Cerebrovascular accident (stroke): Symptoms, treatments
Seek immediate medical attention if you notice any of the signs or symptoms of a stroke, even if seemingly fluctuating or disappearing, every minute.
Cerebrovascular accident (stroke): Symptoms, treatments
A stroke occurs when the blood supply to part of the brain is interrupted or severely reduced, depriving brain tissue of oxygen and nutrients. Within minutes, brain cells begin to die.
A stroke is a medical emergency. Early treatment is very important. Early action can minimize brain damage and potential complications.
Strokes can be treated and prevented. Better control of stroke risk factors - high blood pressure, smoking, and high cholesterol.
Look for signs and symptoms if you think you may have a stroke. Note when signs and symptoms begin, as time can guide treatment decisions.
Difficult to walk. Sudden tripping or dizziness, loss of balance, or coordination may occur.
Problems with speaking and understanding can experience confusion. It may be difficult or impossible to explain what is happening (aphasia). Try to repeat a simple sentence. If you can't, you could have a stroke.
Numbness or numbness on one side of the body or face. You may develop paralysis, weakness, or paralysis on one side of the body suddenly. Try to raise both hands above your head at the same time. If an arm begins to weaken, a stroke may be present. Likewise, one side of the mouth may drop down when trying to smile.
Problems with vision in one or both eyes. May suddenly become blurred or dark, or may have double vision.
Headache. A sudden severe headache, which may be accompanied by vomiting, dizziness, or changes in consciousness, may indicate a stroke.
Seek immediate medical attention if you notice any of the signs or symptoms of a stroke, even if seemingly fluctuating or disappearing, every minute. Don't wait to see if the symptoms go away. An untreated stroke has the potential for brain damage and disability. To maximize the effectiveness of evaluation and treatment, it is best to go to the emergency room within 60 minutes of the first symptoms.
If a stroke is suspected, be careful while you wait for emergency help. It may be necessary to:
Begin mouth-to-mouth resuscitation if breathing stops.
Turn your head to one side if vomiting occurs, which can prevent choking.
Do not feed or drink.
A stroke disrupts blood flow through the brain and damages brain tissue. There are two main types of stroke. The most common type of stroke is ischemic - is caused by a blockage of an artery. The other type of stroke is hemorrhagic which occurs when a blood vessel leaks or bursts. Transient ischemic attack (TIA) - sometimes called a ministroke, temporarily disrupts blood flow through the brain.
Nearly 90% of cerebrovascular strokes are ischemic strokes. They occur when a brain artery is narrowed or blocked, reducing blood flow (ischemia). Lack of blood flow deprives brain cells of oxygen and nutrients, and cells can begin to die within minutes. The most common ischemic strokes are:
Thrombotic stroke. This type of stroke occurs when a blood clot (thrombus) forms in an artery that supplies blood to the brain. Blood clots often form in an area damaged by atherosclerosis - in which an artery is blocked by plaque. This process can occur in one of two carotid arteries - the neck artery that carries blood to the brain, as well as in other arteries of the neck or brain.
Vascular stroke. An embolic stroke occurs when a blood clot or other debris in a blood vessel - often in the heart - causes the arteries to narrow to flow. The blood clot is called an embolus. It is usually caused by an irregular heartbeat (atrial fibrillation). Abnormal heart rhythms can lead to blood clots in the heart and the formation of blood clots that travel to other places in the body.
Hemorrhagic stroke. Hemorrhage is the medical term for bleeding. A hemorrhagic stroke occurs when a blood vessel in the brain leaks or bursts. A brain hemorrhage can be the result of a number of problems affecting blood vessels, including uncontrolled high blood pressure (hypertension) and weakness in the blood vessel walls (aneurysms). A less common cause of the hemorrhagic disease is a ruptured arteriovenous malformation (AVM), an abnormality of blood vessels at birth. There are two types of hemorrhagic stroke:
Hemorrhage in the brain. In this type of stroke, a blood vessel in the brain bursts and spills into the tissues around the brain, damaging cells. The brain cells of the leaky region are stripped of blood and are also damaged. High blood pressure is the most common cause of this type of hemorrhagic stroke. Over time, high blood pressure can cause the small arteries inside the brain to become brittle and prone to cracking and rupturing.
