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Silencing Stroke

Silencing Stroke

May 2005

by Natalie Gutierrez

It was Halloween night, Oct. 31, 2003. Amelia Talamantes, 44, was alone in her home, getting ready to work the graveyard shift at the Holiday Inn. Her eldest daughter, Esperanza, had taken the children trick-or-treating. Talamantes was just about to step out into the cool, dark evening when suddenly, in silence and without warning, something attacked her.

The next morning, Talamantes found herself in the hospital. Her mouth was contorted and her speech slurred. Numbness enveloped the fingers in her left hand, continued up her arm and peaked with a sharp ache in her left shoulder. An MRI indicated a small perforation in her brain.

"You had a stroke," Talamantes recalls the doctor telling her, as he pointed to the tiny, dark spot in her brain displayed on the MRI. "I didn’t believe it," said the single mother of four. "I was too young to have a stroke," she said, wiping away tears. "All I could do at that moment was think about my children."

Talamantes had the scare of her life that Halloween night, but is fortunate to be alive. The type of stroke she had is called a small subcortical stroke, which occurs when blood flow through the small arteries in the brain is blocked. According to the U.S. Centers for Disease Control and Prevention, about 700,000 people suffer a stroke every year. One-third of the victims are under the age of 65. Subcortical strokes, also called lacunar strokes, account for more than 27 percent of all ischemic strokes (the most common type of stroke).
An infarction, visible on an MRI
An infarction, visible on an MRI, indicates a patient has had a small subcortical stroke. Multiple infarctions indicate the patient has had numerous subcortical strokes that could lead to severe disability and cognitive decline (dementia) in the patient.

According to Oscar Benavente, M.D., associate professor of medicine in the division of neurology at the Health Science Center, subcortical strokes are occurring at an alarming rate in Hispanics and blacks, and tend to be slightly more severe in those ethnic groups. "More than one-third of the ischemic strokes occurring in Hispanics in San Antonio are subcortical strokes," Dr. Benavente said. Although subcortical strokes are usually not fatal, they strike again, putting victims at risk for disabling side effects, including dementia and paralysis.

Through a study called "Secondary Prevention of Small Subcortical Strokes" (SPS3), Dr. Benavente and his colleague Robert Hart, M.D., professor of medicine in the division of neurology, are on a mission to prevent strokes in patients who have already had subcortical strokes. The study is funded by a $37 million grant from the National Institute of Neurological Disorders and Stroke (NINDS) of the National Institutes of Health (NIH). This is the largest single research grant in the Health Science Center’s history. The SPS3 is the first study of its kind in the world. Initiated with a pilot project in 1998, the study is now in Phase III with 50 clinical sites throughout the United States and Canada. The coordinating center is based in San Antonio. Within the next few months, the study will expand to include 20 additional sites throughout Mexico, Argentina, Ecuador, Chile and Spain.

Drs. Benavente and Hart and their research team are seeking to learn if a combination of aspirin and an anti-clotting agent called clopidogrel is more effective than aspirin alone for preventing recurrent strokes. Along with Pablo Pergola, M.D., Ph.D., associate professor of medicine, who is leading the hypertension component of the trial, they also are seeking to learn whether or not intensive blood pressure control is associated with fewer recurrent strokes. Their goal is to enroll 2,500 study participants who will be monitored for 3.5 years.

Talamantes is one of the nearly 600 patients already enrolled.

"I feel very glad to be alive and in this study," Talamantes said. "I feel much healthier and more knowledgeable about what I need to do to prevent another stroke. I have diabetes so that makes it tougher, but I know I can do it. I have the support of my family and the caring people at the Health Science Center."

What is a stroke?
What is a stroke?
There are two types of stroke:
1.) Ischemic – caused by a blood clot or the buildup of fatty deposits (plaque) in an artery in the brain, leading to the sudden interruption of blood flow to the brain
2.) Hemorrhagic – caused by the sudden rupture of a blood vessel or artery in the brain
The majority of strokes are ischemic (85 percent), with more than 27 percent of those being small subcortical strokes. Subcortical strokes are usually not fatal but almost always strike again, causing dementia and paralysis. Many subcortical stroke victims initially do not feel symptoms and do not realize they’ve had a stroke.
Study participants are randomly assigned to one of two types of treatment - either aspirin alone or the combination of aspirin and clopidogrel. Participants with hypertension are randomly assigned to one of two groups of blood pressure control - below 130 mmHg of systolic pressure or between 130 and 149 mmHg. All medications and clinic visits are free to study participants. Ana Roldan, M.D., SPS3 study coordinator, provides all participants with a tailored diet and exercise plan, healthy recipes and meal plans, free transportation and home visits if needed, and a 24-hour-a-day emergency hotline.

Renato Ornelas, 83, also participates in the study. In 1945 he was awarded a Purple Heart Medal after he was wounded in Belgium during World War II in the Battle of the Bulge. "I was never in the hospital before or after that time until I had a stroke in 2001," he said. "And I don’t want to go back. That’s why I’m in the study. There are no words to express the gratitude my wife, Carolina, and I have for the Health Science Center doctors and their team. They are educating me, taking care of me and I feel good about my future. I’m a survivor," Ornelas said.

Through the SPS3, Drs. Benavente and Hart and their research team continue to help stroke survivors across the globe prevent a second attack from devastating their lives.

Join the UTHSC’s stroke study
The SPS3 study is enrolling patients who are 40 or older and who have had a subcortical stroke. For more information and study guidelines, call (210) 592-0404.



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