When Lee Roy Selmon suffered the stroke Friday that would end his life, his family and supporters started a vigil that many Americans know well.
Every 40 seconds, someone in the United States has a stroke; every four minutes, a stroke patient dies. Stroke is the nation's third-leading cause of death, and a quarter of all strokes affect people younger than 65; Selmon was just 56.
As treatments have advanced, the death toll has declined, and recoveries are becoming more complete. But in general, how well a patient fares depends on his own medical history, and how quickly the proper treatment begins, said Dr. David Decker, a stroke specialist at Tampa General Hospital and USF Health.
Decker, who also is assistant professor of vascular neurology and neurocritical care at USF Health, was not involved in Selmon's care, but offered general comments on stroke care, prognosis and prevention.
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Selmon was stricken Friday afternoon at his home. It wasn't known if he was alone at the time, and if so, how long it took for someone to summon help. He reportedly was not breathing when paramedics arrived.
Decker explained that in urban areas such as Tampa Bay, paramedics responding to a 911 call are trained to assess patients in the field. If they suspect a stroke, they head directly to the nearest hospital that is designated as a stroke center due to the advanced care it offers.
That's why it's so critical to call 911 whenever a stroke is suspected, Decker said.
At the hospital, the stroke team is standing by to do an initial evaluation. Providing the patient is breathing well on his own, the next step is an emergency CT scan of the brain. But if the patient needs help to breathe, stroke care has to be delayed until respiration is normalized.
If diagnostic tests can go forward, doctors know within 30 to 60 minutes the type of stroke that has occurred and whether it can be treated with a clot-busting drug. Some patients may also be candidates for high-tech clot removal procedures provided at some hospitals.
Within 48 hours of admission, and after additional brain imaging scans, doctors have a better idea of the size and severity of the stroke. Over the next few days, they will know more about the prognosis for recovery.
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The damage a stroke does depends on a number of factors, including the patient's medical condition at the time of the stroke. Uncontrolled high blood pressure, diabetes and heart disease all are among the chronic diseases that can mean more extensive stroke damage.
Selmon stepped down as athletic director at USF in 2004, citing a "private health matter.'' Although there was speculation at the time about the health implications of that high-stress job, the Hall of Famer never publicly elaborated about his health.
The speed and type of treatment also are key to recovery. For instance, if a clot buster is given quickly — within hours of the onset of stroke symptoms, provided the patient can breathe on his own — lost function can start to return in hours. For others, function returns gradually, and new research shows that continuing therapy can mean some improvement continues for months and even after a year.
Patients are monitored closely during the first few days in the hospital for signs of brain swelling, which can affect recovery. So can other complications like kidney failure, breathing problems and any chronic health conditions.
"The worse you start out, the worse you end up usually," said Decker. "If we see a lot of brain swelling in the first 24 hours, that is generally a bad sign. We also worry if the deficits are very severe. Or if they develop respiratory problems early on, that's not a good sign."
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Important as it is to quickly get help for a stroke, it's just as essential to address risk factors early so that stroke can be avoided, Decker explained.
Untreated high blood pressure is one of the most common causes of stroke. Because it usually has no symptoms, high blood pressure and the damage it causes to the heart and blood vessels can go undetected for years until a heart attack or stroke occurs. High blood pressure is a particular stroke risk factor for African-American men. Adding to the problem, African-Americans often don't respond well to standard blood pressure medications.
Still, with persistent effort by both patients and health care providers, the condition can be successfully treated through medication and lifestyle changes.