Stroke 101

What is a stroke?

A stroke occurs when there is bleeding into your brain or when normal blood flow to your brain is blocked. It is also referred to as a “brain attack.” When blood flow is interrupted or severely reduced, brain cells are robbed of vital supplies of oxygen and nutrients. Within minutes, brain cells begin to die. In the United States more than 700,000 people suffer a stroke each year and approximately two-thirds of these individuals survive and require rehabilitation.

  Seek immediate medical assistance. A stroke is a true emergency. The sooner treatment is given; the more likely it is that damage can be minimized. Every minute counts.

What are the Symptoms?

In the event of a possible stroke, use FAST to help remember warning signs.

  • Face. Does the face droop on one side while trying to smile?
  • Arms. Is one arm lower when trying to raise both arms?
  • Speech. Can a simple sentence be repeated? Is speech slurred or strange?
  • Time. During a stroke every minute counts. If you observe any of these signs, call 911 or your local emergency number immediately.

Other signs and symptoms of a stroke include:

  • Weakness or numbness on one side of the body, including either leg
  • Dimness, blurring or loss of vision, particularly in one eye
  • Severe headache — a bolt out of the blue, sudden or severe — with no apparent cause
  • Unexplained dizziness, unsteadiness or a sudden fall, especially if accompanied by any of the other signs or symptoms

What is the Treatment?

There are two types of Strokes:

1. Ischemic Stroke

An ischemic stroke is caused by a blood clot that blocks blood flow to the brain. Blood clots either develop in narrow arteries supplying blood to the brain or travel from the heart or elsewhere in the body to an artery that supplies blood to the brain.

Blood clots are usually the result of other problems in the body affecting normal flow of blood, such as:

  • Hardening of the arteries (atherosclerosis).
  • Atrial fibrillation or other irregular heart rhythms.
  • Certain heart valve problems including having an artificial heart valve, a repaired heart valve, heart valve disease such as mitral valve prolapse or narrowing (stenosis) of a heart valve.
  • Infection of the heart valves (endocarditis)
  • A patent foramen ovale (a congenital heart defect)
  • Blood-clotting disorders
  • Inflammation of blood vessels (vasculitis)
  • Heart attack

Low blood pressure, also called hypotension, also may cause an ischemic stroke. Though not as common, low blood pressure results in reduced blood flow to the brain and may develop as a result of narrowed or diseased arteries, a heart attack, a large loss of blood or a severe infection.

Surgeries such as endarterectomies, or other procedures that are used to treat narrowed carotid arteries, such as angioplasty, may ultimately cause a blood clot to break loose and result in a stroke.

2. Hemorrhagic Stroke or Bleeding Stroke:

A hemorrhagic stroke is caused by bleeding inside the brain, called intracerebral hemorrhage, or bleeding in the space around the brain, called subarachnoid hemorrhage. Bleeding inside the brain may be a result of long-standing high blood pressure. Bleeding in the space around the brain may be caused by a ruptured aneurysm or uncontrolled high blood pressure.

Other causes of hemorrhagic stroke are less common, but include:

  • Inflammation in the blood vessels, which may develop from conditions such as syphilis or tuberculosis
  • Blood-clotting disorders such as hemophilia
  • Head or neck injuries resulting in damage to head or neck blood vessels
  • Radiation treatment for cancer in the neck or brain
  • Cerebral amyloid angiopathy, a degenerative blood vessel disorder

  Call 911 or other emergency services immediately if you suspect you may be having a stroke.

TIA or Transient Ischemic Attack:

A transient ischemic attack (TIA) is like a stroke, producing similar symptoms, but usually lasting only a few minutes and causing no permanent damage.

Often called a mini stroke, a transient ischemic attack may be a warning. About one in three people who have a transient ischemic attack eventually will have a stroke, with about half occurring within a year after the transient ischemic attack.

A transient ischemic attack can serve as both a warning and an opportunity — a warning of an impending stroke and an opportunity to take steps to prevent it.

The signs and symptoms of TIA resemble those found early in a stroke and may include sudden onset of:

  • Weakness, numbness or paralysis in your face, arm or leg, typically on one side of your body
  • Slurred or garbled speech or difficulty understanding others
  • Blindness in one or both eyes or double vision
  • Dizziness or loss of balance or coordination

You may have more than one TIA, and the recurrent signs and symptoms may be similar or different depending on which area of the brain is involved.

