, “because time is still brain.”

May is Stroke Awareness Month, an appropriate time to emphasize the importance of recognizing the signs, which can be memorized by the acronym B.E. F.A.S.T.:

  • B-Balance (Is the person having trouble with balance?)
  • E-Eyes (Does the person have blurred or double vision?)
  • F-Face (Does the face look uneven?)
  • A-Arm (Is one arm or leg suddenly weak?)
  • S-Speech (Does speech sound strange?)
  • T-Time (It’s time to call 911)With early data showing a significant increase in stroke deaths in 2020, stroke remains a leading cause of death in the United States, bumped down to No. 4 only because of COVID- 19. But Fletcher noted that, even among survivors, stroke takes a huge toll as the leading cause of disability.The devastating effects of stroke are another argument to be vaccinated for COVID-19, he said. There is moderate evidence that contracting COVID-19 increases the risk of stroke – and strong evidence it can contribute to more severe stroke outcomes.“In terms of stroke prevention, there’s a lot you can do by limiting risk factors and leading a healthy life,” Fletcher said. “That would include things that mitigate the chance of getting COVID, such as following public health measures, including immunization.”Acknowledging recent concerns about very rare blood clots among people who received vaccines, Fletcher said, “the risk of stroke with COVID is 1,000 times greater.”

Despite the challenges of the pandemic, Fletcher remains optimistic about the future of stroke care. Technological advances mean doctors are able to treat more strokes than ever. But for that to be possible, patients must arrive as soon as possible at a comprehensive stroke center like the one at Metro Health – University of Michigan Health.

“It gets back to recognizing what B.E. F.A.S.T. means,” he said. “Calling 911 can be the difference between death, severe disability and recovery.”

To learn more about recognizing the signs of stroke, plus the resources for stroke survivors and their caregivers, visit the Metro Health – University of Michigan Health website.

A soda-stroke link?

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Research has uncovered an association between soda consumption and stroke risk, particularly among older women. (Courtesy Spectrum Health Beat)

By Alan Mozes, HealthDay


Older women, beware: New research warns that drinking a lot of diet sodas or artificially sweetened fruit juices may increase your risk for stroke.


In a study that tracked nearly 82,000 postmenopausal women, those who drank two or more diet drinks per day saw their overall stroke risk rise by 23 percent, compared with those who consumed diet drinks less than once a week.


Blocked arteries were often the main culprit, with heavy diet drink consumption linked to a 31 percent greater risk for an ischemic stroke, which is triggered by a clot, the study findings showed.


Study author Yasmin Mossavar-Rahmani acknowledged that an “association does not imply causation.” But she stressed that the findings held up even after taking into account the nutritional value of each participant’s overall diet.


So, “we can’t assume these diet drinks are harmless, particularly when consumed at high levels,” Mossavar-Rahmani said.


“The take-home message is that these findings give us pause,” she added. “We need to do more research on why we are seeing these associations. What are the scientific mechanisms? Is there something about the artificial sweeteners, for example, that affect the bacteria in the gut and lead to health issues?”


Mossavar-Rahmani is an associate professor in the department of epidemiology and population health’s division of health promotion and nutrition research at Albert Einstein College of Medicine, in New York City.


The study authors pointed out that the American Heart Association has recently underscored the lack of sufficient research into the cardiovascular impact of diet sodas. Until more work is done, the AHA says the jury remains out on whether artificially sweetened beverages do or do not hasten heart disease.


Women in the latest study were between 50 and 79 when they first enrolled in the Women’s Health Initiative trial between 1993 and 1998.


Investigators tracked the general health of all the enrollees for an average of nearly 12 years. During that time—at the three-year mark—all the women were asked to indicate how frequently they consumed diet sodas and diet fruit drinks over a three-month period.


The researchers did not take note of which brands of artificially sweetened drinks the women drank and so did not know which artificial sweeteners were being consumed.


That said, nearly two-thirds of the women consumed diet sodas or drinks very infrequently, meaning less than once a week or never. Only about 5 percent were found to be “heavy” consumers of artificially sweetened drinks.


