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More InDepth Information on This Condition
Definition
| Causes
| Risk Factors
| Symptoms
| Diagnosis
| Treatment
| Prevention
Definition
Stroke is a brain injury. It occurs when the brain's blood supply is interrupted. Without oxygen and nutrients from blood, brain tissue dies quickly (in less than 10 minutes). This causes a sudden function loss.
Risk Factors
These risk factors increase your chance of developing a stroke. Tell your doctor if you have any of these risk factors.
Risk factors you can affect:
Risk factors you cannot affect:
-
Prior stroke or pre-existing cardiovascular disease, such as
heart attack
-
Prior
transient ischemic attack
(TIA)—Some people experience a "warning stroke" or TIA. This is a temporary interruption of the brain's blood supply (mini-stroke). These are stroke symptoms that resolve completely within minutes. They may signal a very high risk of having a full-blown stroke in the near future.
- Age: 60 or older
- Family members who have had a stroke
- Gender: males are at greater risk
- Race: Black, Asian, Hispanic
-
Blood disorders which increase clotting in
sickle cell disease
and
polycythemia
-
Valvular heart disease, such as
mitral stenosis
Symptoms
Symptoms occur suddenly. They differ depending on the part of the brain affected. Also, multiple symptoms can happen at the same time. If you notice any of the symptoms below, call emergency help right away. Getting help immediately is important, because brain tissue dies quickly when deprived of oxygen.
- Sudden weakness or numbness of face, arm, or leg, especially on one side of the body
- Sudden confusion
- Sudden trouble speaking or understanding
- Sudden trouble seeing in one or both eyes
- Sudden dizziness, trouble walking, loss of balance, or coordination
- Sudden severe headache with no known cause
Diagnosis
Having a stroke is an emergency situation. Diagnosis includes:
- Neurological exams
- Electrocardiogram (ECG, EKG)
—a test that records the heart's activity by measuring electrical currents through the heart muscle
-
Brain and blood vessel imaging by:
- CT scan
—a type of x-ray that uses a computer to make pictures of the brain,
helps doctors identify hemorrhagic versus ischemic stroke
- MRI scan
—a test that uses magnetic waves to make pictures of the brain
- Ultrasonography—a test that uses sound waves to examine the blood vessels feeding the brain
-
Blood tests, especially homocysteine,
prothrombin time
, and other coagulation tests
Some tests may include:
-
Arteriography
(angiography)—a catheter is placed in a blood vessel in the groin and threaded up to the brain, shows arteries in the brain
-
Magnetic resonance angiography
(MRA)—shows brain blood vessels by mapping blood flow
- CT angiogram (CTA)—this test uses a CT scanner, gives images of the blood vessels inside the brain after a dye is injected into the veins
- Functional MRI—shows brain activity by picking up signals from oxygenated blood
-
Doppler ultrasound
—shows narrowing of the arteries (carotid and vertebral) supplying the brain, evaluates flow of blood in brain
-
Echocardiography
—a test that uses high-frequency sound waves (ultrasound) to examine the size, shape, and motion of the heart, shows if the clot comes from one of the heart's chambers
Treatment
Immediate treatment is needed to
:
- Dissolve a clot causing an ischemic stroke
- Stop the bleeding during a hemorrhagic stroke
Other treatment aims to:
- Reduce the chance of later strokes
- Improve functioning
- Overcome disabilities
Medications
-
Clot-dissolving drugs
- Given shortly after the start of symptoms—typically given within 4-½ hours by IV, or intraarterially (IA) within 6 hours
- Used in carefully selected patients
-
Blood-thinning drugs (anticoagulants)
- Heparin
,
given by vein
-
Oral medicine (
warfarin
), given if long-term treatment with blood-thinner is expected
- Lovenox
or other related medicines, given subcutaneously (under skin)
-
Antiplatelet drugs
Other interventions during an acute stroke:
- Adequate oxygen
-
Precautions to
prevent choking
- Frequent neurological examinations
Surgery
Some procedures can be done to prevent damage or allow blood flow back into the affected area after a stroke:
- Extracranial/intracranial bypass—blood supply is rerouted around a blocked artery using a healthy scalp artery
- Craniotomy—done with a hemorrhagic stroke to relieve pressure build-up in the brain caused by swelling
- Embolectomy—a catheter is threaded through blood vessels to the clot; a special device will either mechanically remove the clot or deliver clot-dissolving medicine directly to the area
Other surgeries may be performed following a stroke or TIA to prevent a recurrence. Surgical techniques:
- Carotid endarterectomy
—fatty deposits are removed from a carotid artery (major arteries in the neck that lead to the brain)
- Carotid angioplasty
and
stenting
—less invasive procedure, carotid artery is widened and a mesh tube is placed into the artery to keep it open
A study was done to compare endarterectomy to stenting. Even though endarterectomy is more invasive, it led to fewer deaths. It also had fewer repeat strokes than stenting within the first six months.
Rehabilitation
- Physical therapy—to regain as much movement as possible
- Occupational therapy—to assist in everyday tasks and self care
- Speech therapy—to improve swallowing and speech challenges
- Psychological therapy—to improve mood and decrease depression
Prevention
To help reduce your chance of getting a stroke, take the following steps:
- Exercise regularly.
- Eat more fruits and vegetables
. Limit dietary
salt
and
fat
.
- Stop smoking
.
- Increase your consumption of fish.
- Drink alcohol only in moderation (1-2 drinks per day).
- Maintain a healthy weight.
- Check blood pressure frequently
. Follow your doctor's recommendations for keeping it in a safe range.
- Take a low dose of aspirin (50-325 milligrams per day) if your doctor says it is safe.
- Keep chronic medical conditions under control. This includes high cholesterol and diabetes.
- Talk to your doctor about the use of a statins. These types of drugs may help prevent certain kinds of strokes in some people.
- Seek medical care if you have symptoms of a stroke, even if symptoms stop.
- Stop the use of recreational drugs (cocaine, heroin, marijuana, amphetamines).
Last reviewed August 2010 by Rimas Lukas, MD
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