Some Stroke Risk Factors Include:

Things you can’t control:

  • Age: Your stroke risk increases as you get older, especially after age 55.
  • Race: African Americans have a higher incidence of strokes.
  • Gender: Men have a higher incidence of stroke and TIA, but more women die of stroke than men.
  • Family history of stroke: Your risk may be greater if you have blood relatives that have suffered a stroke or TIA.
  • Sickle cell disease: Stroke is a frequent complication of this inherited disorder.

Health Conditions:

  • A-fib (atrial fibrillation): Atrial fibrillation is an irregular and often rapid heart rate that commonly causes poor blood flow to the body. Episodes of atrial fibrillation can come and go, or you may develop atrial fibrillation that doesn't go away and may require treatment.
  • Carotid artery disease (CAD): The blood vessels in your neck that lead to your brain become narrow or clogged.
  • Diabetes: Diabetes increases the severity of atherosclerosis or narrowing of the arteries, and this can impede circulation.
  • Excessive alcohol intake: Limit alcohol consumption to no more than two drinks per day for men and one drink per day for women.
  • Heart disease: Such as heart attack, heart failure, heart valve problems, heart infections or heart dysrhythmias, all increase your risk of stroke
  • High blood pressure: If you have high blood pressure, take your medicines and talk to your doctor to decide the best target blood pressure for you.
  • High cholesterol: A low cholesterol diet may reduce plaque in your arteries. Your doctor may also prescribe a statin or other medication to help lower your cholesterol.
  • Obesity: A body mass index of 25 or higher and a waist circumference greater than 35 inches (89 centimeters) in women or 40 inches (102 centimeters) in men increase stroke risk.
  • Poor circulation or (PAD) peripheral vascular disease: The blood vessels that carry blood to your arms and legs become narrow and clogged.
  • Physical inactivity: Engaging in 30 minutes of moderate intensity exercise several days a week can help reduce your risk for stroke.
  • Poor nutrition. Eating too much fat and salt, in particular, increases your risk of TIA and stroke.
  • Prior TIA: If you have a history of one or more TIAs, you’re 10 times more likely to suffer a stroke.
  • Smoking: Smoking increases your risk of blood clots, raises your blood pressure and contributes to the development of cholesterol-containing fatty deposits in your arteries (atherosclerosis).
  • Use of birth control pills: If you use any hormone therapy, talk to your doctor about how the hormones may affect your risk of TIA and stroke.
  • Use of illicit drugs: Avoid cocaine and other illicit drug use.

When to call your doctor:

Call your doctor immediately if you have:

  • Had recent symptoms of a TIA or stroke, even if the symptoms have disappeared.
  • Had a TIA or stroke and are taking aspirin or other medications that prevent blood clotting and you notice any signs of bleeding.
  • Had a stroke and have a choking episode from food going down your windpipe.
  • Experienced signs of a blood clot in a deep blood vessel, which include redness, warmth and pain in a specific area of your arm or leg.

Call your doctor for an appointment if you:

  • Think you have had a TIA in the past and have not talked with your doctor about it.
  • Have a pressure sore after experiencing a stroke. Pressure sores usually develop along the elbows, heels, knees, buttocks and tailbone and on the back along the spine, and are caused by staying in one position too long. The first sign of a pressure sore is a reddened area that does not go away with rubbing or massaging.
  • Have had a stroke and notice that your affected arm or leg is becoming increasingly stiff or you are not able to straighten it.
  • Have had a stroke and notice signs of a urinary tract infection. Signs may include fever, pain with urination, blood in urine and low back (flank) pain.

The Importance of Immediate Diagnosis and Treatment

To obtain a clear diagnosis of the type of stroke you may be experiencing, emergency care is necessary. “Time loss is brain loss,” immediate medical attention through EMS is the best option. There are treatments available for a stroke during the immediate onset phases.

Watchful waiting is not appropriate if you have signs of a stroke. Call 911 and seek emergency medical care without delay. Emergency care is needed to identify the type of stroke and to prevent or treat any complications that may be life-threatening. Prompt treatment may prevent extensive damage to the brain, decreasing permanent disabilities from the stroke.

