Know the Warning Signs of a Stroke, as Comedian Sinbad Learns to Walk Again
Sinbad is learning to walk again two years after suffering an ischemic stroke due to a blood clot that traveled from his heart to his brain. In an Instagram post his family shared a photo of the 66-year-old standing on a walker in physical therapy with an update and link to a donations page with the caption, "Sinbad appreciates all the love and support you have shown him over the last two years. Many of you have asked for updates and if there is anything Sinbad needs or what you can do to help. As a result, the family has created a site where you can keep up to date with his progress and also provide an avenue for those who wish to give."
In 2020, the actor and comedian was rushed into surgery "where the doctor's performed a thrombectomy to remove the clot and restore normal blood flow to the brain," his family posted in a statement. "After surgery, Sinbad was talking and moving with some weakness, but the prognosis was very promising. The next day, however, another blood clot formed, half the size of the first. He underwent the same surgery again successfully but it took a little more from him than the first surgery," the statement continued.
However, Sinbad's brain began to swell and he underwent a craniotomy "to relieve the pressure and reduce the swelling," the statement added. "During surgery, however, the doctors discovered a bleed. It was hours before the family learned Sinbad had returned to the Neuro-ICU in a medically induced coma and placed on a ventilator. A few weeks later, the actor opened his eyes, but he couldn't move his left side or hold up his head. Nine months after the stroke, Sinbad finally went home and has been working on his recovery.
Dr. Ali Mesiwala, Director of Neurosurgery at Dignity Health St. Bernardine who has not treated Sinbad explains, "A stroke is defined as damage to the brain that occurs when a blood vessel that carries oxygen and nutrients to the brain (an artery) is either blocked by a blood clot or debris, or bursts/ruptures. Strokes occur in approximately 200,000 people per year in the US, and is the fifth cause of death. It is a leading cause of disability." Eat This, Not That! Health spoke with neurologists who have not treated the actor, but explain what to know about an ischemic stroke and signs to be aware of. Read on—and to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.
How Blood Clots can Trigger a Stroke
Dr. Parham Yashar, MD FACS FAANS Board Certified Neurosurgeon at Dignity Health Northridge Hospital explains, "The term stroke refers to any damage to neurological tissue, especially tissue within the brain itself. Strokes can come in two main varieties, ischemic strokes, and hemorrhaging stroke. An ischemic stroke is caused by lack of adequate blood flow to the brain. This commonly occurs when a blood clot blocks an artery within the brain, thereby essentially suffocating the territory of the brain that was receiving the oxygen by that artery. A Radick stroke, on the other hand, occurs when bleeding occurs in the brain tissue, thereby damaging those brain cells."
Prabhdeep S. Sethi, MD, MPH, FACC, FSCAI, FSVM Program Director, Internal Medicine Residency Program Associate Program Director, Interventional Cardiology Fellowship Program Dignity Health – St. Bernardine Medical Center tells us, "A stroke is a general term for damage to the brain tissue. There are usually two ways they occur. The first is called an ischemic stroke. This occurs much the same way a heart attack does. Cholesterol builds up in the arterial wall and then due to some trigger there is instability and the particles "embolize" to block off the blood supply to various areas of the brain. The other mechanism is called a hemorrhagic stroke. This occurs in people with high blood pressure or with brain aneurysms. There is bleeding from the vessels that then puts pressure on the brain tissue."
Dr. Wally Wazni, a Neurologist and Medical Director of the Stroke Center at Dignity Health St. Mary Hospital in Long Beach says, "If a blood clot forms in an artery that supplies the brain it can cause a stroke by preventing blood circulation to that area of the brain that is affected. Blood circulation to the brain is an important way the brain receives vital nutrients to function and survive. If this blood supply is disrupted for even seconds it cause brain cell to be irreversible damage."
Why Blood Clots Happen
Dr. Yashar says, "Blood clots can occur for many different reasons. One of the most common is due to an abnormal heart rhythm called atrial fibrillation. Because the heart is beating in an abnormal manner, blood clots can develop within the chambers of the heart. If his blood clots make their way out of the heart, and into the arteries of the neck, they can potentially go to the brain, compromising the blood flow, and therefore the oxygenation to the brain leading to the death of the brain cells. This is what's called an ischemic stroke."
