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Hope for Stroke: How to Prevent It & Life Afterwards

May 13, 2009 2:59 PM with Dr. Issam Awad

May is Stroke Awareness Month. Dr. Issam Awad, Director of Neurovascular Surgery and Past President, Congress of Neurological Surgeons will chat about the warning signs of stroke as well as the treatment of this preventable disease. Dr. Awad will also discuss the many aspects of stroke, including how hemorrhagic stroke is diagnosed and what must be done urgently, what to do to prevent a brain hemorrhage and the advances and novel therapies that are on the horizon.

Kristin Philbin (Moderator) - 2:54 PM:
Welcome! Today’s chat: Hope for Stroke: How to Prevent It & Life After a Stroke, will begin shortly. Please start submitting your questions and Dr. Issam Awad, will begin answering them as soon as we get started. While you are waiting for the chat to begin, feel free to visit the Stroke Page to obtain more information.

Dr. Issam Awad (NorthShore) - 3:00 PM:
Good afternoon, my name is Dr. Issam Awad. I am the Director of Neurovascular Surgery at NorthShore University HealthSystem. I am also a professor of Neurosurgery at Northwestern. I look forward to answering your questions about stroke, in particular surgical treatments.

  Anita (Annapolis, MD) - 3:01 PM:
I am a 71 year old woman who has good blood pressure readings with medication and had my carotid artery checked with a doppler reading within the past six months & the results were very good. The problem is that sometimes I have a dull ache in my neck that does not feel as if it is a muscular problem. Should I be concerned that this could be a neurological issue?
Dr. Issam Awad (NorthShore)
Neck pain is only rarely a symptom of stroke. Much more likely, it would be caused by arthritis or other problems. If your carotid ultrasound is clean you should speak with your doctor about having an MRI of the neck.

  Jose (Evanston, IL) - 3:02 PM:
What causes a stroke?
Dr. Issam Awad (NorthShore)
There are two main types of stroke. One is called ischemic, which means brain damage from insufficient blood supply. The second type of stroke is hemorrhagic, it is caused by bleeding in the brain. There are many possible causes of each type.

  Cassie (Park Ridge, IL) - 3:04 PM:
My grandmother had a stroke recently, will she ever be able to fully recover?
Dr. Issam Awad (NorthShore)
The ability to recover after stroke depends mostly on the severity (how large the area of stroke or brain damage), age, and the patient's general health and function prior to the stroke. The good news is that most stroke patients make dramatic recoveries over time.

  Madison (Evanston. IL) - 3:06 PM:
My maternal grandparents, aunt, and uncle all suffered a stroke or died as a result of one. My 71 year old mother has had her carotid artery tested. I am 40 & would like to know which preventative tests should I take to avoid a stroke?
Dr. Issam Awad (NorthShore)
It is important to find out what kind of strokes run in your family. The preventative or treatment measures would largely depend on whether the stroke was related to diabetes, high blood pressure, heart disease and the like or to other genetic causes.

  Cassie (Park Ridge, IL) - 3:07 PM:
What types of surgical treatments do you feel are most effective?
Dr. Issam Awad (NorthShore)
These depend on the type of stroke. For ischemic stroke or the stroke from insufficient blood supply to the brain, the most effective procedure is carotid endartectomy or opening of the carotid artery whenever there is signifcant blockage. Other procedures may be used to enhance blood supply to brain or to treat brain swelling in the middle of a stroke. For hemorrhagic stroke the treatments involve evacuation of the bleeding, relief of pressure or the repair of a weak blood vessel such as aneurysm.

  Jose (Evanston, IL) - 3:10 PM:
What measures need to be taken on a regular basis after a stroke? Will I need to have tests done throughout the year?
Dr. Issam Awad (NorthShore)
This again depends on the type of stroke. Whatever caused a stroke could certainly provoke another one. Hence it is important to discuss with your doctor the specific risks that caused the first stroke. Appropriate treatment can then be recommended.

