‘Time is brain’

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The director of Mount Sinai St. Luke’s Stroke Center reminds New Yorkers to act “F.A.S.T.” as part of National Stroke Awareness Month


  • Ultrasound scans are commonly used to evaluate blood flow through blood vessels in the neck. Strokes are the result of an interruption of blood flow to the brain. Photo: Stroke Association

  • Carolyn Brockington, M.D., is a vascular neurologist and the director of the Stroke Center at Mount Sinai St. Luke’s and Mount Sinai West Hospital. Photo courtesy Carolyn Brockington

Stroke impacts approximately 800,000 Americans each year, but 80 percent of strokes are preventable through management of risk factors such as high blood pressure. May is National Stroke Awareness Month, during which doctors work to educate the public about steps they can take to reduce their risk of stroke and how to recognize and get help when a stroke occurs.

Carolyn D. Brockington, MD, the director of the Stroke Center at Mount Sinai St. Luke’s and Mount Sinai West Hospital, spoke with Straus News to share potentially life-saving information about strokes that every New Yorker should know.

What is a stroke?

A stroke is primarily an injury to the brain that occurs from an interruption of blood flow. So if we think of the blood vessels almost like pipes or plumbing, if there is a blockage of one of those arteries or a clot that interrupts blood flow and not enough blood gets to the brain in a period of time, that part of the brain starts to die.

The symptoms from stoke are going to happen over seconds or minutes, not over weeks to months. It really happens quite fast, and the reason is that brain cells don’t do well if they don’t get enough blood flow. Approximately 1.9 million brain cells die per minute if the brain doesn’t get enough blood flow, so that’s why in stroke treatment we say “time is brain.” The more time that goes by, the more likely the brain can be irreversibly injured. That’s why we want people to be able to recognize what a stroke is and to know that they need to go to the emergency room right away.

What are the signs someone may be having a stroke?

There’s an acronym that the American Stroke Association has been circulating that we think is good. It’s act “F.A.S.T.”

F is for face. If you look at someone’s face and ask them to smile and one side of the face is drooping, if that happened suddenly then they might be having a stroke.

A is for arms. If you ask someone to outstretch their arms and they can’t move their arm on one side or can’t keep it elevated, that person might be having a stroke.

S is for speech. Not only difficulty in articulation and sounding almost like you’re drunk, but also having difficulty communicating. Maybe someone suddenly can’t understand what you’re saying to them, or the words that they’re saying don’t make sense.

T is for time. If those stroke symptoms develop, the key thing is to call 911 right away and go to the closest emergency room so they can be evaluated for treatment.

In this age, everyone sort of Googles their symptoms or calls a friend to ask “what should I do now?” but with a stroke you really don’t have the time to do that. If something’s happening where not enough blood is getting to the brain, the time it takes for them to get to the emergency room and be treated appropriately is really critical and will factor in whether someone recovers very well or is left with some permanent disability.

Who is at risk?

One of the biggest myths of stroke is that people think strokes only occur when you get older — that you only have to worry about them if you’re 80 or 90 or older than that. The reality is, strokes can occur at any age. Stroke in the young has some different risk factors than as you get older, but essentially, if people develop sudden symptoms — weakness on one side of the body, numbness on one side of the body, difficult with speech, difficulty with vision, difficulty walking — they may be having a stroke and need to get to the hospital right away.

What can individuals do to reduce their risk of stroke?

Another myth of stroke is that there’s nothing you can do about it. The reality is that 80 percent of strokes can be prevented, through first identifying what your risk factors are and then modifying them or changing them appropriately.

Modifiable risk factors include high blood pressure, or hypertension, which is the number one risk factor for stroke. Identifying that someone has high blood pressure and getting it under control can reduce their risk of stroke and heart disease. Other risk factors include diabetes and elevated cholesterol, so those have to be controlled. Smoking is very bad for the brain, so if someone smokes they need to stop.

Many times it starts out with just diet and exercise. Some people can really significantly change their cholesterol level by just changing some key things in their diet and becoming more active. Other people require not only those things but also medication. But the only way you’re able to find that out is if you sit down and have a one-on-one with your doctor in order to create a plan and really empower yourself to take care of your health. The brain has tremendous capacity for recovery, but the better thing is to prevent a stroke from happening.

This conversation has been edited and condensed.

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