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Stroke
Overview

stroke is a very serious health condition and needs quick treatment to prevent death or severe disability. Every year, strokes take almost 130,000 lives in the United States and that accounts for one out of every 20 deaths. Strokes are also one of the main causes of long-term disability and handicap among Americans. They require extensive rehabilitation in those who survive and account for over $34 billion in health care costs every year. Strokes can be prevented. This article will help you understand more about strokes, diagnosis, and treatment. Also included are helpful prevention tips if you are at risk.

What is a Stroke?

A stroke aka Cerebrovascular Accident happens when the blood supply to the brain is cut off. This reduces the amount of oxygen to the brain cells and they begin to die off. When brain cells become damaged and die, the symptoms affect the area in the body that the damaged section controls. This is why symptoms often occur on only one side of the body.
Strokes are very serious and requires immediate lifesaving emergency help. The longer treatment is delayed, the more damage to brain cells. This can lead to paralysis, loss of ability to speak or swallow, or in some cases, death.

Types of Strokes

There are two types of strokes:
Ischemic Stroke. This type of stroke happens inside the main arteries in the brain. They become blocked and cannot supply oxygen to the brain cells. It is often a blood clot that causes an ischemic stroke.
Hemorrhagic Stroke. This type of stroke happens when one of the arteries in the brain ruptures and hemorrhages into the brain. This causes pressure and causes damage to the cells. This is often due to a ruptured aneurysm or a result of high blood pressure.
Transient Ischemic Attack – TIA. This is also known as a, “mini-stroke.” These aren’t actually full strokes and occur when the blood supply is cut-off from the brain and then opens back up again. It doesn’t usually cause permanent damage, but due to the blood clots that cause the condition it does put you at higher risk for a full stroke. TIA’s are still a medical emergency.

Causes and Risk Factors for Strokes

Causes
Strokes are caused by a disruption in the supply of blood that carries nutrients and oxygen to the brain cells. This can cause damage to the cells or they can completely die off.
An ischemic stroke is complete blockage of an artery with either a blood clot or some type of embolus (fat, air). A hemorrhagic stroke is caused by pressure due to bleeding in the brain or a blood clot that forms from bleeding in the brain. TIA’s are a short disruption to the blood flow that is only temporary.
Risk Factors
Obesity
Lack of exercise
Heavy alcohol drinking
Amphetamine use
High blood pressure
High cholesterol
Diabetes
Smoking cigarettes/Second hand smoke
Heart disease
Sleep apnea
Family history of stroke
Age over 55
African American ethnicity
Male gender, but women are also at risk

While family history, age, gender and race cannot be eliminated, many of these risk factors can. Eliminating the risk factors that you can greatly decreases your risk of stroke.

Stroke Symptoms

The symptoms of stroke are important to know. The quicker treatment is given, the less damage and chance of death due to stroke. The symptoms include:
Slurred or Confused Speech. The person may speak like they are drunk or have trouble finishing sentences with the right words.
Weakness, Paralysis, or Numbness. This is usually present on one side of the body and affects; arms, legs, or the face. You may notice drooping on one side of the face, inability to raise either arm equally or trouble walking.
Vision Disturbance. Vision may be blurry or blacked out or double vision may occur.
Dizziness and Loss of Balance. Feeling dizzy may be accompanied by a loss of balance and unable to hold yourself upright.
Headache. If you have a headache that comes on suddenly and feels like “the worst headache you ever had” you may have a rupture. Strokes can also be accompanied by a mild to moderate headache with dizziness and vomiting.
There is an acronym to think of when you see stroke symptoms. It is called “FAST” and the letters stand for:

Face. Have the person try to smile and look for facial drooping.
Arms. Have them life both of their arms. Look for uneven lifting or inability to raise an arm.
Speech. Have them repeat a sentence and watch for slurring or inability to repeat the words correctly.
Time. Think FAST and act FAST. If you notice any of these symptoms get emergency medical help by calling 9-1-1. The quicker the treatment, the better chance of survival.

Diagnosing a Stroke

Upon arrival to the hospital, the doctor will need to know the symptoms, medical history, and family history. Give a complete list of medications and allergies. Let the doctor know if there has been any recent head injury or history of TIA’s in the past.

The doctor will repeat the FAST test to check for facial dropping, weakness, numbness, and other neurological signs. Blood pressure will be checked and the doctor will listen to the carotid arteries in the neck. The following tests will be ordered:

Laboratory Tests. The doctor will check a full panel of blood tests. They will check your blood clotting time and your blood sugar.

CT Scan. The computerized tomography or CT scan can look at the brain for any sign of tumor or hemorrhage. They can also look for areas of swelling. Dye can be injected to get a picture of large blood vessels.

MRI Scan. MRI scans gives the doctor a very detailed look into your brain tissue. They can see the actual damage to the tissue. Dye can be injected to see the blood flow in the vessels.

Carotid Ultrasound. The doctor will be able to see any fatty buildup and plaque inside the carotid arteries.

Cerebral Angiogram. The doctor will send a catheter through an artery in the groin and feed it up into your carotid arteries. They use a dye to look at the blood vessels in the brain and neck for blockage.

Transesophageal Echocardiogram. The doctor will send a tube down your esophagus to look through at your blood vessels to see if there are any clots.

Stroke Treatment

Treatment is aimed at the type of stroke you had and getting you through the first minutes with minimal damage to the brain and nervous system. Any symptoms of stroke outlined above is a medical emergency and someone should call 9-1-1 immediately. Do not hesitate or attempt to drive to the hospital. Emergency treatment for stroke symptoms can be given in an ambulance to save valuable time. Treatments include:
Ischemic Stroke

TPA – Tissue Plasminogen Activator.