After taking into consideration a variety of stroke risk factors—including blood pressure status, smoking history and age—the study team concluded that heavy consumption of diet drinks did appear to be tied to cardiovascular risks in a number of ways.


For example, those women who drank two or more diet beverages a day saw their overall risk for developing heart disease increase by 29 percent. They were also 16 percent more likely to die prematurely from any cause.


Certain groups fared even worse: Among obese women and black women with no history of heart disease or diabetes, a diet drink habit pushed clot-driven stroke risk up by roughly twofold and fourfold, respectively, the researchers reported.


Whether or not the findings would apply to either men or younger women remains unclear, the study authors noted.


The findings were published online recently in the journal Stroke.


Lona Sandon is program director of the department of clinical nutrition at the University of Texas Southwestern Medical Center in Dallas.


She agreed that more research is needed to further explore a possible diet drink-heart disease connection. But for now Sandon offered simple advice: diet or regular, sodas offer no nutritional value other than calories.


“If they replace other drinks, such as milk and 100 percent fruit or vegetable drinks, then these women miss out on valuable nutrition for protecting the heart and vascular system,” Sandon warned.


“The nutrition you are missing because you are drinking artificially sweetened beverages instead may be the real problem,” she said.


A group representing the artificial sweetener industry offered another caveat about the findings — that many women who drink diet drinks are already struggling with weight issues.


“It is likely study subjects were already at a greater health risk and chose low-calorie sweetened beverages to manage their calorie and sugar intake as these products are proven safe and beneficial for those managing their weight and blood glucose levels,” said Robert Rankin, president of the Calorie Control Council.


“The contribution of reverse causality, meaning that individuals already at a greater risk of stroke and cardiovascular events chose low-calorie sweetened beverages, is very likely the cause of the associations presented by these researchers,” the council added in a statement.


Reprinted with permission from Spectrum Health Beat.

Stroke rate keeps falling

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Taking medication for high blood pressure or high cholesterol can reduce the odds of stroke. Researchers also suspect improvements in diet, exercise and lifestyle are contributing to better outcomes. (Courtesy Spectrum Health Beat)

By Amy Norton, HealthDay


Starting in the late 1980s, stroke rates among older Americans began to fall—and the decline shows no signs of stopping, a new study finds.


The researchers found that between 1987 and 2017, the rate of stroke incidence among Americans aged 65 and older dropped by one-third per decade.


The pattern has been steady, with no leveling off in recent years.


It’s not completely clear why, according to researcher Dr. Josef Coresh, a professor at Johns Hopkins School of Public Health, in Baltimore.


Over time, fewer older adults in the study were smokers, which is a major risk factor for stroke. On the other hand, some other risk factors—such as high blood pressure and Type 2 diabetes—became more common.


Of course, those conditions can be treated. And it’s known that for any one person, getting high blood pressure, high cholesterol and diabetes under control can cut the risk of stroke, Coresh said.


“However,” he added, “at the population level, we found that the decline (in strokes) was larger than what would be predicted from risk factor control alone.”


That suggests something else is going on, Coresh said.


The findings are based on data from a long-running heart health study that began in 1987. At the outset, it recruited almost 15,800 adults aged 45 to 64 from communities in four U.S. states.


A previous study found that the stroke rate among the participants fell between 1987 and 2011—a decline seen only among people aged 65 and older.


The new analysis, published online recently in JAMA Neurology, shows that the trend continued between 2011 and 2017.


Over 30 years, Coresh’s team found, there were 1,028 strokes among participants aged 65 and older. The incidence dropped by 32% over time.


In more recent years, many more older adults were on medication for high blood pressure or high cholesterol, versus the late 1980s. But risk factor control did not fully explain why the stroke rate dropped so much, according to Coresh.


He said that other factors not measured in the study—including exercise, salt intake and overall diet—might be involved.


Dr. Larry Goldstein, a spokesperson for the American Heart Association/American Stroke Association, made another point: The study could not account for exactly how well-controlled people’s blood pressure and other risk factors were.


That could go a long way toward explaining the decline in stroke incidence, according to Goldstein, who is also a professor of neurology at the University of Kentucky.


