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In the ‘Stroke Belt'

Step toward detection, prevention of brain attack

Last fall, the American Stroke Association categorized Oregon as one of the newest members of the “stroke belt,” a title usually reserved for states in the Deep South that have higher than average stroke mortality rates. Deaths from stroke have increased 27 percent in Oregon since 1990, giving the state the dubious distinction of having the third-highest stroke death rate in the United States.

Stroke is the third leading cause of death in the U.S. behind heart disease and cancer.

A stroke is a sudden interruption in the blood supply to the brain. Most strokes are caused by a blockage of arteries leading to the brain — known as ischemic stroke. Other, less common strokes are caused by the rupture of a blood vessel in the brain — called hemorrhagic stroke.

According to Dr. Michael Hauty, a surgeon with Providence Hood River Memorial Hospital, ischemic strokes account for about three-quarters of all strokes.

“But it’s all just junk in the blood vessels causing an interruption in blood flow,” Hauty says. In the same way a person with loss of blood to the heart suffers a heart attack, a person with loss of blood to the brain can be said to be suffering from a “brain attack,” another term for stroke.

Rapid intervention is the key to treating stroke, according to Hauty.

“We’re beginning to apply the same things to treating strokes as we do to treating heart attacks,” Hauty says. As with heart attacks, “early intervention — within the first hour, if possible, after having a stroke — is best.”

Better yet is to get medical help before a stroke happens. Ischemic strokes tend to have warning signs, according to Hauty. They typically include confusion, trouble speaking, sudden loss of vision in one eye or blurred vision, and weakness in the extremities — usually on one side of the body.

“If you’re having any of those, you should see a physician immediately,” Hauty says. Through tests, including an ultrasound of the neck and a CT scan, doctors can determine if the narrowing of arteries that causes stroke are present. If so, those arteries — the carotid arteries which supply blood to the brain — can be “cleaned out,” meaning built-up fatty deposits can be removed. This procedure, called carotid endarterectomy, can often prevent a stroke.

Other interventions include medications that thin the blood. According to Hauty, people can “go a long way toward preventing stroke” by quitting smoking, getting regular exercise, eating a healthy diet and taking an aspirin each day (Hauty recommends a baby aspirin since it’s easier on the stomach and provides the same anti-clotting benefits).

Regional medical professionals are taking measures to address the causes for Oregon’s recent rise in stroke deaths. Last month, Portland-based Providence Health System’s Center for Outcomes Research and Education (CORE) was awarded a grant of more than $700,000 from the Centers for Disease Control and Prevention (CDC) to establish Oregon’s first statewide stroke registry. The registry is a collaborative effort led by CORE; the Providence Stroke Center, based at Providence St. Vincent Medical Center; Oregon Health & Science University; and the Oregon Health Division.

Sixteen medical facilities around the state, including Providence Hood River Memorial Hospital, are participating in the new registry. The participating hospitals will collect data on each stroke patient treated as an in-patient and then submit their data, without patient-identifying information, to the central CORE registry.

“This project will allow us to determine how acute stroke patients are currently being treated throughout the state,” said Wayne Clark, M.D., director of the Oregon Stroke Center at OHSU. “Hopefully, we will then be able to use this data to improve the delivery of stroke treatment in the future.”

The eventual goal for the CDC is to collect data from statewide registries being launched throughout the country and use it to create a national acute stroke registry.

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