Subarachnoid hemorrhage. In this type of stroke, bleeding begins in an artery above or near the surface of the brain and spills into the space between the surfaces of the brain and the skull. This bleeding is often signaled by a sudden severe headache. This type of stroke is usually caused by a ruptured aneurysm, which can develop with age or be present from birth. After a hemorrhage, blood vessels in the brain can widen and narrow erratically (vasospasm), causing brain cell damage by further restricting blood flow to parts of the brain.
Transient ischemic attack (TIA)
Transient ischemic attack (TIA) - sometimes called a ministroke - symptoms are similar to those found in a stroke. The cause of transient ischemia is a temporary decrease in blood supply to part of the brain. TIA is less than five minutes.
Like an ischemic stroke, a TIA occurs when a blood clot or debris blocks blood flow to part of the brain. But unlike a stroke, which involves a prolonged lack of blood supply and causes permanent tissue damage, a TIA leaves no lasting impact because of the temporary blockage.
Seek emergency care even if symptoms seem obvious. If you've had a TIA, it means there's a chance of a partial blockage or narrowing of an artery leading to the brain, putting you at risk of a full-blown stroke that could cause permanent damage later in life. And it's impossible to tell if you're having a stroke or TIA based on symptoms alone. Up to half of the people with symptoms present actually have a stroke that causes brain damage.
Many factors can increase the risk of stroke. Some of these factors can also increase your chances of having a heart attack. Stroke risk factors include:
Family or personal history of stroke, heart attack, or TIA.
Age 55 or older.
High blood pressure - the risk of stroke begins to increase when blood pressure is higher than 115/75 mm of mercury (mm Hg). Your doctor will help you decide on a blood pressure goal based on your age, diabetes, and other factors.
High cholesterol - total cholesterol levels above 200 mg per dL (mg/dL), or 5.2 millimoles per liter (mmol/L).
Smoking or exposure to secondhand smoke.
Overweight (body mass index 25 - 29) or obese (body mass index 30 or higher).
No physical activity.
Cardiovascular disease, including heart failure, heart defects, heart infections, or abnormal heart rhythms.
Use birth control pills or hormone therapy that includes estrogen.
Use of drugs such as cocaine and methamphetamine.
Because stroke risk increases with age, and women tend to live longer than men, men have more strokes and die each year than women. Black people are more likely to have a stroke than people of other races.
A stroke can sometimes cause temporary or permanent disability, depending on how long the brain is deprived of blood flow and the part affected. Complications may include:
Paralysis or loss of muscle movement. Sometimes a lack of blood flow to the brain can cause paralysis on one side of the body, or loss of control over certain muscles, such as those on one side of the face. With physical therapy, improvement in muscle movement or paralysis may be seen.
Difficulty speaking or swallowing. A stroke can cause poor control of the muscles that move the mouth and throat, making talking, swallowing or eating difficult. There may also be difficulty speaking because the stroke has caused aphasia, a problem in which it is difficult to express thoughts through language. Speech-language pathology and treatment can improve this disability.
Loss of memory or trouble with understanding. Common in people who have experienced a stroke. Others may develop difficulty reasoning and understanding. These complications may improve with rehabilitative therapies.
Pain. Some people who have had a stroke may have pain, numbness, or other strange sensations in the parts of the body affected by the stroke. For example, if a stroke causes loss of sensation in the left arm, you may develop an uncomfortable tingling sensation in that arm. May also be sensitive to temperature changes, especially extreme cold. This is called central pain stroke or central pain syndrome (CPS). This complication usually develops a few weeks after a stroke, and it can improve over time. But because the pain is caused by a problem in the brain rather than a physical injury, there are several medications to treat CPS.
Changes in behavior and self-care. People who have had a stroke may be less socially apathetic or more impulsive. May lose the ability to take care of themselves and may need a carer to help them with caregiving needs and daily errands.
As with any brain injury, the success of treating these complications will vary from person to person.
Examination and diagnosis
To determine the best treatment for a stroke, it is urgent to find out what type of stroke you are having and which parts of the brain are affected. Other possible causes of symptoms, such as a brain tumor or drug reaction, also need to be ruled out. Your doctor may also use a number of tests to determine your risk of stroke.
Examination. The doctor will ask or a family member to tell you what symptoms were present when they started, and what they started, and then assess whether the symptoms are still present. Doctors want to know what medications have been taken and have experienced any head trauma. Your doctor will also ask about your personal and family history of heart disease, TIA, or stroke. Your doctor will check your blood pressure and use a stethoscope to listen to your heart and listen to your carotid (neck) arteries, which can indicate atherosclerosis. Your doctor may also use an ophthalmoscope to check for signs of small cholesterol crystals or blood clots in the blood vessels at the back of the eye.
