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as more canadians experience stroke, survival rates are also up

1.9 million brain cells die every minute during a stroke, making emergency treatment critical.

as more canadians experience stroke, survival rates are also up
checking your blood pressure could substantially reduce the risk of stroke or cognitive decline from stroke throughout life. getty
being stricken with a stroke was the furthest thing from nathan pryor’s mind as he worked out at his halifax gym four years ago. he was fit, ate a healthy diet, didn’t smoke, had no family history — and he was just 38 years old.
“it was kind of a shock to the doctors. they had no idea why i was there, given the state of my health at the time,” says pryor, referring to the emergency department of his local hospital. he had been in the middle of one of his six times weekly cross-fit sessions when he reached down to pick up his water bottle and knocked it over. the third time it happened he thought, “what the hell is going on?”
he says everything became foggy and he felt paralysis creeping into the left side of his body. luckily one of the gym’s staff was training to be a paramedic and tended to him while someone else called 911. in a blur, he was on a stretcher in an ambulance and on his way to the hospital, which was five minutes away, where a team of doctors was waiting for him.
“they did a ct scan and identified a rather sizeable clot on the right side of my brain and administered the clot busting drug [alteplase],” he recalls. “but that didn’t get the job done, so i was pushed into surgery pretty quickly.”

doctors used a treatment called endovascular thrombectomy (evt), in which a retrievable stent was threaded up through pryor’s blood vessels, latched onto the clot, and pulled it out. the procedure can be used for a select group of patients up to 24 hours after symptoms first appear, an increase from the previous window of 12 hours. doctors, however, stress that the sooner the stroke is treated the better. according to the heart & stroke foundation of canada , 1.9 million brain cells die every minute during a stroke, which is why emergency treatment is critical.

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pryor later learned that a clot had formed on the vein on the right side of his neck, dislodged while he was skipping rope and shot up to his brain. “the doctor said it could have happened any variety of ways, even by a fierce sneeze. it was kind of a freak occurrence.”

strokes on the rise, even in younger people

according to the heart & stroke foundation of canada , 878,000 canadians are living with stroke, and more than 89,000 strokes occur in canada every year. it’s the third leading cause of death, and it’s on the rise due to the aging population and to younger people, like pryor, having strokes in increasing numbers. stroke can hit anywhere anytime to anyone of any age, even babies still in the womb.

the good news is, more canadians are surviving stroke because of prevention, awareness, and advancements in treatment and care. also, because more hospitals today are staffed with dedicated stroke teams and stroke units. in addition, telestroke , which allows stroke specialists to participate virtually in lifesaving treatment to patients in remote communities, has expanded since it was introduced in 2002.

nine in 10 canadians have at least one risk factor for stroke

nine in 10 canadians have at least one risk factor for stroke or heart disease, and nearly 80 per cent can be prevented. healthy diet, physical activity and not smoking are the keys to prevention. then there are factors you can’t control: being a woman, especially a pregnant woman or post-menopausal; if you have a close relative who had a stroke; being indigenous or of south asian or african heritage; have chronic migraines; limited access to healthy food, safe drinking water and health services.
 do you know the signs of a stroke? credit: heart & stroke
do you know the signs of a stroke? credit: heart & stroke
powered by
canadian society for exercise physiology

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“our population has made great strides by being healthier, smoking less, being more physically active,” says dr. eric smith, professor of neurology at the university of calgary, as well as medical director of the cognitive neurosciences clinic and member of the calgary stroke program. “on the other hand, we have increasing rates of obesity and diabetes. if people were to be physically active, eat a healthy diet, don’t smoke, have their blood pressure and blood sugar checked and screen for diabetes, that would substantially reduce the risk of stroke or cognitive decline from stroke throughout life.
“but we know for various reasons, not everybody has ideal health, in fact, the minority do,” he says. “we live in an environment that doesn’t always promote healthy choices, particularly if you’re in a lower socio-economic status. the cheapest calories in a restaurant tend to be the empty calories from highly processed foods. it costs more to eat healthy foods like fruit and vegetables.”

we need to find out how stroke happens

smith says more research is needed to not only understand why stroke happens in otherwise healthy people, but also to discover better recovery strategies.
“the brain exhibits a phenomenon called neuroplasticity,” where it can change and adapt after damage or dysfunction.

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“some brain cells may be killed off by the stroke, other brains cells can form new connections and you can relearn many of the functions that were lost,” he says.

in 2020, the heart & stroke foundation began the canstroke recovery trials , along with the canstim platform , to test a combination of brain stimulation and conventional therapy. smith says physical, occupational and speech therapy also helps to relearn what the stroke affected, such as muscle movement, memory loss, difficulty talking. recent research is looking at how robots may be able to help: “[you’d likely] have a human therapist but certain exercises could be assisted by a robot.”

‘silent strokes’ are not silent after all

smith’s own research is focused on covert strokes, previously known as silent strokes, where there are no noticeable symptoms.
“we’ve found maybe they’re not so silent after all, [since] we see them in people that are presenting with cognitive problems. [sometimes] a scan shows a scar from an old stroke that people didn’t know about,” he says, adding that these findings can help to explain some of the cognitive changes that might be mistaken for aging.

smith is also conducting a pilot clinical trial testing a new treatment for cognitive decline caused by covert strokes called remote ischemic conditioning (ric). participants wear a modified blood pressure cuff on their arm once or twice a day.

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“when the cuff inflates it cuts off blood flow to the lower arm and that conditions the arm to protect itself from low blood flow,” he says. “it also signals to the rest of the body, including the brain, to condition itself to be resistant to low blood flow.”

other research includes a new drug, na-1, that can “pause” the brain during a stroke to reduce damage. dr. michael tymianski, a neurosurgeon at toronto’s university health network, is developing an injection , much like an epipen, that can be used to buy time and keep brain cells alive.

meanwhile, four years later, nathan pryor is nearly fully recovered and back to working out at the gym. he says he still notices after effects, such as a shaky left hand and feeling off-kilter when he runs. “but it could have been a lot worse,” he says. “i’m thankful for where it happened and the people who were there recognized what was going on.”
as for what he hopes people take away from his story, it’s “to be able to recognize the signs when someone is having problems with their motor functions or speech, that something really serious might be going on. call 911 and make sure that they receive help in a timely manner because time is crucial in stroke treatment.”

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for more information on stroke, visit heart & stroke
 
robin roberts is a vancouver-based writer.
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