Dr. Sethi explains, "Blood clots' occur because the cholesterol accumulated in artery lining ruptures. The rupture is usually triggered by lifestyle factors such as high blood pressure, poor eating habits, cigarette smoking. When these cholesterol molecules are exposed to other elements in the bloodstream the body tries to isolate them by forming a clot. The signs of a stroke and commonly a sudden change in the ability to move a part of the body, a loss of sensation in a part of the body or even a facial droop or asymmetry."
Dr. Wazni explains, "blood clots can be triggered in a number of ways. They can form in the heart then travel up to the brain. The most common reason for the formation of clots in the heart is atrial fibrillation (abnormal heart rhythm). Less common causes of blood clot formation in the heart include myocardial infarction or heart attack and structural heart disease such as mitral regurgitation. Another common cause of blood clot triggers is atherosclerosis, which is a condition when plaque builds up inside your arteries. Blood clots can form on top of this plaque and block blood flow. If this happens to a blood vessel that supplies the brain it can cause a stroke."
What to Know About an Ischemic Stroke
According to Dr. Sethi, "Ischemic refers to a deprivation in oxygen supply. Blood carries oxygen so when a clot forms in a vessel, the part of the brain that is supplied by that vessel becomes deprived of oxygen, i.e., ischemic. The function that the supplied area of the brain was responsible for is then lost. This can be the inability to move a part of the body, inability to speak or comprehend or loss of sensation."
Dr. Mesiwala explains, "An ischemic stroke occurs when there is a blockage of an artery that supplies the brain. The blockage can result from a blood clot that forms in the artery or when a piece of atherosclerotic plaque breaks off from the heart, heart valve, or artery and obstructs the artery. If the blockage lasts for more than a few minutes, permanent damage to the brain occurs (a stroke). Approximately 80-90% of strokes are ischemic. Atherosclerosis, or fatty deposits along the artery walls, is the main cause of ischemic strokes. A cerebral thrombosis, or blood clot, develops at the site of the fatty deposit of plaque within the artery and blocks blood flow. A cerebral embolism is a piece of a blood clot that breaks off from a large blood clot that forms in the heart or large arteries of the upper chest and neck and lodges in a small artery in the brain causing a stroke. Atrial fibrillation is an irregular heart beat, and a main cause of cerebral embolism."
Signs of a Stroke
According to Dr. Yashar, "Most important thing is that anyone and everyone should be aware of all the signs of a stroke. The pneumonic to remember is: BE FAST.
B – balance, look for balance abnormalities, such as difficulty with a patient's ability to walk
E – eyes, look for abnormal eye-movement, especially if the patient is persistently, looking towards the left or the right side
F – face, have the patience, smile, and look for any asymmetries, or any drooping of the muscles of the face and/or eyelids
A – arms, check the patient for a weakness in their arms and/or legs on one side of the body
S – speech, stroking off and present with speech abnormalities, such as garbled speech, slurred, speech, or lack of a patient's ability to understand or communicate
T – time, if anyone has such symptoms above, time is of the essence. Time to call 911 and time to get to a stroke center."
Dr. Sethi says, "Signs of a stroke are loss of the ability to move a part of the body, loss of sensation, speech difficulty or slurring, inability to understand other people. It is very important to seek help immediately if experiencing symptoms of a stroke. The brain is very sensitive to oxygen deprivation. The more time that passess the more brain tissue can die. If a patient presents within 3 hours of symptom onset, they can receive clot busting medication which can clear the blood clot."
Dr. Wazni shares, "B.E. F.A.S.T. is a way of thinking about the signs and symptoms of stroke. This mnemonic stands for sudden loss of B: Balance – trouble to walking or standing, E: Eyes– sudden loss of vision in one or both eyes, F: Face—drooping or numbness on one side of the face, A: Arm—weakness or numbness of the arm, S: Speech—difficulty talking, T: Time –Strokes can be treated with clot busting medication call Tissue Plasminogen Activator (tPA) administered by intravenous medicine and/or a minimally invasive procedure to remove the blood clot (thrombus) from a blood vessel restoring blood flow called mechanical thrombectomy. Time is of the essence as once the brain tissues are damaged it cannot be reversed. Since there is a limited time window, up to 4.5 hrs. for tPA and up to 24 hrs. for minimally invasive clot removal, call 911 to get to the nearest stroke center."