This is known as the “clot buster” and is injected IV into your arm in the first 4 hours of your symptoms. It has to be given before this window to do its job.

Carotid Endarterectomy.

After you are stabilized, the doctor will go into the carotid arteries and open up any blockage of blood flow.

Intra-Arterial Thrombolysis.

The doctor can send a catheter up into the artery in the groin, then up into the artery in the brain that has the clot. They can send in medication to help break up the clot.
MERCI. This newer device can be sent into the artery that is clogged and can actually remove the clot from the artery.
Hemorrhagic Stroke
Since these strokes are caused by bleeding, clot busting medications and blood thinners cannot be used due to increased risk of bleeding. The treatments for this type of stroke include:

Blood Pressure Medications. The doctor will most likely give you medication to either lower your blood pressure or keep it under control to prevent further damage and further bleeding.

Aneurysm Clipping/Coil Embolization. If you suffered a ruptured aneurysm, the doctor may have to “clip” off the source of bleeding. This requires brain surgery and a stay in the intensive care unit. A coil embolization is done by inserting a catheter into the artery nearest the aneurysm. They send in a coil that will clot off the source of bleeding and seal the aneurysm.

Arteriovenous Malformation Repair. If you have a malformation of arteries and veins in your brain, the doctor may want to go in a repair them to stop bleeding and prevent another stroke.

Alternative Medicine for a Stroke

A stroke is a medical emergency and must be evaluated by an emergency physician initially. Any alternative medicine treatments need to be approved by your doctor as part of your treatment plan to avoid any complications or interactions. These natural remedies have been used to help your body heal from stroke:
Alpha-lipoic Acid. This works in conjunction with vitamin C and E to keep cells from becoming damaged. It can cross over into the brain and can protect the tissues of the brain and nervous system.
Vitamin B6, B12, and Folic Acid with Betaine. These supplements may lower the amount of homocysteine. Homocysteine is an amino acid that when elevated may raise the risk of suffering a stroke.
Omega-3 Fatty Acids.Omega-3 fatty acids have been shown in studies that it can help lower the risk of stroke by reducing plaque and blood clots in arteries that feed the brain. You can reduce the risk by 50 percent just eating fish two times per week.
Bilberry.This fruit is related to cranberries and contains flavonoids. They are antioxidants that may reduce free radicals that cause blood vessel diseases.
Ginkgo Biloba. This herb may help lower dementia that occurs after multiple strokes. It may also reduce brain damage from strokes. It is not safe to take with blood thinning medications.
Panax Ginseng.Ginseng may help reduce dysfunction in the endothelial cells that are inside your blood vessels. When these cells are damaged, a stroke may occur.

Lifestyle Changes for a Stroke

Attend a Rehab Program. If body functions are affected, you may need rehabilitation. These programs include:
Physical Therapy
Occupational Therapy
Speech Therapy
Do Something Fun. During therapy and medical treatment, you can get overwhelmed and feel shut in with your illness. Do something fun for yourself that can further your recovery. Try joining a Yoga class especially for stroke victims, a meditation group, or take up a hobby.

Think About Safety. You may be more prone to falls so make your home safe. Move exposed cords and anchor loose items. If your arms and hands are affected, have someone else do tasks like; working with sharp objects, glass, and climbing ladders. Make sure your home is well lit and use nightlights.

Set Medication Reminders.Make sure you take your medications on time and the right ones. Use a pill minder and set medication alarms so you don’t forget.

Prevent Choking and Aspiration. If your swallowing is affected, make sure you use a thickener in liquids and ask a speech therapist how your food should be prepared. You may need a modified texture to prevent choking.

Stroke Complications and Prognosis

Complications of a stroke include:
Pain
Paralysis
Speech Issues
Trouble doing daily tasks
Emotional Issues
Trouble thinking
Seizures

A stroke can be fatal. If the stroke affects the brainstem area, the prognosis can be fair to poor. Some people live through this type of stroke, but are confined to a bed with nursing care. Those who have mild to moderate strokes have a good prognosis and recovery begins right away after the event. Within 3 months there is quick improvement and over the first year, people recovery most functions with rehabilitation.

Stroke Prevention

Strokes are never 100 percent preventable, but you can lower your risk of having one by making the following changes to your lifestyle:

Don’t Smoke and Use Birth Control Pills Together. This can raise your risk of blood clots. If you choose to use birth control, quit smoking.

Quit Smoking. Men and women who smoke have higher blood pressure, get less oxygen to the brain, and increases the risk of blood clots.

Use Alcohol in Moderation. Excess alcohol can raise the risk of bleeding in the brain and cause high blood pressure.

Get Plenty of Exercise. This will help you lower your cholesterol and keep your blood pressure in a healthy range.

Eat healthy. Reduce high fat and sugar intake to lower your risk of diabetes and blood vessel disease.

Bibliography

Centers for Disease Control. (2015, March 24). Stroke Facts. Retrieved from Centers for Disease Control: https://www.cdc.gov/stroke/facts.htm
Mayo Clinic. (2015, July 30). Stroke. Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/stroke/symptoms-causes/dxc-20117265
ational Heart, Lung, and Blood Institute. (2014, March 26). What is a stroke? Retrieved from National Institute of Health: https://www.nhlbi.nih.gov/health/health-topics/topics/stroke
University of Maryland. (012, January 12). Stroke. Retrieved from University of Maryland Medical Center: https://umm.edu/health/medical/altmed/condition/stroke

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