Other blood tests provide the care team with important information such as blood clots and blood sugar, electrolytes, and a complete blood count for signs of infection. Blood clotting time and key sugar and electrolyte levels must be managed as part of stroke care. Infections must also be treated.
Computed tomography (CT). Brain imaging plays an important role in determining the type of stroke. Computed tomography (CTA), in which dye is injected into a vein, and X-rays create 3-D images of blood vessels in the neck and brain. The doctor looks for an aneurysm or arteriovenous malformation and evaluates the narrowed arteries. CT, done without dye, can provide images of the brain, but provides little detail about the blood vessels.
Magnetic resonance imaging (MRI). Strong magnetic fields and radio waves create 3-D images of the brain. An MRI can detect brain cells damaged by an ischemic stroke. Magnetic resonance imaging (MRA) uses a magnetic field, radio waves, and dye injected into a vein to evaluate arteries in the neck and brain.
Carotid ultrasound. This procedure can show narrowed or clotted arteries in the carotid arteries. A wand-like device (transducer) sends high-frequency sound waves into the neck. The sound waves pass through the tissue and then back, creating an image on a screen.
Angiography. This procedure shows normal arteries in the brain not visible on X-rays. The doctor inserts a tube through a small incision, usually in the groin area. The catheter is manipulated through the main artery and into the carotid or spinal arteries. The doctor then injects a dye through the catheter to provide an X-ray image of the artery.
Echocardiography. Ultrasound technology creates images of the heart, allowing doctors to see if a blood clot (embolus) from the heart has entered the brain and caused a stroke. Your doctor may need to use a transesophageal echocardiogram to see your heart clearly.
Treatments and drugs
Emergency treatment for a stroke depends on the type of stroke you're having, ischemic stroke - the most common type - or a hemorrhagic stroke involving bleeding into the brain.
To treat an ischemic stroke, doctors must quickly restore blood flow to the brain.
Emergency treatment with anticoagulants with clot-busting drugs must begin within 4.5 hours and as soon as possible. Prompt treatment not only improves your chances of survival, but it can also reduce complications a stroke can cause:
Aspirin. Aspirin is the best-proven treatment immediately after an ischemic stroke to reduce the chance of having a stroke. In the emergency room, you will probably receive a dose of aspirin. Doses can vary, but if you're already taking daily blood-thinning aspirin, you may want to let your doctor know you have aspirin.
Blood thinners such as warfarin (Coumadin), heparin, and clopidogrel (Plavix) may also be given, but are not commonly used, such as aspirin, for emergency treatment.
Intravenous plasminogen activator (TPA). Some people who are having an ischemic stroke may benefit from an injection of plasminogen activator (TPA), usually through an arm vein. TPA is a clot-busting drug that helps some people who have had a stroke recover more fully. However, intravenous TPA may only be within the 4.5-hour window of a stroke. TPA is associated with a number of risks, which doctors will review to evaluate appropriate treatment. TPA may not be given to people who are having a hemorrhagic stroke.
Doctors sometimes treat ischemic strokes with procedures that must be performed as soon as possible.
TPA directly to the brain. The doctor may insert a catheter through the groin artery to the brain, and then TPA is administered directly to the area where the stroke is progressing. This treatment time window is slightly longer than that of intravenous TPA but is still limited.
Remove blood clots. Doctors can also use a catheter to insert a small device into the brain to pick up and remove blood clots.
Other procedures. To reduce your risk of having a stroke or TIA, your doctor may recommend a procedure to open an artery narrowed by plaque. Doctors also sometimes recommend procedures to prevent a stroke. Options may include:
Carotid endarterectomy. In this procedure, the surgeon removes the plaque blocking the carotid arteries on both sides of the neck to the brain. The blocked artery is opened, the plaque is removed, and the surgeon closes the artery. The procedure can reduce the risk of ischemic stroke. However, in addition to the risks commonly associated with any surgery, carotid endarterectomy can also cause a stroke or heart attack due to blood clots or fatty debris. Surgeons try to reduce this risk by placing filters (distal protective devices) at strategic points in the blood vessel to "catch" any potentially disruptive plaque during the procedure.
