If I asked you what happens if you have a “brain attack,” what would you say? Louis Caplan, a stroke expert, did just that to see how people viewed stroke; he used the term brain attack because it is similar to heart attack, and “transient ischemic attack” is a mouthful. Ask people what happens during a heart attack, Caplan says, and they’ll describe a bad chest pain. They associate cancer with a lump or bleeding. But ask people about a brain attack and they’ll say one of four things: you go crazy; you go unconscious; you have a seizure; you become stupid.
“But they don’t tell you that you can lose vision in one eye or your hand may go weak,” Caplan says. “We don’t think of the brain as controlling the puppet strings. If people have weakness or numbness in the hand they think of it as a problem in the hand.”
I spoke with Dana Alliance for Brain Initiatives member Louis Caplan, a senior neurologist at Beth Israel Deaconess Medical Center (part of Harvard Medical School), for National Stroke Awareness Month. He has written 40 books, many of them about stroke, including one published by Dana Press, Striking Back at Stroke, and is working on another book about stroke that will likely be published in about a year.
Each year, about 750,000 Americans suffer a stroke, when blood flow to part of the brain stops. “The message to get across is that it is potentially preventable. We know a lot of the risk factors that cause stroke and we can now control most of them. The problem is the patients often don’t go to the doctor,” says Caplan. High blood pressure, high cholesterol, obesity, and smoking are some of the things that increase the risk of stroke.
Caplan once heard a teacher describe asking her 6th-grade students about their family health history and finding that almost none of the kids knew. For homework, she told her students to interview their family members, find out their family illnesses, and then have a pediatrician examine them. It turned out that if the parents had diabetes, the child’s blood sugars were high. If the family was heavy, the kids were usually overweight.
“If you have an 80-year-old who has a stroke, and you try to change his behavior—tell them ‘don’t eat this, don’t do that’—you can’t do it at age 80,” Caplan says. “But what you can do is talk to the children and grandchildren and try to get them to start looking at their risk factors. Years ago, I had my cholesterol checked and it was high, so I had my six kids checked, and five of them were high. So we started pushing the diet—don’t eat at McDonald’s, eat vegetables, stuff like that. People usually ignore that and let the kids do what they want. But that’s the time to prevent problems and start good habits.”
Advances in technology have made it possible for doctors to examine various areas that pose a risk for stroke such as the heart, the neck arteries, and the intra-cranial arteries without having to cut a person open. “With a thorough exam, you can quantify the risks and push treatment to try to prevent a stroke from happening.”
If you recognize you are having a stroke, get to a qualified hospital as quickly as you can. Although the idea that there is a three-hour window for treatment is a myth, he says: “the sooner you go in, the better.” Getting to a primary stroke center—which needs a certain amount of personnel and equipment in order to qualify—is important. You can ask your doctor where to find one near you. And, Caplan says, telemedicine is spreading, so even if you’re in a rural area, your local hospital can connect via the web with larger centers and experts.
Caplan sees two problems in the fight against stroke. One is the technical issue of getting to the hospital. People who are alone may not be capable of calling 911, and even if they did, traffic in big cities can cost a stroke sufferer valuable time. The second is public education: People don’t always associate the body symptoms with a brain problem and therefore may not think it’s very serious.
An increase in the number of stroke-trained doctors, state laws pertaining to medical response to strokes, telemedicine, and treatments that have proven to work well in certain subgroups of patients are reasons why Caplan is optimistic about the future. “Stroke is very heterogeneous—there are lots of different causes and situations. With the technology you can recognize what kind of stroke it is and pinpoint the treatment for that particular patient. It’s a new age.”
For more information on strokes, read Dana’s stroke primer.