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Stroke
Basic Information

Stroke

The brain is arguably the most complex of all the organs in your body. These three pounds of tissue compose the major nerve center of the body, which coordinates all of our bodily functions, including behavior, thought and emotions. Because your brain is a very hard-working organ, it requires constant supplies of oxygen and nutrients from the blood to function effectively. The heart pumps blood throughout the cerebral arteries ("cerebral" means "related to the brain"), delivering blood to the brain. Any significant interruption to this supply of nutrients and oxygen will start killing brain cells. Damage to brain cells occurs almost immediately upon cessation or even significant restriction of blood flow to the brain. Minor damage to any part of the brain can have a serious adverse effect on the rest of the body. Significant damage to the brain can even result in death.

One relatively common cause of brain damage and death is referred to as a stroke. A stroke is similar to ...

 

 
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What is a stroke?

  • A stroke is similar to a heart attack, only in this case, blood flow to brain, rather than the heart, is blocked.
  • The term "stroke" comes from the once popular idea that someone had received a "stroke of God's hand" and was therefore damaged.
  • Strokes are also called cerebrovascular accidents (CVA's; "cerebrum" is Latin for brain, while "vascular" refers to the blood vessels) or "brain attacks" to emphasize the need to call 911 and get immediate medical attention when they occur.
  • Approximately 700,000 Americans suffer a stroke each year and it is the third major cause of death in the United States each year after heart disease and cancer.
  • Arterial blood vessels feeding the brain can become blocked on a permanent or temporary basis.
  • The term stroke is generally reserved for more permanent blockages that do not rapidly and spontaneously resolve themselves.
  • Transient and temporary blockages are called Transient Ischemic Attacks (or TIAs for short).
  • Ischemic strokes occur when a blood clot (called a "thrombi") or a fatty plaque (composed of fat deposits, cholesterol, and waste products) blocks blood flow to an area of the brain, causing death of the associated neurons (brain cells). Approximately 88% of strokes are ischemic events.
  • Hemorrhagic stroke, occurs when a cerebral (brain) artery ruptures and spills blood over the brain tissue.
  • Though strokes can be lethal, there are many people who survive them. These stroke survivors typically experience a range of limitations.

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Can a stroke be prevented?

  • Your risk of stroke is influenced by many factors. Some factors, like age, cannot be changed, but other factors (like high blood pressure) can be minimized by healthy lifestyle choices and medication (if necessary).
  • Here is a list of some of the risk factors for stroke over which people have little control:
    • Age. The risk of stroke increases as people grow older.
    • Family History. Your risk for stroke is greater than average if you have a close blood relative who has had a stroke.
    • Race. The risk of stroke is higher in African Americans, but lower in Asian Americans.
    • Gender. Men are slightly more likely than women to experience a stroke. However, women are slightly more likely to die of stroke than men.
    • Previous History of Stroke or Heart Attack. If you have had a previous stroke you more likely to have another. Similarly, individuals who have had heart attacks (Myocardial Infarction or MI\'s) also have a higher risk of stroke.
    • Transient Ischemic Attack. A person who has experienced a TIA is more likely to have a stroke than an individual who has not had a TIA.
    • Hypercoaguable State: Genetically, some individuals tend to make blood clots more easily than other people, a condition referred to as being "hypercoaguable". Hypercoaguable people are at a higher risk of a stroke.
  • There are also many risk factors for stroke that people can control or manage through careful lifestyle choices and the appropriate use of medicine:
    • Hypertension. Commonly known as high blood pressure, hypertension is a major risk factor for stroke. Without treatment, a hypertensive person's stroke risk can be four to six times that of people with normal or controlled blood pressure.
    • Atrial Fibrillation. An estimated 15% of strokes occur in people with atrial fibrillation, a type of heart disease.
    • Diabetes is a disease in which the body does not produce or properly use insulin, a hormone that is needed to convert sugar, starches and other food into energy. Having diabetes raises a person's stroke risk significantly (diabetics are 3x more likely to have strokes than non-diabetics).
    • High Cholesterol - while some cholesterol is necessary for the body, too much cholesterol (either because of genetics or diet) increases the chance of ischemic stroke.
    • Tobacco Use - Smoking doubles a person's risk for stroke.
    • Alcohol Intake - People who drink alcohol excessively are more likely to have a stroke.
    • Sedentary Lifestyle - Physical inactivity directly contributes to many of the risk factors associated with stroke described above, including obesity, diabetes, hypertension, and high cholesterol.

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What are the symptoms of a stroke?

  • The longer a stroke continues, the more likely it is that you will end up with permanent and irreversible brain damage.
  • The ideal goal is to start treatment for a stroke within 3 hours of the onset of symptoms in order to minimize damage. For this reason, a stroke is considered an emergency medical situation.
  • It is vital that you and your family become familiar with the symptoms and signs of a stroke so that you can recognize when one is occurring.
  • Some of the more common symptoms of stroke include:
    • Numbness in the face or limbs on one side of the body
    • Sudden, painless weakness on one side of the body.
    • Sudden confusion
    • Sudden trouble in understanding language.
    • Sudden slurring of the speech or difficulty speaking.
    • Trouble walking, sometimes accompanied by loss of balance.
    • Sudden onset of a severe headache with no apparent cause.
    • Sudden painless loss of vision in one or both of eyes.
    • Drooping of one side of the face

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How is a stroke diagnosed?

