MEDICAL SURFARI: SURGERY CAN HELP PREVENT STROKES

Today, a person who experiences a stroke has a better chance than ever of survival and recovery. But the person must seek immediate medical help. Treatment and recovery in the long-term involves the full cooperation of the patient, often including changes in lifestyle.

Your best weapon in the fight against stroke is understanding and early detection of your risk factors. Learning that you are at risk for a stroke before it occurs can encourage you to take steps to maintain your health and reduce your risks. The main risk factors for stroke are high blood pressure, elevated cholesterol, diabetes, smoking, and heart rhythm disturbances.

Stroke affects more than 700,000 Americans each year and this is 40 percent higher than previously thought. It is the third leading cause of death in the United States among adults. It is the leading cause of loss of independent living. Although there are two major categories of stroke, the most common is an eschemic stroke which results in brain injury when the blood flow to the brain is insufficient. This can happen when one of the major arteries supplying the brain becomes clogged or blocked with fatty build up. The largest arteries supplying the brain are the carotid arteries. These arteries may become diseased with fatty build up over time that may result in severe narrowing or complete blockage of blood flow to the brain. Small pieces of the cholesterol material that blocks the blood flow may break off and block smaller arteries in the eye or the brain resulting in a mini stroke or a transient ischemic attack (TIA). Common symptoms of a TIA include temporary loss of the ability to speak or understand others, temporary loss or dimming of vision in one eye and temporary paralysis or severe weakness in an arm or leg. Often these symptoms resolve in less than 10 minutes to an hour. But even if all the symptoms resolve entirely, you must know that an event of this type is a strong warning sign of an impending large stroke. These symptoms can sometimes be vague and difficult to recognize. If in doubt, see a physician at the nearest emergency center.

Carotid endarterectomy, performed by neurosurgeons and vascular surgeons, is a surgical procedure designed to prevent strokes. Since I perform this operation, I can tell you firsthand that it is effective for patients who have high grade narrowing or "blockages" of the carotid artery. This operation generally takes less than two hours and can be done under general or local anesthesia. Although each individual is different, most patients spend only one or two days in the hospital. Since the exposure of the artery for operation only requires a skin incision, there is very little discomfort and the recovery period is very short.

Your heart contracts about 100,000 times each day recirculating your blood volume, a high proportion which goes to your brain. The best way to assure this is to have your physician help you identify and reduce your risk factors for carotid artery disease.

World Wide Web Resources

Neurosurgery On Call

www.neurosugery.org/pubpages/patres/features/may98_endarterectomy.html

This Web page provided by the American Association of Neurological Surgeons Web site provides information on carotid endarterectomy, including common questions asked about the procedure.

Carotid Endarterectomy Information Guide

www.mediconsult.com/strokes/shareware/cartentire/

This site provides information on carotid endarterectomy, including results of clinical studies in laymen's language.

National Stroke Association

www.mediconsult.com/associations/nsa/

The National Stroke Association is dedicated to reducing the incidence and impact of stroke and provides resources on stroke prevention, treatment, rehabilitation, research and support for stroke survivors and their families.

Dr. Scott Gibbs is a neurosurgeon and editor-in-chief of Mosby's Medical Surfari. You may e-mail questions to him at drgibbs@semissourian.com or write in care of the Southeast Missourian, P.O. Box 699, Cape Girardeau, Mo., 63701.