Dr. Mesiwala says, "Signs of a stroke include a sudden loss of neurological function, rapid deterioration in mental status, and in some cases death. Depending on what part of the brain is affected, there may be a loss of movement or paralysis on one side of the body (a right sided stroke causes left body symptoms, and vice versa), speech and language problems, memory loss, change in behavior, and loss of vision. Facial droop is a common sign. If the brainstem is affected, devastating neurological damage can result, including quadriplegia, coma, and death. In some people they may have no loss of neurological function, instead suffering the worst headache of their life, a thunderclap headache, and stiff neck. Permanent and daily effects of stroke include emotional and physical changes. Depending on the amount of brain damage and the parts that are affected, people can have problems with seeing, sleeping, controlling bladder and bowel function, moving parts of their body, walking, chronic pain, fatigue, thinking and memory, depression, and seizures."
Dr. Yashar says, "Truthfully, everyone is at risk for a stroke. However, those risks are pretty minimal and young, healthy patients without the various risk factors. With age comes the possibility of developing various health conditions. There are risk factors that are called modifiable, which means that patients can change, or do something about them. These include diet, exercise, and smoking. It is important to eat a well-balanced and healthy diet, and be mindful of your glucose/sugar intake, cholesterol intake."
Dr. Sethi states, "The traditional risk factors for a stroke include cigarette smoking, high blood pressure, high cholesterol and sedentary lifestyle. You can lower your risk predominantly by preventing the onset of these illnesses and leading a healthy lifestyle. If one does develop elevated blood pressure or cholesterol, they should still practice a healthy lifestyle in addition to adhering to the medication regimen prescribed by their physician. Smoking cessation is extremely vital in preventing strokes especially in women."
According to Dr. Wazni, "They are most common in the older population and most common in people with diabetes, high blood pressure and high cholesterol. We obviously cannot control getting older however working with your general practitioner to better control blood pressure, diabetes and cholesterol can significantly reduce your risk. Other factors that reduce risk of stroke include a healthy diet such as a mediterranean diet and exercise such as daily walking."
Dr. Mesiwala tells us, "Risk factors for having a stroke can be broken down into lifestyle and medical groups:
Lifestyle: being overweight or obese, physical inactivity, heavy or binge drinking, use of stimulants such as cocaine and methamphetamines. Medical: high blood pressure, smoking or secondhand exposure, high cholesterol, diabetes, obstructive sleep apnea, cardiovascular disease (heart failure, heart defects, irregular heart rhythms, heart infection), personal or family history of stroke, and COVID 19 infection. Other risk factors include age over 55, African and/or LatinX heritage, sex – men have a higher risk than women, and the use of birth control pills and other hormone therapies that include estrogen."
How Having a Stroke Can Affect Daily Life
Dr. Yashar tells us, "The effects of a stroke vary in severity. Patients can have minimal symptoms at one end of the spectrum while other patients may have devastating symptoms, including vegetative, state, and even death. One common issue that comes from a stroke is that patients may be weak in their arm, and/or legs, making it difficult to take care of themselves, feed themselves, or even bathe themselves."
Dr. Sethi emphasizes, "A major stroke results in loss of function. One can lose the ability to move an entire side of the body. In extreme cases bowel and bladder function can also be affected. Speech is often affected as well. A stroke may not be fatal but can leave one with loss of major functions and in a dependent state."
Dr. Wazni says, "Stroke can affect our daily lives because they can affect our speech which in turn can affect our communication. Strokes can cause motor weakness which can affect our ability to ambulate. Other effects of stroke can include vision and memory loss."
Dr. Sethi shares, "It's vital to understand that most strokes can be prevented by lifestyle measures such as a heart healthy diet and moderate exercise. Smoking cessation is crucial. Finally, if you experience any symptoms which are concerning a stroke, call 911 immediately and time is brain."
Dr. Mesiwala adds, "According to the American Heart and American Stroke Association, the most effective ways to reduce your risk of having a stroke are: treating high blood pressure, identifying and treating atrial fibrillation, smoking cessation, lowering alcohol consumption, lowering cholesterol levels, controlling diabetes, daily exercise, cutting down on the consumption of sodium and saturated and trans fat, and eating a diet rich in fruits and vegetables."