Stroke

Apr 1, 2009
2009 / April 2009

Our March Travel Rx column focused on the types and symptoms of stroke. This month, learn about ways to reduce your risk for stroke and steps to take in case of stroke while traveling.

The complications of stroke differ depending on the part of the brain affected and how long the brain suffers from a lack of blood flow. A stroke can cause either permanent or temporary disabilities, such as paralysis or loss of muscle movement, difficulty talking or swallowing, memory loss, trouble with understanding, pain and social withdrawal.

Early treatment can minimize damage to the brain and potential complications, which is why time is the most critical factor in treating stroke. The good news is that treatments and surgical interventions are now available to stroke patients if they are candidates. Nonetheless, prevention remains most important, primarily through control of three major risk factors — hypertension, smoking and high cholesterol — as prescribed by the National Stroke Prevention Guidelines (see sidebar).

When traveling with others, review with them the symptoms of stroke and what to do if you have a stroke. Inform them that you want to be taken to the closest well-equipped hospital, one with 24/7 availability of computed axial tomography (CT or CAT) scanning, as well as radiologists or neurologists to read scan results immediately. Your companion may need to speak to the physicians if you are unable to do so, so be sure he or she has the proper authorization to do so.

Carry your medical history with you when traveling, along with a list of your medications, drug allergies, your physicians’ phone numbers and emergency contact numbers at home and where you are traveling. If you experience a stroke in your hotel room, dial the front desk or the hotel operator. Many hotels also have security personnel available 24/7 to assist their guests. In the United States, you can call 911 from any hotel phone by accessing an outside line or by contacting the hotel operator. If you cannot speak, leave the phone off the hook. Try to open your hotel door and get someone’s attention in the hall for help.

When traveling outside the United States, it is important to know the local medical emergency system before you are in an emergency situation. Ask your hotel manager about the hotel’s medical emergency procedure. Find out who to call for emergency care, or if there is a hotel or countrywide emergency phone number. Ask if your hotel has a physician on staff to see guests and facilitate their transport to the hospital, or if you have to rely on your companions or hotel manager or concierge to recommend and transport you to the best hospital in the area. Inquire about the availability of CT scanners and radiologists or neurologists in that country and at the closest well-equipped hospital. U.S. Embassies and Consulates (http://usembassy.state.gov) maintain lists of hospitals and physicians abroad.

Travelers may be concerned about how soon they can travel after having a stroke. This depends on each individual person and the stroke itself. The best advice is to check with your doctor to determine if you are medically fit to fly; also check with your airline and insurance company for restrictions that may apply. Doctors often recommend avoiding flying for three months after stroke due to an increased risk of deep venous thrombosis or pulmonary embolism and to allow adequate time for recovery. However, sometimes it may be necessary to fly — for example, to return home if the stroke has occurred abroad.

In the United States, calling 911 is the fastest way to get immediate life-saving medical treatment. Note the time that the symptoms first started so that you can tell the medical personnel. Emergency Medical Services, ideally with advanced cardiac life support capabilities, can assess for a stroke, start initial treatment and rapidly transport you to the hospital, where you can be more thoroughly assessed and treated by the emergency department physician and stroke team.

Ischemic strokes (resulting from a clot in an artery to the brain) can be treated with a clot-busting medication called tPA (tissue plasminogen activator) in the emergency department within three hours of the onset of symptoms, reducing the chances of long-term disability.

A study published in October 2008 revealed that the tPA administration window may be expanded to four and a half hours from onset of symptoms, but this new timeframe has not yet been approved by the FDA. For more information, visit http://www.stroke.org.


Reduce Your Risk

Follow the National Stroke Prevention Guidelines:

• Know your blood pressure. Ideal: 110–120/70–80 New guidelines: <135/• Know your cholesterol numbers
• Find out if you have atrial fibrillation
• Find out if you have circulation problems
• Follow a diet lower in sodium and fat
• Stop smoking
• Drink alcohol only in moderation
• Exercise daily
• Control diabetes with doctor’s recommendations

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