But while the latest findings are good news, there are also more sobering stroke statistics, Goldstein said. Although strokes are most common among people aged 65 and older, they strike younger adults, too, and the incidence of stroke among younger people has been inching up in recent years.


Plus, Goldstein said, the death rate from stroke—which had been declining—has recently “stalled” and is starting to reverse course.


“It might be because folks are now having more severe strokes,” Goldstein noted.


It’s critical, he added, that people be aware of the signs of stroke and get help quickly if they think they, or a family member, is having one.


Some of the warning signs include a drooping or numbness on one side of the face; arm weakness or numbness; slurred speech; sudden confusion or difficulty seeing or walking; or, as Goldstein described it, “the worst headache of your life.”


His advice: “Don’t delay getting help. Time saved is brain saved.”


Reprinted with permission from Spectrum Health Beat.



Beat the clock, reverse the stroke

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Photo by Taylor Ballek, Spectrum Health Beat

By Eve Clayton, Spectrum Health Beat

Photos by Taylor Ballek


Tramell Louis Jr. has diabetes, and his friends all know it.


So when he collapsed at lunch while waiting to place his order, his buddy thought Tramell was having a diabetic attack.


He helped him out to his car and called LaGenda, Tramell’s wife, who drove to meet them outside the restaurant.


It didn’t take her long to figure out that this was no low-blood-sugar attack, so she followed her instincts and called 911.


“I’m asking him questions and he’s looking at me, but he won’t respond. So at that point I knew something was grotesquely wrong,” she said. “I just knew it wasn’t related to the diabetes.”


As she watched “his mouth go crooked,” she wondered whether he was having a stroke.

Clot retrieval

An ambulance took Tramell to the emergency department at Spectrum Health Butterworth Hospital, where doctors confirmed LaGenda’s suspicions: At age 37, her husband had suffered an acute ischemic stroke.


The doctors quickly got him hooked up to an intravenous drip and administered a clot-busting medicine known as IV tPA. As the only drug approved by the Food and Drug Administration for treating acute ischemic stroke, this is the standard of care in a case like Tramell’s.


At the same time, emergency room staff called one of the hospital’s stroke specialists, who ordered a CT angiogram to pinpoint the source of the stroke. Tramell was rushed to the interventional radiology suite for imaging.


With the images on screen, the Spectrum Health Medical Group neurointerventionalist could see that Tramell was a perfect candidate for an advanced intervention called a mechanical thrombectomy, or clot retrieval.


Tramell’s brain scans showed two blood clots—one in the carotid artery in his neck and the other lodged in the left-middle cerebral artery, a major artery supplying the brain.


This second clot had shut down the blood flow to the left side of his brain, like a dam blocking a river.


“When the doctor showed me the CT scan of his brain, you could clearly see that (one) side of his brain had no blood flow to it at all,” LaGenda recalled.

Time is brain

With stroke, speed is everything. The longer the brain is deprived of blood, the more damage the brain suffers.


Studies have shown that for every minute blood supply is blocked, approximately 2 million neurons die.


So if a patient fits the criteria for intervention, “the sooner you start the procedure, the sooner you take out the blood clot, the sooner you restore the blood flow, the better the outcomes at three months.” That’s the standard measurement in the United States today.


Thankfully, Tramell beat the clock. From the moment he arrived at the hospital to the time he underwent surgery, less than an hour had passed.


Because there were two clots, the doctor used a two-step process to retrieve them. First he inserted a catheter into a blood vessel in the patient’s groin and fed it up to the carotid artery. Using a tool called the Solitaire device, he trapped the first clot in a tiny mesh stent and pulled it out.

Photo by Taylor Ballek, Spectrum Health Beat

Then he repeated the technique, fishing out the clot in the central brain. Immediately the blood began to flow again, in what doctors call complete recanalization—the channel was open again.


The results for Tramell proved to be dramatic.


His symptoms—loss of language function and right-side weakness—improved literally overnight, said Vivek Rai, MD, a neurologist with Spectrum Health Medical Group who specializes in stroke and vascular neurology. He took over Tramell’s care after his release from intensive care.


