Stroke

Within minutes, brain cells begin to die. There are two kinds of stroke. The more common kind, calledischemic stroke, is caused by a blood clot that blocks or plugs a blood vessel in the brain. The other kind, called hemorrhagic stroke, is caused by a blood vessel that breaks and bleeds into the brain. “Mini-strokes” or transient ischemic attacks (TIAs), occur when the blood supply to the brain is briefly interrupted.

SYMPTOMS OF STROKE ARE

• Sudden numbness or weakness of the face, arm or leg (especially on one side of the body)
• Sudden confusion, trouble speaking or understanding speech
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause

If you have any of these symptoms, you must get to a hospital quickly to begin treatment. Acute stroke therapies try to stop a stroke while it is happening by quickly dissolving the blood clot or by stopping the bleeding. Post-stroke rehabilitation helps individuals overcome disabilities that result from stroke damage. Drug therapy with blood thinners is the most common treatment for stroke.

Prevention

Taking action to control your risk factors can help prevent or delay a stroke.

IF YOU’VE ALREADY HAD A STROKE, THESE ACTIONS CAN HELP PREVENT ANOTHER ONE.

• Be physically active. Physical activity can improve your fitness level and health.
• Don’t smoke, or if you smoke or use tobacco, quit. Smoking can damage and tighten blood vessels and raise your risk of stroke. Also, secondhand smoke can damage the blood vessels.
• Maintain a healthy weight. If you’re overweight or obese, work with your doctor to create a reasonable weight loss plan. Controlling your weight helps you control risk factors for stroke.
• Make heart-healthy eating choices. Heart-healthy eating can help lower your risk or prevent a stroke.
• Manage stress. Use techniques to lower your stress levels.

If you or someone in your family has had a stroke, be sure to tell your doctor. By knowing your family history of stroke, you may be able to lower your risk factors and prevent or delay a stroke. If you’ve had a transient ischemic attack (TIA), don’t ignore it. TIAs are warnings, and it’s important for your doctor to find the cause of the TIA so you can take steps to prevent a stroke.

Risk Factors

Certain traits, conditions, and habits can raise your risk of having a stroke or transient ischemic attack (TIA).

The more risk factors you have, the more likely you are to have a stroke. You can treat or control some risk factors, such as high blood pressure and smoking. Other risk factors, such as age and gender, you can’t control.

THE MAJOR RISK FACTORS FOR STROKE INCLUDE:

• High blood pressure. High blood pressure is the main risk factor for stroke. Blood pressure is considered high if it stays at or above 140/90 millimeters of mercury (mmHg) over time. If you have diabetes or chronic kidney disease, high blood pressure is defined as 130/80 mmHg or higher.
• Diabetes. Diabetes is a disease in which the blood sugar level is high because the body doesn’t make enough insulin or doesn’t use its insulin, a hormone that helps move blood sugar into cells, properly.
• Heart diseases. Coronary heart disease, cardiomyopathy, heart failure, and atrial fibrillation can cause blood clots that can lead to a stroke.
• Smoking. Smoking can damage blood vessels and raise blood pressure. Smoking also may reduce the amount of oxygen that reaches your body’s tissues. Exposure to secondhand smoke also can damage the blood vessels.
• Age and gender. Your risk of stroke increases as you get older. At younger ages, men are more likely than women to have strokes. However, women are more likely to die from strokes. Women who take birth control pills also are at slightly higher risk of stroke.
• Race and ethnicity. Strokes occur more often in African American, Alaska Native, and American Indian adults than in white, Hispanic, or Asian American adults.
• Personal or family history of stroke or TIA. If you’ve had a stroke, you’re at higher risk for another one. Your risk of having a repeat stroke is the highest right after a stroke. A TIA also increases your risk of having a stroke, as does having a family history of stroke.
• Brain aneurysms or arteriovenous malformations (AVMs). Aneurysms are balloon-like bulges in an artery that can stretch and burst. AVMs are tangles of faulty arteries and veins that can rupture within the brain. AVMs may be present at birth, but often aren’t diagnosed until they rupture.

OTHER RISK FACTORS FOR STROKE INCLUDE:

• Alcohol and illegal drug use, including cocaine, amphetamines, and other drugs
• Certain medical conditions, such as sickle cell disease, vasculitis and bleeding disorders
• Lack of physical activity
• Overweight and Obesity
• Stress and depression
• Unhealthy cholesterol levels
• Unhealthy diet
• Use of nonsteroidal anti-inflammatory drugs (NSAIDs), but not aspirin, may increase the risk of heart attack or stroke, particularly in patients who have had a heart attack or cardiac bypass surgery. The risk may increase the longer NSAIDs are used. Common NSAIDs include ibuprofen and naproxen.

Following a healthy lifestyle can lower the risk of stroke. Some people also may need to take medicines to lower their risk.

Sometimes strokes can occur in people who don’t have any known risk factors.

Causes

An ischemic stroke or transient ischemic attack (TIA) occurs if an artery that supplies oxygen-rich blood to the brain becomes blocked. Many medical conditions can increase the risk of ischemic stroke or TIA.

For example, atherosclerosis is a disease in which a fatty substance called plaque builds up on the inner walls of the arteries. Plaque in an artery can crack or rupture. Blood platelets stick to the site of the plaque injury and clump together to form blood clots. These clots can partly or fully block an artery.