  Cassie (Park Ridge, IL) - 3:11 PM:
Is weight a risk factor for strokes?
Dr. Issam Awad (NorthShore)
Only in an indirect way. Obesity can aggravate cardiovascular disease and diabetes, and can cause high blood pressure. All of these are risk factors for stroke.

  Jose (Evanston, IL) - 3:12 PM:
What is aphasia?
Dr. Issam Awad (NorthShore)
Aphasia is difficulty with speech. It can happen after a stroke involving typically the left side of the brain.

  Cassie (Park Ridge, IL) - 3:13 PM:
From your experience, is it more difficult to treat an ischemic or a hemorrhagic stroke? Why?
Dr. Issam Awad (NorthShore)
Both are challenging and the treatments are very different. In one case we have to ensure that vascular blockage is relieved, and in the other case we have to evacuate pressure from the brain and fix the bleeding source, if possible.

  Farrah (Lake Forest, IL) - 3:14 PM:
Should someone in their 30's be concerned about having a stroke if they have high blood pressure and a family history of heart disease?
Dr. Issam Awad (NorthShore)
Stroke can ultimately result from those risk factors. At age 30 there is incredible possibility to modify the risk factors by avoiding smoking, by monitoring blood pressure and cholesterol closely and by staying fit.

  Madison (Evanston. IL) - 3:16 PM:
following up to previous question: my aunt had diabetes & my other relatives who suffered strokes all had high blood pressure. two of them were also long-term smokers. I do not have high blood pressure and I am not a smoker, should I assume that I am still predisposed to strokes?
Dr. Issam Awad (NorthShore)
Only to a minimal extent as long as you keep an eye on risk factors like blood pressure, cholesterol, diabetes and smoking.

  Jose (Evanston, IL) - 3:17 PM:
My father suffered from a stroke and I feel like his quality of life is not where it was because he cannot be as active, what can I do to help?
Dr. Issam Awad (NorthShore)
The emotional impact of a stroke can be enormous and the burden of coping with disabilities such as weakness, speech problems or simply memory and cognitive difficulties. Family support can be very helpful, discussing specific rehabilitation options with your doctor, or even treating depression.

  Melissa Calvert (Alexandria, VA) - 3:19 PM:
Is it true that strokes are more prevalent among minority groups? If so, why & does it affect minority men or women more?
Dr. Issam Awad (NorthShore)
We go again to the issue of risk factors. Smoking, high blood pressure and to a lesser extent diabetes and cholesterol affect some minority groups to a greater extent. This may be related to socioeconomic status and education about fitness, obesity and the treatment of these various risk factors.

  Anonymous (Lake Forest, IL) - 3:21 PM:
I realize the topic is prevention and life after a stroke, but what are the early warning signs? Do they differ by age or sex?
Dr. Issam Awad (NorthShore)
This is an excellent question. The stroke warning signs should be known by everyone. They are as follows: Any sudden or transient difficulty with speech, vision, weakness or numbness. Any severe headache worse than any before. Any altered awareness or consciousness. Should one suspect these signs, 911 should be called immediately. Timely arrival to a hospital prepared to treat stroke can be a lifesaver.

  Cassie (Park Ridge, IL) - 3:23 PM:
Would you recommend clinical trials for stroke victims?
Dr. Issam Awad (NorthShore)
There are some established standards for stroke care such as the use of clot buster (tPA) shortly after a stroke, or opening an occluded carotid artery. These standards were established through careful research and clinical trials. These treatments do not require further testing. However, many stroke victims do not qualify for the above treatments or may benefit from additional therapies. Participation in clinical trials is strongly recommended, to get the benefit of latest advances and innovations.

  Gladys A. (San Antonio,Texas) - 3:26 PM:
I am in my 70's. Should I avoid exercise that requires my head to hang down below the rest of my body? Does this position make me more at risk?
Dr. Issam Awad (NorthShore)
No. There is no evidence that this type of exertion causes a stroke.

