A stroke is the rapid loss of brain function caused by a disturbance in blood supply, either a blockage (ischemia) or leakage (hemorrhage). When brain cells are deprived of blood, some die immediately, and others remain at risk of death for several hours, but can be saved with prompt treatment.
Symptoms of stroke include:
- Dizziness and loss of balance or coordination
- Difficulty with speaking and understanding
- Paralysis or numbness on one side of your body or face. If you try to raise both arms over your head and one begins to fall, you may be having a stroke.
- Vision problems
- Sudden, severe headache
Seek immediate medical attention if you or someone with you experiences any of these symptoms, even if they disappear. Every minute counts - brain cells may be dying.
If someone with you may be having a stroke, watch him/her carefully while awaiting emergency personnel. You may have to:
- Render artificial respiration if the person stops breathing
- If vomiting occurs, turn the person's head to prevent choking
- Prevent the person from eating or drinking
Causes and Prevention
Almost 90% of strokes are ischemic (caused by blockage). The most common types of ischemic strokes are:
- Thrombotic - a clot develops in an artery that supplies blood to the brain.
- Embolic - a clot develops elsewhere and is moved by the blood to a narrower brain artery. This is often caused by an irregular heartbeat, which can lead to pooling and clotting of blood in the heart.
A hemorrhagic stroke is the leak or rupture of a blood vessel in the brain. There are two types of hemorrhagic stroke:
- Intracerebral hemorrhage - a blood vessel in the brain bursts, spilling blood into the brain, damaging cells, and depriving the region of the brain beyond the rupture of blood. This is usually caused by high blood pressure.
- Subarachnoid hemorrhage - an artery on or near the surface of the brain spills into the space between the brain and the skull, commonly caused by the rupture of an aneurysm, a weak spot in the artery.
Risk factors for stroke include:
- Having had a transient ischemic attack (mini-stroke)
- Family history of a stroke or heart attack
- Age 55 or older
- High blood pressure
- High cholesterol
- Smoking and exposure to secondhand smoke
- Heart disease
- Use of birth control pills or other therapies containing estrogen
- Heavy drinking
- Use of drugs like cocaine and methamphetamines
More women than men have strokes, but this is because women tend to live longer. African-Americans and Latinos are at higher risk of stroke than those of other races.
Diagnosis of a stroke begins with a short neurological examination, in which your WellStar physician will ask what symptoms you've had, when they occurred, what you were doing when they began, and whether they are still present. He/she will ask what medications you take, whether you've had a head injury, and about any family history of heart disease or stroke. Listening with a stethoscope can indicate atherosclerosis (hardening of the arteries), and examination of the back of your eyes can reveal tiny clots in the blood vessels there.
Brain imaging has a critical role in determining if you are having a stroke, what type it is, and where it is occurring. The types of imaging include:
- In computerized tomographic angiography (CTA), a dye is injected into your bloodstream, and X-rays create a three-dimensional image of the blood vessels in your neck and brain, rapidly revealing bleeding in or around the brain. If none is found, a diagnosis of ischemic (blockage) stroke is made.
- Magnetic resonance imaging (MRI) also creates a three-dimensional image of the brain, and can detect damage from an ischemic stroke. However, it is not as quick as a CTA scan.
- Carotid ultrasound uses sound waves to reveal narrowing or clotting in you carotid arteries.
- Arteriography is the injection of a dye into a specific artery through a catheter to provide X-ray images.
- Echocardiography is an ultrasound image of your heart, to see if a clot from your heart has traveled to your brain, causing a stroke.
Emergency treatment depends upon whether you are having an ischemic (blockage) stroke, or a hemorrhagic (leakage) stroke.
To treat an ischemic stroke, blood flow must be quickly restored to the affected part of your brain. Therapy with clot-breaking drugs begins as soon as possible, not only to improve chances of survival, but to reduce the neurological complications of a stroke. The most common clot-breaking drug is aspirin.
Another urgent medication is tissue plasminogen activator (TPA). If provided soon after the stroke, it may help you recover more fully. It can be injected intravenously, or delivered directly to the brain through a catheter.
The clot can also be removed mechanically using a catheter.
Once blood flow has been restored, your WellStar neurologist may recommend procedures to prevent recurrence of a stroke, including:
- Carotid endarterectomy is the physical removal of plaques in the arteries that run up your neck, supplying your brain with blood.
- Angioplasty widens the passage in an artery with a balloon, and a stent, a metal mesh tube, is often placed in the artery to keep it open.
Treatment for a hemorrhagic stroke entails controlling bleeding and reducing pressure on the brain. If you have been taking anti-clotting drugs, you will be given drugs to counter their effects. You may also be given drugs to lower blood pressure and prevent seizures and spasms.
Once bleeding stops, treatment is usually bed rest while your body reabsorbs the blood, as it does with a large bruise. In some cases, surgery may relieve the pressure of blood on the brain, or to repair the leaking blood vessel. This may include:
- In aneurysm clipping, a clamp is placed at the base of the aneurysm (bubble), keeping it from bursting.
- Coiling is the placement of multiple coils in the aneurysm, to induce formation of a clot to seal off the aneurysm.
- If it is accessible, the malformation can be removed surgically.
Stroke is the number one cause of serious disability in adults in the United States, placing a great burden on patients and their families. However, even if portions of the brain are lost in a stroke, there are therapies that rehabilitate stroke patients.
After emergency treatment, your WellStar neurologist will work with therapists to design a treatment program based on your age, health, and effects of your stroke. Physical therapy (PT) is the foundation of most post-stroke rehabilitation. Your WellStar physical therapist will use exercises and manipulation of your body to restore movement, balance, and coordination, helping you relearn simple activities like sitting, standing, and walking.
Occupational therapy involves relearning more complex tasks like eating, drinking, reading, and writing, helping you become more independent.
If your stroke has damaged the parts of your brain responsible for speech, you may have to relearn language skills. Fortunately, the brain has a great ability to learn and adapt, so other portions of your brain can be trained to take over lost communication function. With time, survivors of strokes that impact speech usually regain some or all of their previous language ability.
Many stroke patients also require psychiatric or psychological care, including counseling and medication, to help with depression, frustration, and anger resulting from their strokes.