Stroke

    Definition

    A stroke is sometimes called a “brain attack.” Most often, stroke occurs when blood flow to the brain stops because it is blocked by a clot. When this happens, the brain cells in the immediate area begin to die.

    Some brain cells die because they stop getting the oxygen and nutrients they need to function. Other brain cells die because they are damaged by sudden bleeding into or around the brain. The brain cells that don’t die immediately remain at risk for death. These cells can linger in a compromised or weakened state for several hours. With timely treatment, these cells can be saved.

    Stoke is identified as being 67% higher in African American men than other ethnic groups and 88% of blacks are more likely to die from a stroke than whites.

     

    Alternative Names

    Cerebrovascular disease; CVA; Cerebral infarction; Cerebral hemorrhage; Ischemic stroke; Stroke – ischemic; Cerebrovascular accident; Stroke – hemorrhagic

    Causes

    If blood flow is stopped for longer than a few seconds, the brain cannot get blood and oxygen. Brain cells can die, causing permanent damage.

    Even though a stroke occurs in the unseen reaches of the brain, the symptoms of a stroke are easy to spot. They include sudden numbness or weakness, especially on one side of the body; sudden confusion or trouble speaking or understanding speech; sudden trouble seeing in one or both eyes; sudden trouble walking, dizziness, or loss of balance or coordination; or sudden severe headache with no known cause. All of the symptoms of stroke appear suddenly, and often there is more than one symptom at the same time. Therefore stroke can usually be distinguished from other causes of dizziness or headache. These symptoms may indicate that a stroke has occurred and that medical attention is needed immediately.

    There are two forms of stroke: ischemic – blockage of a blood vessel supplying the brain, and hemorrhagic – bleeding into or around the brain.

    Symptoms

    Because stroke injures the brain, you may not realize that you are having a stroke. To a bystander, someone having a stroke may just look unaware or confused. Stroke victims have the best chance if someone around them recognizes the symptoms and acts quickly.

    If you see or have one or more of these symptoms, they could be indicative of a stroke.
    •    Sudden numbness or weakness of face, arm, or leg, especially on one side of the body.
    •    Sudden confusion or trouble speaking or understanding speech.
    •    Sudden trouble seeing in one or both eyes.
    •    Sudden trouble walking, dizziness, or loss of balance or coordination
    •    Sudden severe headache with no known cause.

    Other danger signs that may occur include double vision, drowsiness, and nausea or vomiting. Sometimes the warning signs may last only a few moments and then disappear. These brief episodes, known as transient ischemic attacks or TIAs, are sometimes called “mini-strokes.” Although brief, they identify an underlying serious condition that isn’t going away without medical help. Unfortunately, since they clear up, many people ignore them. Don’t. Paying attention to them can save your life.

    Exams and Tests

    A complete exam should be done. Your doctor will:
    •    Check for problems with vision, movement, feeling, reflexes, understanding, and speaking. Your doctor and nurses will repeat this exam over time to see if your stroke is getting worse or improving.
    •    Listen for an abnormal sound, called a “bruit,” when using a stethoscope to listen to the carotid arteries in the neck. A bruit is caused by abnormal blood flow.
    •    Check your blood pressure, which may be high.

    Tests can help your doctor find the type, location, and cause of the stroke and rule out other disorders.
    •    Angiogram of the head can show which blood vessel is blocked or bleeding
    •    Carotid duplex (ultrasound) can show if the carotid arteries in your neck have narrowed
    •    CT scan of the brain is often done soon after symptoms of a stroke begin. An MRI scan of the brain may be done instead or afterwards
    •    Echocardiogram may be done if the stroke could have been caused by a blood clot from the heart
    •    Magnetic resonance angiography (MRA) or CT angiography may be done to check for abnormal blood vessels in the brain

    Other tests include:
    •    Lab tests will include:
    •    Bleeding time
    •    Blood cholesterol and sugar
    •    Blood clotting tests (prothrombin time or partial thromboplastin time)
    •    Complete blood count (CBC)
    •    Electrocardiogram (ECG) and heart rhythm monitoring — to show whether an irregular heartbeat (such as atrial fibrillation) caused the stroke

    Treatments

    With stroke, treatment depends on the stage of the disease. There are three treatment stages for stroke: prevention, therapy immediately after stroke, and rehabilitation after stroke. Stroke therapies include medications, surgery, and rehabilitation.