  Jose (Evanston, IL) - 3:27 PM:
I hear that people can have strokes regardless of age, is that correct?
Dr. Issam Awad (NorthShore)
Yes. Different types of strokes can occur at different ages. For example, aneurysms, blood vessel malformations and arterial dissection can all cause strokes in younger patients, even in children. Illegal drug use causes many strokes in young patients. However, in the big picture, there are far greater numbers of stroke as we age.

  Ashley (Alexandria, VA) - 3:28 PM:
Could you tell us more about the clot buster, tPA?
Dr. Issam Awad (NorthShore)
Currently it is a standard of care to receive intravenous tPA (literally a clot buster) in many patients with ischemic strokes presenting in the first hours after symptom onset. However, the criteria for using this drug (inclusion and exclusion criteria) are very strict and considered in individual cases. In general, the sooner a stroke is accurately diagnosed the more likely and beneficial is tPA.

  Jose (Evanston, IL) - 3:31 PM:
How does ones diet impact their likelihood of a stroke? Are their any diet tips that help decrease the risk factors of a stroke?
Dr. Issam Awad (NorthShore)
The diets that help decrease obesity and diabetes help prevent stroke. There is no other specific diet designed to prevent stroke in general.

  Jordan T. (Evanston, IL) - 3:33 PM:
Should kids with a history of stroke in the family be tested before playing sports?
Dr. Issam Awad (NorthShore)
Not necessarily unless the stroke in the family affected a young patient (below age 40), or resulted from an athletic injury (arterial dissection). Otherwise, one should keep an eye on the risk factors we mentioned previously starting at a young age.

  Monica (Wilmette, IL) - 3:35 PM:
I know that "baby" aspirin is recommended for people to help prevent heart attacks. Is the same thing is recommended for people to help prevent strokes?
Dr. Issam Awad (NorthShore)
Yes, this is often recommended in the same way. This and other specific recommendations should be discussed with your doctor.

  Jonathan (Evanston, IL) - 3:35 PM:
What are mini-strokes as opposed to a single one?
Dr. Issam Awad (NorthShore)
Mini strokes are strokes which result in minor disability or full recovery. They can occur and accumulate before an accurate diagnosis is made. A major stroke is hard to miss.

Dr. Issam Awad (NorthShore) - 3:39 PM:
Ischemic strokes can be caused by arterial blockage, heart disease (throwing clots into the cerebral circulation) or by excessive clotting of the blood. Hemorrhagic are caused by weakened blood vessels from high blood pressure or simply aging, from excessive blood thinners, or from cerebral aneurysms, or other vascular anomalies.

  Natalie (Winnetka, IL) - 3:39 PM:
My uncle had a stroke about a year ago and currently suffers from migraines. Are the two related?
Dr. Issam Awad (NorthShore)
They can be. This should be discussed specifically with your physician. Medications may need to be altered to best address the headaches.

  Alyssa (Chicago, IL) - 3:41 PM:
Are you seeing a better recovery/survival rate from strokes with all of the new medications and treatments?
Dr. Issam Awad (NorthShore)
Absolutely yes. We are always seeking medications or treatments to prevent a first stroke (primary prevention), to avoid stroke reoccurence (secondary prevention), and treatments to minimize brain damage after a stroke, hence improving survival and enhancing recovery.

Dr. Issam Awad (NorthShore) - 3:45 PM:
I'd like to thank all of you for taking the time to participate today. I enjoyed answering your excellent questions. Always speak with your doctor about stroke prevention as he or she will best know when special tests and consultation are needed. For more information see our Neurosurgery page as well as our - Neurology page Thank you again.

Kristin Philbin (Moderator) - 3:46 PM:
Thank you again for participating in our chat today. For more information please visit our Neurosciences pages.

Also, a transcript of this chat will be available shortly.

This chat has ended.

Thank you very much for your participation.