Stroke

Stroke happens when blood flow to part of the brain stops.

First, you received treatment to prevent further damage to the brain, and to help the heart, lungs, and other important organs heal.

After you were stable, doctors did testing and started treatment to help you recover from the stroke and prevent a future stroke. You may have stayed in a special unit that helps people recover after a stroke.

High blood pressure is the main risk factor for strokes.

Other major risk factors are:
  • Irregular heartbeat, called atrial fibrillation
  • Diabetes
  • Family history of stroke
  • High cholesterol
  • Increasing age, especially after age 55
  • Ethnicity (African Americans are more likely to die of a stroke)
Stroke risk is also higher in:
  • People who have heart disease or poor blood flow in their legs caused by narrowed arteries
  • People who have unhealthy lifestyle habits such as smoking, a high-fat diet, and lack of exercise
  • Women who take birth control pills (especially those who smoke and are older than 35)
  • Women who are pregnant have an increased risk while pregnant
  • Women who take hormone replacement therapy
There are two major types of stroke:
  • Ischemic stroke
  • Hemorrhagic stroke

Ischemic stroke occurs when a blood vessel that supplies blood to the brain is blocked by a blood clot. This may happen in two ways:

  • A clot may form in an artery that is already very narrow. This is called a thrombotic stroke.
  • A clot may break off from another place in the blood vessels of the brain, or from some other part of the body, and travel up to the brain. This is called cerebral embolism, or anembolic stroke.

Ischemic strokes may also be caused by a sticky substance called plaque that can clog arteries.

A hemorrhagic stroke occurs when a blood vessel in part of the brain becomes weak and bursts open. This causes blood to leak into the brain. Some people have defects in the blood vessels of the brain that make this more likely.

Hemorrhagic strokes may also occur when someone is taking blood thinners, such as warfarin (Coumadin). Very high blood pressure may cause blood vessels to burst, leading to hemorrhagic stroke.

An ischemic stroke can develop bleeding and become a hemorrhagic stroke.

Symptoms of stroke depend on which part of the brain is damaged. In some cases, a person may not know that a stroke has occurred.

Most of the time, symptoms develop suddenly and without warning. But symptoms may occur on and off for the first day or two. Symptoms are usually most severe when the stroke first happens, but they may slowly get worse.

A headache may occur if the stroke is caused by bleeding in the brain.

The headache includes the following:
  • Starts suddenly and may be severe
  • May be worse when you are lying flat
  • Wakes you up from sleep
  • Gets worse when you change positions or when you bend, strain, or cough

Other symptoms depend on how severe the stroke is, and what part of the brain is affected.

Symptoms may include:
  • Change in alertness (including sleepiness, unconsciousness, and coma)
  • Changes that affect touch and the ability to feel pain, pressure, or different temperatures
  • Confusion or loss of memory
  • Problems swallowing
  • Problems writing or reading
  • Dizziness or abnormal feeling of movement (vertigo)
  • Eyesight problems, such as decreased vision, double vision, or total loss of vision
  • Lack of control over the bladder or bowels
  • Loss of balance or coordination, or trouble walking
  • Muscle weakness in the face, arm, or leg (usually just on one side)
  • Numbness or tingling on one side of the body
  • Personality, mood, or emotional changes
  • Trouble speaking or understanding others who are speaking
The doctor will do a physical exam to:
  • 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 to the carotid arteries in the neck with a stethoscope for an abnormal sound, called a bruit, which is caused by abnormal blood flow.
  • Check for high blood pressure.
You may have the following tests to help find the type, location, and cause of the stroke and rule out other problems:
  • Angiogram of the head to look for a blood vessel that is blocked or bleeding
  • Ultrasound to see if the carotid arteries in your neck have narrowed
  • Echocardiogram to see if the stroke could have been caused by a blood clot from the heart
  • Magnetic resonance angiography (MRA) or CT angiography to check for abnormal blood vessels in the brain

Other tests include:

  • Blood tests
  • Electrocardiogram (ECG) and heart rhythm monitoring

A stroke is a medical emergency. Quick treatment is needed. Call 9-1-1 or your local emergency number right away or seek urgent medical care at the first signs of a stroke.

People who are having stroke symptoms need to get to a hospital as quickly as possible.

  • If the stroke is caused by a blood clot, a clot-busting drug may be given to dissolve the clot.
  • To be effective, this treatment must be started within 3 to 4 1/2 hours of when the symptoms first started. The sooner this treatment is started, the better the chance of a good outcome.

Other treatments given in the hospital depend on the cause of the stroke.

These may include:
  • Blood thinners such as heparin, warfarin (Coumadin), aspirin, or clopidogrel (Plavix)
  • Medicine to control risk factors, such as high blood pressure, diabetes, and high cholesterol
  • Special procedures or surgery to relieve symptoms or prevent more strokes
  • Nutrients and fluids

Physical therapy, occupational therapy, speech therapy, and swallowing therapy will all begin in the hospital. If the person has severe swallowing problems, a feeding tube in the stomach (gastrostomy tube) will likely be needed.

The goal of treatment after a stroke is to help you recover as much function as possible and prevent future strokes.

Recovery from your stroke will begin while you are still in the hospital or at a rehabilitation center. It will continue when you go home from the hospital or center. Be sure to follow up with your health care provider after you go home.