Your Brain On... Stroke

Ayesha Sherzai (0:00)

This is Your Brain On podcast, supported by Neuro World. By many metrics, stroke is one of the top five leading causes of death in the world. And yet, it's something we rarely talk about in depth, especially when it comes to its prevention. Because the good news is, by the CDC's numbers, about 80% of strokes are preventable. As neurologists and public health advocates, we've seen firsthand how devastating stroke can be.

Not just because of its physical aftermath, but because of the emotional and the cognitive toll, the memory issues, the depression, the stigma, the loss of independence that comes with it. And we've seen how many of those strokes just didn't have to happen. So today we're talking about the science of stroke, its connection to general brain health and dementia, and the communities that are affected by it more so than anyone else. We're joined by one of our favorite voices in this space. Dr. Olajide Williams. He's a stroke neurologist, a public health innovator, and the founder of Hip Hop Stroke, a campaign that has helped thousands of kids teach their parents and their elderly how to save lives. This is Your Brain On Stroke.

Dean Sherzai (1:20)

As neurologists, one of the most urgent things we experience is the call to the emergency room, and it's the stroke call. It's middle of the night, you get the stroke call, and you're running because time matters. We say time is brain. The amount of time that you take to intervene is brain lost. There aren't many other events in neurology that are as urgent as when a person has stroke. And every single time, I feel my heart beating fast because I know that the decisions we make could have a profound effect on their life going forward. You're losing tissue by the minute. And the other positive side of this is, it's one of the areas of neurology that we can do a lot about. It's a preventable event for a majority. And that's why stroke is a very important concept for us to learn. Now, the big strokes we all learn very quickly, don't we? It's the left side of the body, that means the right side of the brain had a stroke, and vice versa. But there are these subtle cases where a person comes in and they're stuttering, and they can't speak. Actually, at the first we think it's a confusion, but it's actually a cerebral stroke in the language centers. In other cases, they come in with a stroke and they've lost vision. So stroke also manifests in really different and interesting and very disparate manners. Stroke has had a profound mark in our experiences. Every patient that we saved, if I had to, I could remember them. And every patient that we lost, we can remember them. So I want people to know that this is a very important topic, one that you can affect your family members, because every family gets affected by stroke, either directly or indirectly at some point. It's a major common disease. It's not a rare disease. Or they can make others aware to know what to do when it happens. We can do much to prevent a significant portion of these strokes.

Ayesha Sherzai (3:10)

The field of neurology is divided into subspecialties and often after neurology residencies, some of us want to go and subspecialize in different fields and stroke is one of them. Stroke neurology actually makes you a better physician because it is one of those conditions where you are forced to learn everything about the brain, specifically localization of the brain, which is phenomenal. It's so much fun. What part of the brain functions in a different way? What part of the body does it control? And what happens to it if there is a stroke in that area?

You quickly see the manifestation in the body, like you said. You either lose vision, or you slur your speech, or you can't recognize familiar faces, or suddenly you start laughing or crying, and there's emotional vacillation, paralysis of one side of the body, just the arm, just the leg, numbness versus tingling, versus movement disorder, et cetera. All of these fascinating things happen when you have a stroke. But at the same time, it is a beautiful window into the inefficiencies and the broken health care system that we have. Stroke is one of those conditions where we know that eight out of ten cases could be prevented. But here we are only having a point of touch with a patient when they are going through it, instead of looking at the upstream events that led to that event and not addressing that. And so there's going to be big emphasis on prevention of stroke in this conversation. Let's go ahead and start about just the very beginning. What stroke is? The word stroke means something that happens right away, all of a sudden, a stroke of an event. It's a good representation of what happens in the brain. So we have hundreds and thousands of these little arteries that keep on branching and supplying oxygen and nutrients to the different parts of the brain. And they function very well. They have to for the brain to function better. But sometimes a small little clot or any impediment lodges in one of the arteries, and it prevents blood from getting to the brain tissue. And that's what a stroke is. There are different types of strokes. Broadly speaking, we have two types of strokes. The first type is called an ischemic stroke, which is related to a clot stopping blood flow. And about 85% or more of strokes are all ischemic. Then we have hemorrhagic stroke or the bleeding type, which is when an artery bursts open and there's bleeding into the brain, and because of the pressure that it clogs and stops blood flow to the periphery of that area. And then there is another type of stroke. It's not a stroke per se, but it is a transient ischemic attack or a TIA. It's also known as mini strokes, and that's basically a small clot that causes disruption to the blood flow to the brain, but it resolves rather quickly. Usually within 20 minutes and most of the time, within 24 hours, the symptoms go away, and it doesn't leave any deficit in the brain, because the minute it does cause some problem in the brain, it's not a TIA anymore, it's a stroke. Sometimes people make a mistake between an ischemic stroke and a TIA, and they don't get the right kind of treatments.