HEALTHY LIFESTYLE · MAY 2018
Some of the troubling experiences I’ve faced so far are
the time frames of which some patients present to the
hospital. In some cases, patients present days, even weeks
after symptoms have occurred, only presenting because of
worsening symptoms. So despite all the medical advances,
a good percentage of our patient population still presents
too late to the hospital for timely care. About 1.9 million
Neurons die each minute in an untreated stroke. An
untreated brain ages roughly 3.6 years for each hour during
an untreated stroke. Time is brain indeed. Whether it’s a
financial, cultural, geographical, or social restraint, it is our
continued responsibility to educate and raise awareness to
the community. Stroke does not just affect the patient, but
the family as well. Entire family dynamics can change after a
stroke. The increasing cost of care has made stroke one of
the most expensive and costly diseases in our country. An
average 65 billion dollars is spent on stroke annually.
A stroke
caused by
hypertension
typically looks
different
than a stroke
caused
by atrial
fibrillation
or any other
cardiac cause.
Strokes on
both sides of
the brain are
likely to be
caused by a
more central
source,
thrombus from within the heart for example,
or a tendency to develop clotting due to
underlying malignancy, genetic causes, etc. And
for that reason, the cause of stroke needs to be
determined. There are circumstances, in some
literature, where up to 40 percent of strokes
are without an etiology or undetermined
source. These strokes are termed cryptogenic
strokes. Our job as physicians is to assure
Stroke risk factors are well known and are
that every potential etiology is investigated
no different than those of cardiac disease
to determine the source of stroke. It is also
and peripheral vascular disease. For example:
important for every patient, family member,
hypertension, diabetes, tobacco use, and
and loved one to ask and understand the
elevated cholesterol. Aside from these very
diagnosis in order to address the underlying
common diseases, atrial fibrillation is also a
cause to prevent recurrence. When my
major risk factor for ischemic stroke. Even
grandmother had a stroke, I remember asking
non-sustained atrial fibrillation can carry a
my aunts who were taking care of her, “how and
high stroke risk. Identifying the etiology of the
stroke is critical in an attempt to reduce the risk why?” The response was, “she just had surgery
a few weeks before, so she had a stroke.” I
of a recurrent stroke going forward. Another
accepted the answer as much as it confused
unfortunate and gut-wrenching experience is
me and didn’t bring it up again until seven years
the number of patients whom I’ve seen who
later when things made more sense to me. No
were diagnosed with a stroke years ago. When
asked, “why did you have a stroke?” they answer one had investigated why this mildly overweight
hypertensive right-handed female developed
with a blank face, which is sometimes better
than the, “they said it was stress,” response I’ve what appeared to be an embolic ischemic
stroke causing severe long-term disability. It was
heard countless times.
upon further questioning, about seven years
after the stroke, that it was revealed that my
An etiology of a stroke, to a vascular
grandmother had paroxysmal atrial fibrillation
neurologist, can be suspected based on its
and was placed on oral anticoagulation for
appearance on imaging, MRI, for example.
further stroke risk reduction.
Seeking immediate emergent care is the key
point of the national stoke campaign. Known
as FAST (Face, Arm, Speech, Time). Speaking
broadly, any symptoms involving the face,
arm, or speech, require a 911 call and to seek
immediate medical attention. While not every
hospital is the same, most hospitals are capable
of providing acute care for stroke, and the
closest hospital should be visited anytime
a stroke is suspected. When 911 is called,
emergency medical services can determine
the severity of symptoms and transport
patients to the appropriate hospital. Stroke
care is comprised of a multidisciplinary team.
Active members include the neurologist, and
in some cases, a neurosurgeon, hospitalist, at
times other specialists (cardiologists, intensive
care), dedicated nursing staff, nutritionists,
speech therapists, and physical therapists all
working together in order to achieve the best
possible outcome for the patient. Studies
have shown the most important predictor of
a good outcome in stroke is being treated in a
dedicated stroke unit.
Being in the Rio Grande Valley over the past
several months, I’ve learned a lot about this
region. Some good, some bad. The weather
is hot, except for when it snowed for an hour.
The food is amazing. People are genuine and
sincerely appreciative. People will also do
whatever it is you need, but tomorrow. People
in the Valley are down to earth, genuine,
sincere, and very appreciative of our efforts
as physicians. I was in awe of the amount of
respect they show towards physicians and
healthcare providers. Again, coming from New
York, you can see why it’s a culture shock for
so many different reasons. One of the biggest
things I’ve learned while here in the Valley is the
value placed on family. Family is everything. It
has helped me constantly remember the keys
to happiness. God, family, and health. With
change come growing pains. But I can assure
you this; I’ve come to the Valley as the only
stroke neurologist to provide a service that
wasn’t provided to my grandmother. I see my
Dr. Huda in every stroke patient I encounter. I
wish I never had to meet anyone in the hospital,
but when we are met with the unfortunate
circumstance, I guarantee that everything in our
power, knowledge, and skill-set as physicians
and health care providers will be applied to
your recovery. We will always do our part; we
just need our patients to allow us to do so.
By Hamzah M. Saei, MD
29 HEALTHY MAGAZINE