Basics & Facts
Stroke is one of the leading causes of death in the United States. This condition – also called a brain attack — occurs when the blood supply to a section of the brain is interrupted or blocked for a period of time. This lack of blood deprives the tissue of nutrients and oxygen and the brain cells begin to die. The consequences of a stroke are usually very significant and can cause substantial physical and mental disability. Because of the serious implications of stroke, it is considered a medical emergency.
There are two basic forms of stroke, ischemic and embolic, and both can be life-threatening.
The majority of strokes – around 85 percent — are ischemic strokes. When an artery in your brain becomes narrowed or blocked, the blood flow to that section of brain is decreased (which is called ischemia) or blocked completely. With appropriate medical care, people survive this type of stroke although they may have some disabilities afterwards.
There are two kinds of ischemic strokes.
- Thrombotic: A thrombotic stroke occurs when a blood clot forms in one of the blood vessels leading to the brain.
- Embolic: An embolic stroke occurs when a blood clot travels through the bloodstream and is lodged in the narrowed blood vessel blocking blood flow.
When a blood vessel in the brain breaks and leaks, it is called a hemorrhagic stroke. These types of strokes are quite often fatal; eighty percent of massive bleeds lead to death and even smaller bleeds are fatal 50% of the time.
There is more than one type of hemorrhagic stroke as well.
- Intracerebral hemorrhage: In this condition, a blood vessel inside the brain leaks and damages the brain cells.
- Subarachnoid hemorrhage: Here an artery on or near the surface of your brain bleeds and the blood goes into the space between your brain and your skull. Subarachnoid hemorrhages usually cause a horrible, sudden headache.
A transient ischemic attack (TIA) or a mini-stroke is a temporary episode caused by a temporary decrease or blockage of blood to your brain. TIAs are often warning signs for a more serious ischemic stroke and can cause the same type of symptoms. TIAs only last for around five minutes, but it doesn’t mean that you should not seek medical help as a more significant event may be on the way.
Symptoms of a stroke include:
- Sudden issues with walking or balance
- Sudden numbness or weakness of face, arm, or leg – especially if all on one side of the body
- Sudden difficulty with speaking or understanding
- Sudden problems with vision in one or both eyes
- Sudden severe headache
The changes you notice during a stroke are related to the area of the brain that is affected. If you notice any of these signs or symptoms, it is important to seek medical help immediately. It is also important to remember when the symptoms started because that information may help the doctors make treatment decisions.
Risks & Causes
Anyone can have a stroke, but your chances are higher if you have certain risk factors. Risk factors can be either controllable or uncontrollable.
Controllable risk factors can be managed or treated and include:
- Lifestyle Risks: Smoking, physical inactivity, heavy alcohol use and use of illicit drugs like cocaine, obesity.
- Medical Risks: High blood pressure, heart disease, high cholesterol levels, use of birth control pills and diabetes.
Uncontrollable risk factors can’t be treated or changed:
- Over age 55
- Being male
- Being African American, Hispanic, or Asian/Pacific Islander
- Having a family history of stroke or TIAs
Diagnosis & Tests
Making the diagnosis of stroke as quickly as possible is important as the medical professionals will ask you and your family a lot of questions. They will also start a work-up to determine which part of the brain is being affected and how much damage has been done.
- Physical Examination: The doctor will check your medications, medical history, and family history; the doctor will also check your blood pressure, listen to your heart and neck with a stethoscope, and look into your eyes with an ophthalmoscope. The doctor will also perform an exam and repeat it regularly to see if your symptoms have changed.
- Lab Work: Your health care provider will have your blood tested to see if it forms clots normally, if your blood sugar level is normal, if you have any infection, or if any of the substances in your blood are out of balance.
- Heart Monitoring: The doctor will order an electrocardiogram (ECG) to see if an irregular heart rhythm may have caused your stroke.
- Computerized Tomography (CT scan): This scan shows a detailed image of your brain and can pick up bleeding, tumors or other conditions. Sometimes the doctor will inject a dye to get better resolution.
- Magnetic Resonance Imaging (MRI): This test uses radio waves and magnets to detect areas of damaged brain tissue. Dye may also be used during this test as well.
- Carotid Ultrasound: This is an ultrasound of the arteries in your neck to see if they are narrowed.
- Cerebral Angiogram: This is a dye test of the blood vessels in your brain. It shows if a vessel is blocked or bleeding.
Treatment & Management
For an ischemic stroke, blood flow to your brain has to be restored as soon as possible. The damage to your brain may be minimized if the clot is removed soon enough. There are several medications that you may be given to try to achieve this:
- Thrombolytics: These clot-busting medications – also called thrombolytic therapy – have to be given by 4.5 hours after the symptoms first started in order to be effective. This usually means you would have arrived at the hospital three hours after the initial signs. This medication is given by vein.
- Aspirin: You may be given aspirin because aspirin prevents clots from forming.
- Other Blood Thinners: You may be given other medications that also prevent clots from forming but those don’t always work as well in the emergent setting.
There are also procedures that your physician may try to remove the clot in your blood vessel:
- Sometimes the doctor will administer the clot-busting medication directly into the brain through a catheter snaked through a vein in your groin up to your head.
- The doctor may use the same type of catheter to try to manually remove the clot from your brain.
Treatment that may be needed in the non-emergent setting involves surgically cleaning out or widening any narrowed blood vessels in your neck.
For a hemorrhagic stroke, the treatment is different. The main goal here is to lower your blood pressure and to prevent or decrease high pressures in your brain.
- If you already take a blood-thinning medication like warfarin (Coumadin) or cloplidogrel (Plavix), the clinicians may give you transfusions or other medications to counteract the effect of the blood thinner.
- Surgery on a blood vessel that caused the bleed may be needed.
- Sometimes surgery to remove the blood in the brain may be necessary.
The main treatment after the bleeding has stopped is bed rest and general medical care while you wait for your body to absorb the blood.
For both types of strokes, the aftercare includes stroke rehabilitation and recovery. The goal will be to help you regain as much mobility as you can and as much independence as you can manage. Most survivors spend time in a rehabilitation center undergoing physical, speech, occupational and any other therapy that is needed.
Depending on your disability and level of independence, you may be able to return home or may have to go to some other facility after your time in the hospital or rehab center.
Up to 80% of all strokes can be prevented by reducing your risk factors. Your doctors can develop strategies and work with you to lower your risk.
Some things that you can do – with your doctor’s help — to lower your risk of stroke:
- Lower your blood pressure
- Stop smoking
- Lower your cholesterol
- Manage your diabetes
- Manage your weight
- Drink in moderation
- Avoid illicit drugs
- Eat a healthy diet
- Manage sleep apnea if you have it
- Reduce salt intake
Your physician may also prescribe some medications that may lower your risk:
- Anti-platelet drugs like aspirin, a combination of aspirin and dipyridamole, or clopidogrel (Plavix) to lessen the risk of your blood forming clots.
- Anticoagulant drugs (blood-thinners), like heparin or warfarin (Coumadin).
Following your doctor’s recommendations can improve your chances of not being affected by a stroke.
Bettering Your Odds
Knowing the signs and symptoms of a stroke may save you or a loved one’s life; quick medical attention can make a significant difference in many cases. However, knowing the risks for developing a stroke and working with your health care provider to lower those risks can make a tremendous difference as well. Prevention is the best treatment – talk to your physician about changes you can make to lower your risk.