Treatment options:

Emergency treatment for stroke depends on whether you're having an ischemic stroke blocking an artery — the most common kind — or a hemorrhagic stroke that involves bleeding into the brain.

Ischemic Stroke:

To treat an ischemic stroke, doctors must quickly restore blood flow to your brain.

Emergency treatment with medications:

If you seek help within three hours, you may qualify for medications that dissolve clots such as tissue plasminogen activator (TPA). TPA medication should be given within the first three hours after symptoms begin. Not everyone can safely receive this medication. Aspirin also may be considered as an option for an ischemic stroke.

  • Aspirin. Aspirin is an immediate treatment given in the emergency room to reduce the likelihood of having another stroke. Aspirin prevents blood clots from forming. Aspirin is only given after first ruling out any bleeding in the brain.
  • Intravenous injection of tissue plasminogen activator (TPA). Some people can benefit from an injection of a recombinant tissue plasminogen activator (TPA), also called alteplase. An injection of TPA is usually given through a vein in the arm. This potent clot busting drug needs to be given within 3 hours after stroke symptoms begin if it's given in the vein.
    TPA restores blood flow by dissolving the blood clot causing your stroke, and it may help people who have had strokes recover more fully. Your doctor will consider certain risks, such as potential bleeding in the brain, to determine if TPA is appropriate for you.

Ischemic stroke emergency treatment procedures:

Doctors sometimes treat ischemic strokes with procedures that must be performed as soon as possible. Baptist Hospital has a group of specially trained physicians who can perform these interventions within an eight-hour time frame from the onset of your stroke, only if you are an eligible candidate.

  • Mechanical clot removal. Specially trained physicians use a catheter to maneuver a tiny device into your brain to physically break up or grab and remove the clot. Additional tests are used to determine if this treatment option is available, as not everyone that has a stroke is a candidate for this specialized treatment.

Other treatment options for some patients:

To decrease your risk of having another stroke or transient ischemic attack, your doctor may recommend a procedure to open up an artery that's narrowed by fatty deposits (plaques). Doctors sometimes recommend the following procedures to prevent a stroke. Options will vary depending on your situation:

  • Carotid endarterectomy. In a carotid endarterectomy, a surgeon removes plaques from arteries that run along each side of your neck to your brain (carotid arteries). In this procedure, your surgeon makes an incision along the front of your neck, opens your carotid artery and removes plaques that block the carotid artery. Your surgeon then repairs the artery with stitches or a patch made from a vein or artificial material (graft). The procedure may reduce your risk of ischemic stroke. However, a carotid endarterectomy also involves risks, especially for people with heart disease or other medical conditions.
  • Angioplasty and stents. In an angioplasty, a surgeon gains access to your carotid arteries most often through an artery in your groin. Here, he or she can gently and safely navigate to the carotid arteries in your neck. A balloon is then used to expand the narrowed artery. Then a stent can be inserted to support the opened artery.

Hemorrhagic stroke initial treatment:

Initial treatment for hemorrhagic stroke is difficult. Efforts are made to control bleeding, reduce pressure in the brain and stabilize vital signs such as blood pressure.

  • Few medications are available to treat hemorrhagic stroke. In some cases, medications may be given to control blood pressure, brain swelling, blood sugar levels, fever and seizures. You will be closely monitored for signs of increased pressure on the brain, such as restlessness, confusion, difficulty following commands and headache. Other measures will be taken to keep you from straining from excessive coughing, vomiting or lifting, or straining to pass stool or change position.
  • Surgery generally is not used to control mild to moderate bleeding resulting from a hemorrhagic stroke. However, if a large amount of bleeding has occurred and the person is rapidly getting worse, surgery may be needed to remove the blood that has built up inside the brain and to lower pressure inside the head.
  • If the bleeding is due to a ruptured brain aneurysm, surgery may be initiated to repair the aneurysm. The procedure used to repair a brain aneurysm is called endovascular coil embolization. It involves inserting a small coil into the aneurysm to block it off. Whether this surgery can be done depends on the location of the aneurysm and your condition following the stroke.

Regardless of the treatment options, time is of the essence in the treatment of strokes.