Stroke Education* 

Q: What is a stroke?

Answer: If you're like most Americans, you plan for your future. When you take a job, you examine its' benefit plan.  When you buy a home, you consider its' location and condition so that your investment is safe. Today, more and more Americans are protecting their most important asset--their health.  Are you?

Stroke ranks as the third leading killer in the United States. A stroke can be devastating to individuals and their families, robbing them of their independence. It is the most common cause of adult disability. Each year more than 700,000 Americans have a stroke, with about 160,000 dying from stroke-related causes. 

A stroke, or "brain attack," occurs when blood circulation to the brain fails. Brain cells can die from decreased blood flow and the resulting lack of oxygen. There are two broad categories of stroke: those caused by a blockage of blood flow and those caused by bleeding.

While not usually fatal, a blockage of a blood vessel in the brain or neck, called an ischemic stroke, is the most frequent cause of stroke and is responsible for about 80 percent of strokes. These blockages stem from three conditions: 

  1. the formation of a clot within a blood vessel of the brain or neck (called thrombosis)
  2. the movement of a clot from another part of the body such as the heart to the neck or brain (called embolism) or
  3. a severe narrowing of an artery in or leading to the brain (called stenosis).

Bleeding into the brain or the spaces surrounding the brain causes the second type of stroke, called hemorrhagic stroke.

Risk Factors and Prevention

Two key steps you can take will lower your risk of death or disability from stroke: know stroke's warning signs and control stroke's risk factors.

Q: What are Warning Signs of a Stroke?

Answer: Stroke warning signs are clues your body sends that your brain is not receiving enough oxygen. If you observe one or more of these signs of a stroke or "brain attack," don't wait, call a doctor or 911 right away!

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

Other danger signs that may occur include double vision, drowsiness, and nausea or vomiting. Sometimes the warning signs may last only a few moments and then disappear. These brief episodes, known as transient ischemic attacks or TIAs, are sometimes called "mini-strokes." Although brief, they identify an underlying serious condition that isn't going away without medical help. Unfortunately, since they clear up, many people ignore them. Don't. Paying attention to them can save your life.

Q: What are Risk Factors for a Stroke?

Answer: A risk factor is a condition or behavior that occurs more frequently in those who have, or are at greater risk of getting, a disease than in those who don't. Having a risk factor for stroke doesn't mean you'll have a stroke. On the other hand, not having a risk factor doesn't mean you'll avoid a stroke. But your risk of stroke grows as the number and severity of risk factors increases.
Stroke occurs in all age groups, in both sexes, and in all races in every country. It can even occur before birth. In African-Americans, stroke is more common and more deadly--even in young and middle-aged adults--than for any ethnic or other racial group in the United States. Scientists have found more and more severe risk factors in some minority groups and continue to look for patterns of stroke in these groups.

Q: What Are the Treatable Risk Factors?

Answer: Some of the most important treatable risk factors for stroke are:

  • High blood pressure: Also called hypertension is by far the most potent risk factor for stroke. If your blood pressure is high, you and your doctor need to work out a plan to bring it down to the normal range. Some ways that work: Maintain proper weight. Avoid drugs known to raise blood pressure. Cut down on salt. Eat fruits and vegetables to increase potassium in your diet. Exercise more. Your doctor may prescribe medicines that help lower blood pressure. Controlling blood pressure will also help you avoid heart disease, diabetes, and kidney failure.
  • Cigarette smoking: Cigarette smoking has been linked to the buildup of fatty substances in the carotid artery, the main neck artery supplying blood to the brain. Blockage of this artery is the leading cause of stroke in Americans. Also, nicotine raises blood pressure; carbon monoxide reduces the amount of oxygen your blood can carry to the brain.   Cigarette smoke makes your blood thicker and more likely to clot. Your doctor can recommend programs and medications that may help you quit smoking. By quitting, at any age, you also reduce your risk of lung disease, heart disease, and a number of cancers including lung cancer. 
  • Heart disease: Common heart disorders such as coronary artery disease, valve defects, irregular heart beat, and enlargement of one of the heart's chambers can result in blood clots that may break loose and block vessels in or leading to the brain. The most common blood vessel disease, caused by the buildup of fatty deposits in the arteries, is called atherosclerosis. Your doctor will treat your heart disease and may also prescribe medication, such as aspirin, to help prevent the formation of clots. Your doctor may recommend surgery to clean out a clogged neck artery if you match a particular risk profile. If you are over 50, some scientists believe you and your doctor should make a decision about aspirin therapy. A doctor can evaluate your risk factors and help you decide if you will benefit from aspirin or other blood-thinning therapy. 
  • Warning signs or history of stroke: If you experience a mini-stroke, get help at once. If you or someone you know is experiencing stroke's warning signs, don’t wait.  Dial 911 for emergency medical assistance! If you have had a stroke in the past, it's important to reduce your risk of a second stroke. Your brain helps you recover from a stroke by drawing on body systems that now do double duty. That means a second stroke can be twice as bad. 
  • Diabetes: You may think this disorder affects only the body's ability to use sugar, or glucose. But it also causes destructive changes in the blood vessels throughout the body, including the brain. Also, if blood glucose levels are high at the time of a stroke, then brain damage is usually more severe and extensive than when blood glucose is well-controlled. Treating diabetes can delay the onset of complications that increase the risk of stroke.

