San Jose Mercury News (CA)
January 30, 2004
Section: Front
Edition: Morning Final
Page: 1A
Memo:Related Stories: pages 1A,11A
...................................... Anatomy of a stroke
WARNING SIGNS OF STROKE
If you develop any of these symptoms, even if they go away quickly or don't cause pain, call 911 immediately. Treatment is more effective if given quickly.
For additional information about stroke, contact the National Stroke Association at (800) 787-6537 or www.stroke.org.
Most common stroke symptoms
- Sudden numbness or weakness of the face, arms or legs, especially on only one side of the body.
- Sudden confusion, trouble speaking or understanding.
- Sudden trouble seeing.
- Sudden trouble walking, dizziness, loss of balance or coordination.
- Sudden severe headache with no known cause.
Less common symptoms
- Sudden nausea, fever and vomiting -- distinguished from a viral illness by the speed of onset (minutes or hours vs. several days).
- Brief loss of consciousness or period of decreased consciousness (fainting, confusion, convulsions or coma).
Source: National Stroke Association
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WARNING SIGNS: ATTACKS LIKE GONZALES' CAN BE HARD TO DIAGNOSE
LISA M. KRIEGER, Mercury News
The initial suspicion that Mayor Ron Gonzales had food poisoning Wednesday night shows just how difficult some strokes are to detect -- and experts say it offers a warning to people who might find themselves with similar symptoms.
His repeated vomiting prompted paramedics to treat him with oxygen and monitor his heart for half an hour -- routine care for a sudden food-borne illness.
Instead, Gonzales was bleeding from a small burst blood vessel in the brain.
Vision problems, dizziness and weakness are some of the classic stroke symptoms. But vomiting and severe headache also can signal trouble in
blood flow to the brain -- and indicate the need to call 911.
Quick action is crucial because treatment is most effective within the first three hours -- and then only with certain types of strokes.
Gonzales' type of stroke is called an intraventricular hemorrhage, according to Leslie Kelsay of San Jose Medical Center. This means that a blood vessel had broken and was leaking into the ventricle, which carries spinal fluid. This type of stroke is somewhat less common than that caused by a blood clot.
The diagnosis could not be confirmed until a computerized tomography scan was done at the hospital, Kelsay said. A CT scan Thursday showed no further bleeding in the area, Kelsay said.
Gonzales' symptom of vomiting is very characteristic of his type of stroke, said neurologists Dr. Harmeet Sachdev of Good Samaritan Hospital in San Jose and Dr. Christine Wijman of Stanford University Medical Center. Severe headache and high blood pressure are also common, they said.
The symptoms are caused by a spasm of the broken blood vessel, as well as damage to the brain cells immediately surrounding it, say neurologists. It is as if part of the brain is bruised.
Gonzales will be monitored for several days. The chief concern now is to prevent blockage of the ventricle from a blood clot; it must remain open so that spinal fluid can flow. Doctors will also monitor the area for signs of swelling in response to the trauma.
If only a small amount of blood is lost, with little cellular damage and no subsequent problems, the prognosis is good, Sachdev and Wijman said.
The term ''stroke'' is a very general one. It means that brain tissue has died due to lack of blood flow and insufficient oxygen.
There are two types of stroke. One, the most familiar, is called an ischemic stroke, where blood supply is cut off due to a blood clot. Gonzales suffered the other type -- called a hemorrhagic stroke -- where a vessel is broken.
A hemorrhagic stroke is most commonly caused by high blood pressure. It can also occur when blood vessels grow fragile, due to age.
When a stroke takes place on one side of the brain disability is restricted to one arm, or leg, or one side of the body.
But when it happens in a central location -- as did Gonzales' -- the symptoms are more general, often affecting core functions of the body.
''Usually, a hemorrhage in this part of the brain is not localized to one side or the other. It can affect both sides. That is because that is where all the messages come through,'' Sachdev said.
The fact that the bleeding stopped quickly could have saved his life, said neurologists.
''If it was a small hemorrhage, he is certainly very fortunate,'' Wijman said.
...................................... DIAGRAM: PHIL LOUBERE - MERCURY NEWS
WHAT IS A STROKE?
A stroke happens when a part of the brain dies from lack ofblood, usually because one of the arteries that supply oxygencarryingblood to the brain has been damaged. There are twoways this can happen:
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CLOGGED VESSEL
Ischemic stroke: Caused byblockage of a blood vessel inthe brain, usually by a bloodclot or by fatty deposits onthe vessel wall.
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BURST VESSEL
Hemorrhagic stroke: Causedby a burst blood vessel,preventing normal flow andallowing blood to leak intobrain tissue, destroying it.
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Percentage of occurrence
Ischemic: 88%
Hemorrhagic: 12%
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INCIDENCE
700,000Americansexperience strokeseach year.
Of every fivedeaths from stroke,two are men andthree are women.
Strokes are thethird leading causeof death, behindheart disease andcancer.
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SYMPTOMS
Loss ofsensation in alimb or on oneside of the body
Partial loss ofvision or hearing
Double vision
Dizziness
Slurred speech
Imbalance,falling or fainting
Loss ofcoordination
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RISK FACTORS
High bloodpressure
Highcholesterol
Diabetes
Smoking
Family history of stroke
Obesity
Previousstrokes
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THE MAYOR'S STROKE
Mayor Gonzales had a ventricularhemorrhagic stroke, meaningthat a blood vessel burst andallowed blood to enter theventricular area of the brain.......................................
Sources: American Stroke Association;American College of Emergency Physicians
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