Stroke

What is a stroke?

A stroke or "brain attack" is a brain injury. It happens when the blood flow to part of the brain is suddenly reduced or stopped. The part of the brain that loses its blood supply stops working. You may have trouble using the part of the body that is controlled by the part of the brain that is damaged.

Many times, strokes are small, causing little damage and not much disability. However, a stroke may cause life-long damage. Sometimes it causes death. How much you recover from a stroke depends on how much the brain was damaged. Some people recover fully from a stroke. Others have life-long problems, such as weakness in an arm or leg, inability to speak, or paralysis. Full recovery from a stroke is more likely if you get medical help right away.

A stroke is also called a cerebral vascular accident, or CVA.

What is the cause?

A stroke may be caused by anything that stops or slows down blood flow to part of the brain. Blood can be kept from reaching brain tissue when a blood vessel gets blocked (an ischemic stroke) or bursts (a hemorrhagic stroke).

• An ischemic stroke is the most common kind of stroke. A blood vessel in the brain can be blocked in different ways.
  • Fatty deposits called plaque may build up in blood vessels and make them very narrow. The narrowing decreases the amount of blood flow to the brain. Small pieces of plaque may break off from the wall of a blood vessel and completely block a smaller blood vessel.
  • Blood clots may form in a blood vessel of the brain or neck and block the blood vessel.
  • Blood clots, air, or fat from other parts of the body may travel to the brain or neck and block a blood vessel in the brain.
• A hemorrhagic stroke happens when an artery in the brain breaks and causes bleeding into the brain. A hemorrhage often happens without warning. High blood pressure can cause hemorrhagic strokes. Sometimes a blood vessel defect present since birth can cause this type of stroke.

Your risk of having a stroke is higher if you:

• are over the age of 55
• have a family member who has had a stroke
• are African American
• are male
• have already had a stroke, transient ischemic attack (TIA), or heart attack

You are more likely to have a stroke if you have a medical condition that puts a strain on your heart and blood vessels such as:

• high blood pressure
• diabetes or metabolic syndrome
• high cholesterol
• blood vessel disease
• heart rhythm or heart valve problems
• sickle cell anemia

Some unhealthy lifestyle habits can increase your risk for a stroke. You are more likely to have a stroke if you:

• Smoke.
• Eat an unhealthy diet.
• Are overweight.
• Don't get enough exercise.
• Use illegal drugs or too much alcohol.

What are the symptoms?

The symptoms of a stroke depend on what part of the brain is affected and how much is damaged. Symptoms of a stroke come on suddenly and may include:

• numbness or weakness of the face, arms, or legs, especially on one side of the body
• confusion or trouble speaking or understanding others
• trouble seeing with one or both eyes
• trouble walking, dizziness, or loss of balance or coordination
• severe headache with no known cause

A TIA may happen before a stroke. TIAs happen when the blood flow to the brain is reduced for a short time without causing lasting damage. The symptoms of a TIA are similar to the symptoms of a stroke. Having a TIA can mean that you are at high risk for having a stroke.

If you think that you or someone near you is having a stroke, call 911 right away. Don't do anything else before you call 911.

How is it diagnosed?

Your healthcare provider will ask about the history of your symptoms and any medicines or supplements you take. Your provider will examine you.

Tests you may have to look at the blood vessels in your head or neck may include:

• MRI scan, which uses a powerful magnetic field and radio waves to make detailed pictures of the brain and blood vessels
• CT scan, which uses X-rays taken from different angles and arranged by a computer to show detailed pictures of the brain and blood vessels
• ultrasound scan, which uses sound waves and their echoes passed through your body from a small device held against your skin to create pictures of the brain and blood vessels
• cerebral angiogram, which uses a thin tube inserted into a blood vessel, contrast dye, and X-rays to look at how blood flows through the brain

Other tests you may have are:

• electrocardiogram (ECG), which measures and records the electrical activity of your heart
• echocardiogram, which uses ultrasound to create pictures of the inside of the heart

The type of stroke is not known for sure until you have a CT or MRI. If either test shows bleeding in the brain, the stroke is hemorrhagic. If the tests show damage without much bleeding, then the stroke is considered ischemic. Since treatment is different tor these 2 types of stroke, it’s important to have these tests as soon as possible.

How is it treated?

Strokes are treated at the hospital. The treatment depends on what kind of stroke you are having.

• A stroke caused by blood clots may be treated with clot-dissolving medicine. This medicine can help limit or prevent long-term problems. It needs to be given as soon as possible within 4 and a half hours after you start having symptoms of an ischemic stroke. The sooner you get the medicine, the better your chances of recovery.
• A stroke caused by bleeding in the brain from a torn artery is not treated with clot-dissolving medicine. If you have been taking medicine for blood clots, you will be taken off that medicine. If you have high blood pressure, you may be given medicine to lower your blood pressure.

You may need an IV and oxygen. You will be treated for any medical problems that may have caused the stroke. You may need surgery to repair a blood vessel or remove a blood clot.

Rehab may start at the hospital or at a nursing facility. Most rehab programs last several weeks to several months after you leave the hospital. Rehab includes different types of therapy.

• Physical therapy can help your muscles get strong again. You will learn ways to move safely with weak or paralyzed muscles.
• Occupational therapy helps you relearn ways to do things like eating and getting dressed.
• Speech therapy may help you if you have problems with swallowing, speaking, or understanding words.

How can I take care of myself and help prevent a stroke?

• Take your medicine just as your healthcare provider tells you to take it.
• Get regular medical checkups. Follow your provider's advice for healthy living and for preventing strokes.
• Keep your blood pressure under control.
• Keep your cholesterol levels within acceptable limits
• Avoid smoke from any source. If you are a smoker, quit. Talk with your healthcare provider if you need help quitting.
• Keep a healthy weight. Lose weight if you are overweight.
• Don’t drink too much alcohol.
  • Men should have no more than 1 to 2 drinks a day.
  • Women should have no more than 1 drink a day.
  • Limit alcohol as your provider tells you to.
• Exercise regularly for at least 2 hours and 30 minutes each week.
• Eat a healthy diet that is low in sodium and saturated and trans fat.
• Ask your provider if you should take aspirin. If your stroke was hemorrhagic (caused by bleeding), you will probably not take aspirin. If you had an ischemic stroke (caused by blockage of a blood vessel), your provider may recommend taking an aspirin or other type of medicine every day to help prevent blood clots.
• Don't take aspirin if you think you are having a stroke. Aspirin can make some types of stroke much worse.
• You can get more information from:

  American Stroke Association (affiliated with the American Heart Association)
  Phone: 1-888-4-STROKE
  Web site: http://www.strokeassociation.org