Americans have shown that stroke is preventable and treatable. In recent years, a better understanding of the causes of stroke has helped Americans make lifestyle changes that have cut the stroke death rate nearly in half.

Many risk factors for stroke can be managed, some very successfully. Although risk is never zero at any age, by starting early and controlling your risk factors you can lower your risk of death or disability from stroke.

Scientists at the NINDS predict that, with continued attention to reducing the risks of stroke and by using currently available therapies and developing new ones, Americans should be able to prevent 80 percent of all strokes!

Current Stroke Treatment

A stroke occurs when blood flow to the brain is affected by a blocked or burst blood vessel. Time is of the essence in the chain of survival for stroke and calling 9-1-1 at the first onset of stroke symptoms is critical. Depending on the type of stroke, and the hospital facilities capability, treatment options can vary.

Treatment options

  • A large percentage of ischemic strokes (blockage of blood vessels in brain or neck) can be treated with clot-busters such as anticoagulants (an agent used to prevent the formation of blood clots), angioplasty (a procedure used to widen blood vessels), and stents (a tiny tube placed into an artery or blood vessel). 
  • Hemorrhagic stroke (when a blood vessel in the brain bursts or is leaking)  can be treated with surgery. 
  • TIAs (Transient Ischemic Attacks) are "warning strokes" or mini strokes  that may occur before a more devastating stroke. Blood flow through an  artery in the brain is blocked or reduced for a brief period.   Treatment  for a TIA typically involves the following: Lifestyle changes, such  as  quitting smoking, changing your diet, and increasing physical  activity, medications used to help keep blood from clotting,   controlling  TIA risk factors such as high blood pressure,  surgical procedures to  help decrease the chances of another TIA. 
  • Diagnostic procedures could include various medical imaging tests or an exam to determine if the nervous system is impaired.

Rehabilitation

Stroke rehabilitation includes physical therapy and other approaches intended to help individuals achieve long-term recovery from stroke. Physical therapy involves using exercises to restore movement and coordination. Many people also receive occupational therapy, which focuses on improving daily activities such as eating, drinking, dressing, bathing, reading, and writing. Speech therapy may help people who have problems producing or understanding speech.  Depression, anxiety, and social isolation are common among individuals who have had a stroke.   The potential benefits of psychological or psychiatric treatment should be considered.

Use it or lose it - Basic research on the brain has shown that the most active connections between brain cells tend to become stronger while the quietest connections tend to weaken until they disappear. Inspired by these findings, researchers are testing a few innovative techniques that follow a "use it or lose it" approach to stroke rehabilitation.

Forced use focuses on improving upper limb function in people who are affected by weakening on one side of the body. It involves constant restraint of the unaffected hand and arm with a mitt shaped like a boxing glove, so that the person is forced to use the affected hand and arm for daily activities. Meanwhile, the person receives regular training sessions to exercise the weakened arm.
Another therapy involves using a body-weight-supported treadmill to help people who have trouble walking. Individuals walk on a treadmill while being supported by an overhead harness, which protects them from falling and allows them to concentrate on coordination and speed.

The goal of rehabilitation is not simply for the individual to cope with disability, but to relearn skills that have been lost. This relearning is made possible by the brain's ability to reorganize itself forming new connections between nerve cells. This ability is high in the developing brain and lessens as the brain matures, but even the aged brain appears to have some capacity to repair itself after a stroke.

* Medical Disclaimer: the medical information presented on this website is meant for general educational purposes only. Persons should consult qualified physicians regarding specific medical concerns or treatment.