Angioplasty and stents. Angioplasty is a technique that can expand inside the plaque-covered artery leading to the brain, usually the carotid artery. In this procedure, a balloon catheter is inserted into the area of the blocked artery. The balloon is inflated, compressing the plaque against the artery wall. A metal mesh tube (stent) is usually left in the artery to prevent the narrowing from recurring. Inserting a stent in a brain artery (intracranial stent) is similar to placing a carotid stent. Using a small incision in the groin, doctors insert the catheter through an artery and into the brain. Sometimes angioplasty is used to enlarge the affected area first, in other cases, angioplasty is not used before stenting.
Emergency treatment for hemorrhagic stroke focuses on controlling bleeding and reducing pressure in the brain. Surgery may also be used to help control future risks.
Emergency measures. If warfarin (Coumadin) or an antiplatelet drug such as clopidogrel (Plavix) causes bleeding, medications or blood products can be given or infused to counteract their effects. Medications may also be given to lower blood pressure, prevent seizures, and reduce vasospasm. People who have had a hemorrhagic stroke may not be given aspirin and TPA because these drugs can make bleeding worse.
After the bleeding in the brain stops, treatment usually involves bed rest and supportive medical care. If the area of bleeding is large, surgery may be used in some cases to remove the bleeding and relieve pressure on the brain.
Vascular surgery, repair. Surgery may be used to repair blood vessel abnormalities associated with hemorrhagic stroke. Your doctor may recommend one of these procedures after a stroke or if you're at high risk of spontaneous aneurysm or arteriovenous malformation (AVM) rupture:
Aneurysm clamp. Small forceps are placed at the site of the aneurysm, isolating the arterial circulation. This may keep the aneurysm from bursting or may prevent the re-bleeding of an aneurysm that has recently bled. The clamp will stay in place permanently.
Close the artery. This procedure replaces the aneurysm clamp. The surgeon uses a catheter to insert a small coil of wire into the aneurysm. This coil provides a scaffold where a blood clot can form and closes the aneurysm.
Surgical removal of the AVM. It is not always possible to remove an AVM if it is too large or if it is deep in the brain. Although surgically removing a smaller AVM from a more accessible part of the brain, it can eliminate the risk of rupture, reducing the overall risk of hemorrhagic stroke.
Stroke and rehabilitation
After emergency treatment, stroke care focuses on helping to regain strength, restore as much function as possible, and return to independent living. The impact of a stroke depends on the area of the brain involved and the amount of damaged tissue. Damage to the right side of the brain can affect movement and sensation on the left side of the body. Damage to brain cells on the left side can affect movement on the right side, and damage can also cause speech and language disorders. Also, if you've had a stroke, there may be problems with breathing, swallowing, balance, and hearing. You may also experience loss of vision and loss of bladder or bowel function.
Most stroke survivors are treated in a rehabilitation program. Your doctor will recommend the most rigorous program possible based on your age, overall health, and degree of disability from the stroke. Recommendations will also take into account the lifestyle, rights and preferences, and availability of other family members or caregivers.
A rehabilitation program can begin before leaving the hospital. It may continue in a rehabilitation unit of the same hospital, other rehabilitation unit or skilled nursing facility, outpatient unit, or at home.
Everyone's stroke recovery is different. Depending on the complications, the team of people helping with recovery may include specialists:
Rehabilitation doctor (physiatrist).
Psychiatrist or psychiatrist.
Coping and supporting
A stroke is a life-changing event that can affect emotional, physical, and functional functioning. Feelings of helplessness, depression, frustration, and apathy are not unusual. Decreased libido and mood swings are also common.
Maintaining self-esteem, connecting with others, and taking an interest in the world around you is an essential part of recovery. These strategies can help both you and your carers:
Don't be hard on yourself. Accept that physical and emotional recovery will involve hard work and take time. Aim for "normal" and progressive memories. Allow time for rest.
Get out of the house even if it's hard. Try and don't get discouraged or self-conscious if moving slowly and needing a cane, walker or wheelchair to get around.
Join a support group. Meeting with others who are dealing with stroke allows receiving and sharing experiences, exchanging information and feelings.
Let friends and family know what to expect. People may want to help but aren't sure how. Let them know that you'd like to bring a meal and stay to eat and talk, or go out to lunch or attend social events or church activities.
Not alone. Nearly 800,000 Americans have a stroke each year. About 6.5 million people live with stroke today.
