Guess what the 5th leading cause of death is?

Staff writer Jerry Carino: jcarino@gannettnj.com.

Over the last two decades, the medical community has made considerable advances in treating strokes. A big stumbling block remains, though.

Human nature.

Treatment is time sensitive — three to four hours after a stroke’s onset, it’s ineffective or less effective — so the key is discerning when you, or someone around you, has had a stroke.

“People have to be aware of the risk factors and recognize when it’s happening,” said Ellen Ciacciarelli, clinical leader of neurology at CentraState Medical Center.

A new study found that people who have extended work weeks are at a higher risk of stroke. Emily Eden (@edenandtheapple) has the details. Buzz60

It’s not necessarily obvious.

“The one thing about the majority of strokes is they’re not painful,” said Gerald Ferencz, medical director of the Primary Stroke Center at Community Medical Center in Toms River. “It’s rare that people get headaches.”

What do they get? Here is what to look for.

Signs of a stroke

The classic acronym for stroke awareness is FAST. It stands for Face, Arms, Speech and Time, and it functions as sort of a stroke checklist. Here is Ciacciarelli’s breakdown of each.

Face: “Does it look irregular? When you look at someone’s face, does one side droop down? Ask them to smile. Is there a lopsided smile?”

Arms: “Is one of the arms weaker? If they hold it out in front, does it drift off? Hold their arm in front of them and close their eyes. See if one arm drops toward the ground.”

Speech: “Does their speech sound garbled? Are they having challenges verbalizing at all? Have them repeat a phrase after you and see if they can do it.”

Time: “Call 9-1-1 and get help immediately. We only have a golden three hours to give them this medication (tPA). If someone is sitting at a dinner table at 6 and drops their glass, and their face looks funny, don’t wait until 9 to get them to an emergency room. The longer you wait, the more damage there is.”

Ciacciarelli added two more letters to the acronym to form BE FAST. The B is for balance (“see if they are off-balance or dizzy”) and E is for eyes (“double vision or difficulty seeing through one or both eyes”).

Risk factors

Strokes might seem to strike at random, but there are risk factors, some of which can be managed. Ferencz explains:

Age: “Generally the older you get the more risk there is of a stroke. That’s something we can’t change of course. Ocean County tends to be a high stroke-risk group location mainly because of age. We have a lot of retirees.”

Eating habits: “Hypertension, diabetes, high cholesterol, excess weight — these are things we have some control over and are potentially treatable. There is a stroke belt in this country in the southern states. It’s related to high-cholesterol foods — butter, grease, fatty foods, carbs. We (in New Jersey) are just at the outside portion of that. The closer you get to the Mason-Dixon line, where diets change, the higher the risk.”

Gender: “Younger women who have normal hormones may be in a protected phase, but when they get to the age when they are post-menopausal they are at the same risk as men.”

Bad habits: “Smoking, alcohol, drugs increase the risk”

Genetics: “There are cases where people inherit a stroke risk, but those are very uncommon.”

Evolving treatments

Advances is stroke treatment have been “huge,” Ferencz said, since the breakthrough drug known as tPA came out in 1995.

“Given within three to four-and-a-half hours of a stroke’s onset,” he said, “it can help reverse a stroke or make the outcome significantly better by a three-month window, which is what we look at for stroke recovery.”

More recently, “in situations where drugs are not getting an effect or when large arteries are blocked,” Ferencz said, doctors have made progress in inserting tiny catheters into the brain similar to those used to treat cardiac disease. The goal is to capture the blood clot and withdraw it.

“We can do that up to a six-hour period,” he said.

Progress also is being made in treating a different class of stroke — bleeding in the brain. If a blood vessel bursts and causes a stroke because an artery develops a hole, there are intravascular procedures available as opposed to underdoing major open surgery.

For those suffering this class of stoke, Ferencz issued a warning.

“Unlike people having a heart attack, when you have a stroke it’s not the best thing to take Aspirin right away,” he said. “The best thing is to get to an emergency room. If you take Aspirin and are bleeding in the brain, it will not help and it could make it worse.”

“A long way to go’

The bottom line is education. Ciacciarelli speaks to as many groups as she can.

“We have a lot of patients wake up and feel as though their face is numb and their arm is numb, and they go back to sleep,” she said. “When they wake up (later) their arm is totally flaccid. If you wake up and something doesn’t feel right, don’t go back to sleep. Have it evaluated. Once you go back to sleep, it could be too far out (time-wise) for us to do anything.”

She points out that stroke has dropped from the third-most common killer to “four or five,” but remains one of the leading causes of disability.

“The word is out there but we still have a long way to go,” she said. “We need to have everybody understand that the face of stroke is everybody — young and old, male and female, black and white. Our youngest here (at CentraState) was 29 years old. Our oldest was late 90s.”

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