Stroke – Back to basics

According to the Centers for Disease Control and Prevention (CDC,) more than 795,000 US adults have strokes every year and they are the 5th leading cause of death in the United States. Follow along below as we break down the basics of strokes so you can be prepared with the knowledge you need to act quickly in the event you experience or witness a stroke.

What is a stroke?

When a blood vessel in the brain ruptures or bleeds, or when there is a blockage of the blood supply to the brain, a stroke occurs. This prevents oxygen-rich blood from reaching the brain in which brain cells and tissue become damaged. These cells and tissue begin to die within minutes.

What are the types of stroke?

There are 3 main categories of strokes, which are then further broken down into more specific types of strokes.

Ischemic Stroke – These are the most common type. According to the CDC, 87% of all strokes fall into this category. This type occurs when the arteries that supply blood to the brain become blocked or severely narrowed. This can occur from a blood clot or due to pieces of plaque from buildup within the arteries. There are two main types of strokes that are included in the category of ischemic strokes – thrombotic and embolic. A thrombotic stroke occurs when a blood clot forms within the arteries supplying blood to the brain. An embolic stroke occurs when a blood clot (or other debris, such as plaque) forms in another part of the body, becomes dislodged and travels to the arteries in the brain. Often these clots originate from within the upper chest or neck, or can be a result of heart disease.

Hemorrhagic Stroke -  This type of stroke occurs when an artery in the brain breaks open or is leaking blood and creates pressure within the skull. This excess pressure causes the brain to swell which damages the brain tissues and cells. According to the CDC, about 13% of strokes fall into this category. The intracerebral hemorrhagic stroke and occurs when an artery bursts and the tissues surrounding the brain fill with blood, this is the most common type in this category. A less common type, the subarachnoid hemorrhagic stroke, causes bleeding between the brain and the tissues that cover it.

Transient Ischemic Attack (TIA) – This is commonly known as a mini-stroke and occurs when the blockage to the brain is temporary. The symptoms of these strokes are similar to a major stroke, but are temporary and may disappear within minutes or hours. Typically, a blood clot leads to these mini-strokes and they should be seen as a warning sign for the possibility of a future major stroke. More than 1/3 of patients that have a mini-stroke and do not seek medical treatment will have a major stroke within one year, according to the CDC. Even more staggering is that up to 10-15% of these mini-stroke patients will have a major stroke within 3 months.

What are the symptoms?

Symptoms can range greatly. This is because these symptoms come from the damage being caused to the brain, so depending on what part of the brain is damaged, the symptoms may differ.

In all cases, the faster treatment is received – the better the outcome is likely to be for the stroke patient. A stroke requires immediate medical attention! Seek emergency medical treatment right away if you believe you, or someone else, may be experiencing a stroke.

Without immediate medical attention, strokes can lead to brain damage, death and long-term disability.

Some general symptoms may include:

  • Sudden, severe headache with no known cause
  • Trouble walking
  • Dizziness
  • Loss of balance or coordination
  • Confusion
  • Difficulty speaking or understanding speech
  • Paralysis
  • Numbness or loss of function/weakness in one side of the body (usually arm, face or leg)
  • Slurring speech
  • Vision difficulty (blurred, double vision or blackened vision)

Symptoms for women may include:

According to the CDC, women have a higher lifetime risk of having a stroke than men and it is the 4th leading cause of death in US women. Males and females may experience any of the symptoms above, but the following symptoms tend to be more common in women than in men.

  • Vomiting or nausea
  • General weakness
  • Shortness of breath/trouble breathing
  • Confusion, lack of responsiveness, disorientation
  • Hallucination
  • Pain
  • Seizures
  • Sudden, unexplained behavioral changes (often sudden agitation)

Risk Factors for Strokes:

According to the National Heart, Lung and Blood Institute (NHLBI,) there are risk factors that may increase your chances of having a stroke. Some of those are as follows:

  • Diet
    • A diet high in salt, trans fats, saturated fat and cholesterol is not good for your overall health and can increase your stroke risk.
  • Lack of activity
    • The CDC recommends at least 2.5 hours of moderate aerobic exercise per week for adults.
  • Alcohol and Tobacco Use
    • Using tobacco in any form increases your risk for stroke. This is because tobacco has been known to weaken and damage your blood vessels and your heart. It also can raise your blood pressure leading to a higher likelihood of stroke.
    • Excessive alcohol consumption can raise your blood pressure and your triglyceride levels, causing an increased risk of strokes. It is recommended that woman consume no more than one drink/day and men stick to no more than two drinks/day.
  • Health History
    • There are several medical conditions linked to an increase risk of stroke. These include high blood pressure, high cholesterol, heart disorders and defects and diabetes, to name a few.
  • Personal/Family background
    • Some risk factors such as family history, age, gender and race may all play a role in your stroke risks and are out of your control. This is why reducing your other stroke risk factors is so important.

Diagnosis of Stroke

When you arrive to the emergency room, doctors will work quickly to evaluate your condition. They will typically ask about your symptoms (a family member who witnessed the symptoms may be helpful,) your medical history and your medications. Some of the following tests may also be performed to determine if you have had a stroke and to rule out other medical conditions:

  • Blood tests – There are many markers your doctor may be looking for including blood sugar levels, signs of infection, testing blood clot efficiency and your platelet levels.
  • CT scan and/or MRI – These tests help doctors visualize your brain to look for bleeding or damage caused by a stroke and to rule out other medical conditions.
  • EKG – Your doctor may want to monitor your heart with an EKG to see if any heart conditions may have led to a stoke.
  • Cerebral angiogram – This x-ray uses contrast for your doctor to get a detailed view of the arteries in your head and neck to look for blockages or clots.
  • Echocardiogram – This test is used to find clots within your heart.
  • Carotid ultrasound – This test is used to determine the amount of fatty deposits, also known as plaque, within the carotid arteries.

Treatments for Stroke

The treatment plan prescribed by your doctor may vary greatly depending on your specific medical condition, type of stroke and your medical history and needs. Some treatments may include:

  • Clot-blocking medications – A common treatment, these medications break up clots within your arteries.
  • Clotting medications – in the event of a hemorrhagic stroke, the goal will be to encourage the blood to clot.
  • Antiplatelet & anticoagulants – Over-the-counter aspirin is often recommended quickly on the onset of stroke symptoms.
  • Stents – These are used to widen narrowed arteries.
  • Mechanical thrombectomy – This is a surgical procedure in which a catheter is fed into a large vessel within the head and used to remove the clot from the vessel.
  • Coiling/Clamping – These procedures are used to strengthen artery walls or clamp off arteries prone to bleeding.

 

The Bottom Line

Strokes are serious and life-threatening. If you believe you may be experiencing a stroke, it is imperative that you seek emergency medical treatment. Some of the treatment options are only helpful during the first few hours after symptoms begin. Prevention and reducing your risk factors is possible. Make sure you discuss your risk factors and concerns with your doctor


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Written By: S. Campbell for Access Health Care Physicians, LLC. 

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