“After the procedure, the next morning when he woke up, he was night and day,” Dr. Rai said. “And he continued to do so well.”


Now that Tramell is in the clear, Dr. Rai will see him annually in the neurovascular program’s stroke clinic, keeping tabs on his carotid artery disease, which was the cause of the stroke, and monitoring his general health. To prevent a future stroke, Tramell will need to take aspirin and cholesterol medication, and carefully control his diabetes and blood pressure.

Driven to change

At five months post stroke, Tramell is feeling better than ever.


“I feel great. I really do,” he said. “I feel healthier than I have in a long time.”


He looks and sounds healthy, too, with no lingering effects. At least, none that a bystander would notice.


“The only problem I have is my speech,” he said. “When I speak, if it’s a word I haven’t used after I had my stroke, it takes—it’s like a pause and then I have to remember the word and then it jogs it, and then I start using it fluently.”


The stroke served as a major wake-up call for the father of two. Realizing his life could be snatched from him—separating him from his wife and children—brought out strong emotions.


“I felt anger, extreme anger—with myself. I just knew I had to change. I had the worst—the worst—eating habits in the world,” he said, noting that before he started taking insulin, he weighed over 300 pounds.


Today Tramell is eating better, faithfully taking his medications, drinking more water, kicking his soda habit and “running on a treadmill like crazy”—even when his job as a shipping and receiving clerk keeps him at work late.


“My wife—she’s the one that motivates me to do all the things I do,” he said.


Reprinted with permission from Spectrum Health Beat.


Visions of better tomorrows

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Photo by Chris Clark, Spectrum Health Beat

By Zinta Aistars, Spectrum Health Beat

Photos by Chris Clark


It happened the day after Christmas 2018.


Not a creature was stirring—except for Myra Moritz, 61, a Hudsonville, Michigan, business supervisor who had no plans of missing work.


But something felt a little odd that day. A sluggish left arm. And a heavy hip.


“It got worse over the day,” Moritz remembers. “I told my husband the next morning that I was having a stroke.”


Her husband, Dennis Moritz, took her to Spectrum Health Butterworth Hospital, where doctors soon confirmed what she suspected: She had suffered a stroke.

Lifestyle change

Not all strokes move quickly.


While minutes and seconds certainly matter when treating the victims, the type that hit Moritz had been slow-moving.


“I was too late for that magic pill that turns a stroke around,” she said. “But the staff immediately started tests and treatment and they found I had 95 percent blockage in my right artery and 75 percent in my left.”


In the years leading up to the stroke, Moritz underwent treatment for high blood pressure and high cholesterol. She also had five successful bypasses eight years prior, with surgery performed at Spectrum Health Fred and Lena Meijer Heart Center.

Photo by Chris Clark, Spectrum Health Beat

She knew enough about stroke to recognize her condition, even though she didn’t experience the more classic FAST symptoms associated with stroke:

  • F—Facial drooping
  • A—Arm weakness
  • S—Speech difficulties
  • T—Time to call emergency services

“I did not have any facial drooping or slurred speech,” Moritz said. “But as the day went on, I felt more weakness in my arm. And my brain was getting foggy. I was having trouble comprehending.”


Justin Singer, MD, Spectrum Health Medical Group neurosurgeon, served on the stroke team that treated Moritz.


“Myra had severe bilateral carotid stenosis, or carotid artery disease,” Dr. Singer said. “Lifestyle habits that contribute to this are high blood pressure, cholesterol, smoking, but also genetics. She had these high risk factors.”


To reduce Moritz’s chances of having another stroke, Dr. Singer performed carotid endarterectomy on her right artery. This surgical procedure removes blockages in the carotid arteries of the neck.


Carotid endarterectomy is not a cure, Dr. Singer said. Arteries can become blocked again if conditions such as high blood pressure and cholesterol are not controlled. This causes new plaque buildup.


“So I quit smoking,” Moritz said. “That was the last day I smoked.”