  • The ideal goal is to start treatment for a stroke within 3 hours of the onset of symptoms in order to minimize damage.
  • Therefore, doctors will move quickly to diagnose a suspected stroke using one or several of the following methods:
  • CT (or CAT) Scan. CT-scans are one of the most commonly used diagnostic tests for stroke, as they are relatively quick, and easy to perform in most medical centers. Doctors often use CT scans to make certain that a hemorrhagic stroke has not occurred. Once doctors have verified that there is no brain bleeding, medication can be used to dissolve remaining clots (which can cause an ischemic stroke).
  • MRI, or magnetic resonance imaging, uses magnetic fields to create detailed images of the body and brain tissue. MRI provides a more detailed brain image than does CT scanning, allowing for more sensitive detection of small changes.
  • An angiogram provides an image of the blood flow in a person\'s arteries. Angiography is currently the best method for determining the location of a stroke in the brain (i.e., which blood vessel) as well as the type of stroke (ischemic or hemorrhagic), but is typically reserved for times when there is uncertainty that is not clarified by a CT or MRI scan.
  • In an ultrasound test, sound waves are aimed at areas of the neck or head, where blood flow may be abnormal. The images provide doctors with a picture of blood flow through these arteries. Ultrasound can be helpful for identifying the causes of stroke such as plaques, carotid artery stenosis (blockage), or emboli (blood clots that have broken loose).

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How is a stroke treated?

  • The key to successful treatment of stroke when it is occurring is getting help as soon as possible.
  • Receiving faster medical care results in a greater chance of recovery and minimizing brain damage.
  • The type of stroke that has occurred, as well as the length of time between when the stroke occurred and treatment is initiated determine which therapies doctors can use.
  • The goals of treatments for ischemic stroke are to remove blockage and restore blood flow to the brain as quickly as possible. Doctors may use one or more of the following techniques in the service of these goals:
    • "Clot Buster" Medications (e.g., TPA or tissue plasminagen activators). Clot busting drugs (otherwise known as "thrombolytics") work to dissolve blood clots that can block arteries, decreasing the disability caused by a stroke. In order to work, they must be administered within three hours of the onset of stoke symptoms.
    • Aspirin blocks the ability of platelets to clot, which might decrease the chance of death or disability from stroke.
    • Immediately during and following a stroke, your blood pressure, oxygen, and glucose levels will be monitored.
  • The goals of hemorrhagic stroke treatment are to seal off the ruptured artery to prevent further blood loss, and to prevent uncontained blood from contacting brain tissue. Doctors use the following techniques in the service of these goals:
    • In many instances of hemorrhagic stroke, surgery will be necessary to seal the ruptured artery. Surgery also allows removal of the extra blood, so pressure does not increase in the brain and cause damage.
    • Endovascular Treatment - In this procedure, doctors insert a tube called a catheter into a major artery. The tube is guided through the blood vessel until it reaches the affected area in the brain at risk for rupture and a stabilizer is inserted into the arterial wall, making a rupture less likely. Endovascular treatment is most useful as a preventative measure (rather than a treatment for a stroke that has already occurred).

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What types of rehabilitation are used after a stroke?

  • A range of therapies are available to help patients work towards recovery of lost functioning (in as much as that is possible) and to prevent them from experiencing future strokes.
  • In general, the severity of the stroke determines the amount of time a person will need to spend in post-stroke rehabilitation.
  • Physical therapists can help stroke patients to relearn important everyday activities such as sitting, standing up, walking, and balancing.
  • Occupational therapists can help people relearn important activities of daily life (such as eating, drinking, using the restroom, preparing food, bathing, reading and writing) to the greatest extent possible.
  • Speech therapists can work with a stroke patient to help them regain some of their communication abilities to the extent that is possible.
  • Approximately 20% of individuals will go on to develop Major Depression. Psychotherapy and/or anti-depressant medication are effective strategies for treating depression in most people.
  • Stroke patients also need to lean on a strong support group of family and loved ones to provide encouragement and assistance during the often difficult rehabilitation stage.

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What types of lifestyle changes should be made after a stroke?

  • Quit Smoking - the first change in your life (if applicable) should be to quit smoking.
  • Eat A Healthy Diet - your dietary choices can inflate or lessen your stroke risk. In addition to the amount of food (and calories) you consume, it is also important to pay attention to the types of food you eat.
  • Exercise Regularly - getting regular aerobic exercise that raises your heart rate for extended periods of time (brisk walking, jogging, swimming, court sports, etc.) is another way to lower your stroke risk.
  • Get Your Affairs In Order - stroke is a sometimes disabling event that can rob people of the ability to communicate their wishes. All adults should prepare a "living will" in advance of developing health problems such as stroke. These documents help people articulate their desires for medical intervention and life support in the event that they are not able to speak for themselves. Stroke survivors who don't have such a document prepared should strongly consider preparing such a document now. Discussing end-of-life issues can be hard for some people, but having this discussion with family members allows all relevant parties to be aware of an individual's wishes ahead of time.

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