Challenging speech and language
One of the most frustrating effects of a stroke is that it can affect speech and language. Here are some tips to help both the stroke survivor and the caregivers cope with the challenges:
Practice. Try a conversation at least once a day. It will help learn what works best, help feel connected, and rebuild confidence.
Relax. Saying maybe the easiest and most enjoyable to be in a relaxed state when there is plenty of time. Some stroke survivors after dinner is a good time.
Speak in your own way. When recovering from a stroke, it may be necessary to use fewer words or rely on gestures or tone of voice to get an idea.
Use props and support communication. May find it helpful to use pictures of loved ones and family members, and everyday activities such as a favorite TV show or the bathroom.
Know the risk factors for stroke. Following your doctor's recommendations and adopting a healthy lifestyle are steps you can take to prevent a stroke. If you've had a stroke or TIA, these measures can also help avoid having another one. Many stroke prevention strategies are similar to those for preventing heart disease. In general, a healthy lifestyle means:
Control high blood pressure (hypertension). One of the most important things you can do to reduce your risk of stroke is to keep your blood pressure under control. If you've had a stroke, lowering blood pressure can help prevent another transient ischemic attack or stroke. Exercising, managing stress, maintaining a healthy weight, and limiting sodium and alcohol intake, eating and drinking are all ways to keep high blood pressure under control. Adding more potassium to the diet can also help. In addition to recommendations for lifestyle changes, your doctor may prescribe medications to treat high blood pressure, such as diuretics, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, and receptor blockers. angiotensin body.
Lower cholesterol and saturated fat in the diet. Eating less cholesterol and fats, especially saturated and trans fats, can reduce plaque in the arteries. If your cholesterol cannot be controlled through dietary changes, your doctor may prescribe a statin such as simvastatin (Zocor), atorvastatin (Lipitor), or cholesterol-lowering medication.
No smoking. Smoking increases the risk of stroke and is not exposed to secondhand smoke. Quitting smoking reduces risk - a few years after quitting, a former smoker's risk of stroke is the same as that of a non-smoker.
Control diabetes. Diabetes can be managed with diet, exercise, weight control, and medication.
Maintain a healthy weight. Being overweight contributes to other risk factors for stroke, such as high blood pressure, cardiovascular disease, and diabetes. Weight loss of as little as 10 pounds can lower blood pressure and improve cholesterol levels.
Eat a diet rich in fruits and vegetables. A diet that contains more fruits or vegetables in the daily diet may reduce the risk of stroke.
Exercise regularly. Exercise reduces the risk of stroke in several ways. Exercise can lower blood pressure, increase levels of high-density lipoprotein (HDL, "good") cholesterol, and improve the overall health of your blood vessels and heart. It also helps reduce diabetes, control weight, and relieve stress. Gradually work up to 30 minutes of activity - such as walking, swimming, jogging or biking on most days, if not all days of the week.
Drink alcohol in moderation, if you do. Alcohol can be both - a risk factor and a preventative measure for stroke. Binge drinking, alcohol consumption, and heavy drinking increase the risk of high blood pressure and stroke, ischemia, and hemorrhage. However, drinking little to moderate amounts of alcohol can raise HDL cholesterol and decrease its tendency to clot. Both factors may contribute to a reduced risk of ischemic stroke.
Do not use illegal drugs. Certain drugs, such as cocaine and methamphetamine, are thought to be risk factors for a TIA or stroke.
If you've had an ischemic stroke or TIA, your doctor may recommend medication to help reduce your risk of having another. These include:
Antiplatelet drugs. Platelets are cells in the blood that initiate blood clots. Antiplatelet drugs make these cells non-sticky and less likely to form blood clots. The most frequently used antiplatelet agent is aspirin. Your doctor can help determine the right dose of aspirin.
Your doctor may also consider Aggrenox, a combination of low-dose aspirin and dipyridamole, which reduces blood clotting. If aspirin doesn't prevent a TIA or stroke or if aspirin can't be taken, your doctor may prescribe an antiplatelet drug such as clopidogrel (Plavix) or ticlopidine (Ticlid).
Anticoagulants. These drugs include heparin and warfarin (Coumadin). They affect the clotting mechanism in a different way than antiplatelet drugs. Heparin is quick to act and is used for a short time in the hospital. Warfarin slow is used long term.
Warfarin is a strong blood thinner, so it's important to follow directions and watch for side effects. Your doctor may prescribe these drugs if you have certain blood clotting disorders, some abnormal arteries, an irregular heartbeat, such as atrial fibrillation, or other heart problems.