Hallucinations

On Dec. 30, 2018, doctors sent Moritz to stroke rehabilitation at Spectrum Health Blodgett Hospital. She worked with Christa Rector, MD, a Spectrum Health physical medicine and rehabilitation doctor.


Moritz immediately began to exhibit mild seizures during rehab.

Photo by Chris Clark, Spectrum Health Beat

“That’s not uncommon after a stroke,” Dr. Rector said.


But the seizures were enough to set Moritz back in her recovery.


“After the seizures, my memory seemed to be more affected,” Moritz said. “I was very tired. And about six days later I started to have hallucinations—probably a side effect from some of the meds I was taking to control the seizures.”


Moritz remembers seeing pirate ships sailing across the lake outside her window at Blodgett Hospital. Dogs she had owned in the past, now dead, suddenly trotted into the room to greet her. When she reached out to pet them, there was nothing there.


“I learned to check with my husband before trusting anything I was seeing,” she said. “And then I also realized that if I blinked, if it was a vision, it would go away.”


The good news: Moritz wasn’t bedridden during recovery.


Under Dr. Rector’s guidance, the rehab team gave her a proper workout to strengthen her left leg and left arm.


She practiced ascending and descending the stairs. She’d get in and out of a pretend car, use the bathroom independently and improve her balance with a walker.


“All the things I needed to be able to do when I go home,” Moritz said.

A return to normal

Before the stroke, Moritz would swim 60 laps twice a week at an indoor pool.


It may be a while before she achieves that level again, but her prognosis is excellent.

Photo by Chris Clark, Spectrum Health Beat

On leaving the hospital a little more than a month after her stroke, she felt optimistic and strong.


“A physical therapist comes out to the house three times a week to work with me,” she said. “That will go down to twice a week soon. My brain doesn’t feel foggy anymore and my appetite is better.


“Although, maybe that’s not so great,” she laughed.


Her doctors have recommended a Mediterranean diet, heavy on fruits and vegetables. She expects to drive again in about six months, when the risk of seizure has passed.


“Myra has made a remarkable recovery,” Dr. Rector said. “By the time she was discharged, we scored her 4 out of 5. We expect her to eventually return to normal or near normal.”


The directive from her doctors: control blood pressure, screen for hypothyroidism, stay active, maintain a healthy diet and keep watch on any reoccurring stroke symptoms.


And don’t smoke.


“An amazing group of doctors and nurses and rehab people have worked with me,” Moritz said. “Everyone has been so kind and supportive throughout every step of my recovery. My rehab people always ask me during my exercises: ‘Can you do one more?’”


Moritz nods. She can always do one more.


Reprinted with permission from Spectrum Health Beat.


Research links HPV to heart disease

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HPV—one of the most common sexually transmitted diseases—has been linked to increased risk of cardiovascular disease and stroke. (Courtesy Spectrum Health Beat)

By American Heart Association, HealthDay


Human papillomavirus, or HPV, is the most common sexually transmitted infection in the country.


In several studies, it’s also linked to the nation’s leading cause of death—cardiovascular disease.


There are more than 150 strains of HPV, including the ones responsible for cancers of the cervix, penis, anus and the back of the throat.


In a study published earlier this year in Circulation Research, researchers found that Korean women infected with these “high-risk” strains of HPV were 22 percent more likely to develop heart disease or have a stroke than women not infected with the virus.


The risk was calculated after adjusting for other common cardiovascular risk factors, including smoking, physical activity and body mass index.


A 2011 study also connected HPV with heart attacks and strokes in women.


“But at this stage, we’re not completely clear on what the link is,” said Dr. Christine Jellis, a cardiologist at The Cleveland Clinic.


Jellis said HPV may encourage chronic inflammation in the body, which can contribute to atherosclerosis, or the hardening of fatty plaque along the lining of arteries.


“But there may be some other social factors that make people both more prone to developing coronary artery disease—atherosclerosis—and also HPV,” she said. “At the moment, we don’t have that information but this … definitely warrants further evaluation.”


The link between HPV and cardiovascular risk is not restricted to women.


A 2017 study of mostly men tied HPV to an increased risk of stroke in people who received radiation therapy for head and neck cancer.