    Medication or drug therapy is the most common treatment for stroke. The most popular kinds of drugs to prevent or treat stroke are antithrombotics — which include antiplatelet agents and anticoagulants — and thrombolytics.

    Surgery and Vascular Procedures

    Surgery and vascular procedures can be used to prevent stroke, to treat stroke, or to repair damage to the blood vessels or malformations in and around the brain.

    Physical Therapy

    For most stroke patients, rehabilitation mainly involves physical therapy. The aim of physical therapy is to have the stroke patient relearn simple motor activities such as walking, sitting, standing, lying down, and the process of switching from one type of movement to another.

    Occupational Therapy

    Another type of therapy to help patients relearn daily activities is occupational therapy. This type of therapy also involves exercise and training. Its goal is to help the stroke patient relearn everyday activities such as eating, drinking and swallowing, dressing, bathing, cooking, reading and writing, and toileting. Occupational therapists seek to help the patient become independent or semi-independent.

    Speech Therapy

    Speech and language problems arise when brain damage occurs in the language centers of the brain. Due to the brain’s great ability to learn and change, which is called brain plasticity, other areas can adapt to take over some of the lost functions.

    Therapy for Mental Health

    Many stroke patients require psychological or psychiatric help after a stroke. Psychological problems such as depression, anxiety, frustration, and anger are common disabilities in people who have suffered a stroke.

    Possible Complications

        •    Breathing food into the airway (aspiration)
    •    Dementia
    •    Falls
    •    Loss of mobility
    •    Loss of movement or feeling in one or more parts of the body
    •    Muscle spasticity
    •    Poor nutrition
    •    Pressure sores
    •    Problems speaking and understanding
    •    Problems thinking or focusing

    When to Contact a Medical Professional

    Stroke is a medical emergency that needs to be treated right away. Call your local emergency number (such as 911) if someone has symptoms of a stroke.

    Preventions

    Stroke is preventable and treatable. A better understanding of the causes of stroke has helped people make lifestyle changes that have cut the stroke death rate nearly in half in the last two decades.

    While family history of stroke plays a role in your risk, there are many risk factors you can control:
    •    If you have high blood pressure, work with your doctor to get it under control.
    •    If you smoke, quit.
    •    If you have diabetes, learn how to manage it. Many people do not realize they have diabetes, which is a major risk factor for heart disease and stroke.
    •    If you are overweight, start maintaining a healthy diet and exercising regularly.
    •    If you have high cholesterol, work with your doctor to lower it. A high level of total cholesterol in the blood is a major risk factor for heart disease, which raises your risk of stroke.

    Natural Remedies

    Several types of strokes can strike the
    brain with little warning—but you can cut your risk for future strokes.
    According to research or other evidence, the following self-care steps may be
    helpful:

    What You Need To Know:

    • Modify your diet
      Reduce stroke risk by eating lots of
      fruits, vegetables, whole grains, and fish
    • Steer clear of smoke
      Kick the habit and avoid
      secondhand smoke to lower your risk
    • Trim down
      Shed those extra pounds and maintain a
      healthy weight to lower your risk
    • Work in a workout
      Being a couch potato increases your
      stroke risk, so be sure to get regular exercise
    • Take a test
      Visit your doctor for a series of tests to
      determine if you have problems with high blood pressure or high blood levels of
      cholesterol, triglycerides, or glucose; all may increase your risk of stroke

    These recommendations are not comprehensive and are not intended to replace
    the advice of your doctor or pharmacist. Continue reading the full stroke
    article for more in-depth, fully-referenced information on medicines, vitamins,
    herbs, and dietary and lifestyle changes that may be helpful.

     

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