Plaque can build up in any artery in the body, including arteries in the heart, brain, and neck; the two main arteries on each side of the neck are called the carotid arteries.

When plaque builds up in the carotid arteries, the condition is called carotid artery disease. Carotid artery disease causes many of the ischemic strokes and TIAs that occur in the United States.

An embolic stroke (a type of ischemic stroke) or TIA also can occur if a blood clot or piece of plaque breaks away from the wall of an artery. The clot or plaque can travel through the bloodstream and get stuck in one of the brain’s arteries. This stops blood flow through the artery and damages brain cells.

Heart conditions and blood disorders also can cause blood clots that can lead to a stroke or TIA. For example, atrial fibrillation, or AF, is a common cause of embolic stroke.

In AF, the upper chambers of the heart contract in a very fast and irregular way. As a result, some blood pools in the heart. The pooling increases the risk of blood clots forming in the heart chambers.

An ischemic stroke or TIA also can occur because of lesions caused by atherosclerosis. These lesions may form in the small arteries of the brain, and they can block blood flow to the brain.

HEMORRHAGIC STROKE

Sudden bleeding in the brain can cause a hemorrhagic stroke. The bleeding causes swelling of the brain and increased pressure in the skull. The swelling and pressure damage brain cells and tissues.

Examples of conditions that can cause a hemorrhagic stroke include high blood pressure,aneurysms, and arteriovenous malformations (AVMs).

If blood pressure rises and stays high over time, it can damage the body in many ways.

Aneurysms are balloon-like bulges in an artery that can stretch and burst. AVMs are tangles of faulty arteries and veins that can rupture within the brain. High blood pressure can increase the risk of hemorrhagic stroke in people who have aneurysms or AVMs.

Symptoms

The signs and symptoms of a stroke often develop quickly. However, they can develop over hours or even days.

The type of symptoms depends on the type of stroke and the area of the brain that’s affected. How long symptoms last and how severe they are vary among different people.

SIGNS AND SYMPTOMS OF A STROKE MAY INCLUDE:

• Sudden weakness
• Paralysis or numbness of the face, arms, or legs, especially on one side of the body
• Confusion
• Trouble speaking or understanding speech
• Trouble seeing in one or both eyes
• Problems breathing
• Dizziness, trouble walking, loss of balance or coordination, and unexplained falls
• Loss of consciousness
• Sudden and severe headache

A transient ischemic attack (TIA) has the same signs and symptoms as a stroke. However, TIA symptoms usually last less than 1–2 hours (although they may last up to 24 hours). A TIA may occur only once in a person’s lifetime or more often.

At first, it may not be possible to tell whether someone is having a TIA or stroke. All stroke-like symptoms require medical care.

If you think you or someone else is having a TIA or stroke, call 9–1–1 right away. Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room. During a stroke, every minute counts.

Diagnosis

Your doctor will diagnose a stroke based on your signs and symptoms, your medical history, a physical exam, and test results.

Your doctor will want to find out the type of stroke you’ve had, its cause, the part of the brain that’s affected, and whether you have bleeding in the brain.

If your doctor thinks you’ve had a transient ischemic attack (TIA), he or she will look for its cause to help prevent a future stroke.

MEDICAL HISTORY AND PHYSICAL EXAM

Your doctor will ask you or a family member about your risk factors for stroke. Examples of risk factors include high blood pressure, smoking, heart disease, and a personal or family history of stroke. Your doctor also will ask about your signs and symptoms and when they began.

During the physical exam, your doctor will check your mental alertness and your coordination and balance. He or she will check for numbness or weakness in your face, arms, and legs; confusion; and trouble speaking and seeing clearly.

Your doctor will look for signs of carotid artery disease, a common cause of ischemic stroke. He or she will listen to your carotid arteries with a stethoscope. A whooshing sound called a bruit may suggest changed or reduced blood flow due to plaque buildup in the carotid arteries.

Treatment

Treatment for a stroke depends on whether it is ischemic or hemorrhagic. Treatment for a transient ischemic attack (TIA) depends on its cause, how much time has passed since symptoms began, and whether you have other medical conditions.

Strokes and TIAs are medical emergencies. If you have stroke symptoms, call 9–1–1 right away. Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin lifesaving treatment on the way to the emergency room. During a stroke, every minute counts.

Once you receive immediate treatment, your doctor will try to treat your stroke risk factors and prevent complications by recommending heart-healthy lifestyle changes.

TREATING AN ISCHEMIC STROKE OR TRANSIENT ISCHEMIC ATTACK

An ischemic stroke or TIA occurs if an artery that supplies oxygen-rich blood to the brain becomes blocked. Often, blood clots cause the blockages that lead to ischemic strokes and TIAs. Treatment for an ischemic stroke or TIA may include medicines and medical procedures.

Recovery

The time it takes to recover from a stroke varies—it can take weeks, months, or even years. Some people recover fully, while others have long-term or lifelong disabilities.

Ongoing care, rehabilitation, and emotional support can help you recover and may even help prevent another stroke.

If you’ve had a stroke, you’re at risk of having another one. Know the warning signs and what to do if a stroke or transient ischemic attack (TIA) occurs. Call 9–1–1 as soon as symptoms start.

Do not drive to the hospital or let someone else drive you. By calling an ambulance, medical personnel can begin lifesaving treatment on the way to the emergency room. During a stroke, every minute counts.