Dr. Tomas Neilan, the lead author of that study published in the Journal of the American Heart Association, said the results show HPV infection has consequences beyond the cervical lesions and cervical cancer typically associated with the virus.


“Specifically, and importantly, this also has implications for men beyond transmission” of the virus, said Neilan, director of the cardio-oncology program at Massachusetts General Hospital in Boston.


HPV is such a common virus that an estimated 80 percent of the population will be infected at some point in their life, according to the Centers for Disease Control and Prevention. About 14 million Americans, including teens, become infected with HPV each year. Most infections go away on their own, but those that don’t can lead to certain types of cancer.


That’s where prevention can help, Neilan said.


HPV vaccines, which have been available for females since 2006 and for males since 2009, have proven effective in decreasing HPV incidence and preventing precancerous growths or infections.


The CDC recommends all girls and boys get two doses of the vaccine before they turn 13. Children who start the vaccine series on or after their 15th birthday need a third dose for complete protection.


Jellis hopes to see more research about the HPV connection to cardiovascular disease, as well as other types of studies that look beyond the factors already known to contribute to heart attacks and strokes.


“We certainly see patients who don’t have any of the traditional cardiovascular risks, but they still have atherosclerotic disease,” she said. “So, whether they have additional genetic factors or additional lifestyle factors, for those patients, maybe these other things like a presence of HPV will end up being the reason why they are at higher risk.”


Reprinted with permission from Spectrum Health Beat.



Metro Health ‘gets with the guidelines,’ earns award

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By Jennifer Hoff

Metro Health – University of Michigan Health

 

Metro Health – University of Michigan Health has received the American Heart Association/American Stroke Association’s Get With The Guidelines® Stroke Gold Plus Quality Achievement Award with Target: Stroke Honor Roll Elite Award.

 

“Metro Health-University of Michigan Health is committed to striving for excellence in the acute treatment of stroke patients,” said Metro Health – University of Michigan Health Chief Medical Officer Dr. Peter Y. Hahn. “This recognition from the American Heart Association/American Stroke Association’s Get With The Guidelines Stroke further reinforces our team’s hard work and commitment. We are proud to have achieved this status.”

 

Get With The Guidelines® sets specific quality measures to ensure hospital teams follow the most up-to-date, evidence-based guidelines with the goal of speeding recovery and reducing death and disability for stroke patients. To receive these awards, Metro Health – University of Michigan Health has provided patient care at or above most achievement indicators for the last 24 consecutive months.

 

One of these quality measures is to reduce the time between the patient’s arrival at the hospital and treatment with the clot-buster tissue plasminogen activator, or tPA, the only drug approved by the U.S. Food and Drug Administration to treat ischemic stroke. This award recognizes that Metro Health – University of Michigan Health has been treating patients with intravenous tPA within 60 minutes in 75 percent or more of acute ischemic stroke patients.

 

“The American Heart Association and the American Stroke Association recognizes Metro Health – University of Michigan Health for its commitment to stroke care,” said Paul Heidenreich, M.D., M.S., national chairman of the Get With The Guidelines Steering Committee and Professor of Medicine at Stanford University. “Research has shown there are benefits to patients who are treated at hospitals that have adopted the Get With The Guidelines program.”

 

Get With The Guidelines® puts the expertise of the American Heart Association and American Stroke Association to work for hospitals nationwide, helping hospital care teams ensure the care provided to patients is aligned with the latest research-based guidelines. Developed with the goal to save lives and improve recovery time, Get With The Guidelines® has impacted more than 3 million patients since 2003.

 

“A stroke patient loses 1.9 million neurons each minute stroke treatment is delayed,” Hahn said. “This recognition further demonstrates our commitment to delivering advanced stroke treatments to patients quickly and safely.”

 

According to the American Heart Association/American Stroke Association, stroke is the no. 5 cause of death and the leading cause of adult disability in the United States. On average, someone in the U.S. suffers a stroke every 40 seconds, someone dies of a stroke every 4 minutes, and nearly 800,000 people suffer a new or recurrent stroke each year.