Stroke (Cerebrovascular Accident), Ischemic

What is a stroke?

A stroke is damage to part of the brain when its blood supply is suddenly slowed or stopped. A stroke may also be called a cerebral vascular accident, or CVA. The part of the brain that does not get enough blood dies and can no longer function.

An ischemic stroke is the most common kind. This type of stroke happens when there is a blockage in a blood vessel in the brain. The blockage may be caused by a blood clot that forms in a blood vessel of the brain or neck or a clot that travels from another part of the body to the brain or neck, such as a blood clot caused by an irregular heart rhythm called atrial fibrillation. An ischemic stroke may also be caused by a severe narrowing of an artery in the brain, or of an artery leading to the brain, such as an artery in the neck.

Any of the following factors can increase the risk of a stroke:

• High blood pressure
• Diabetes or borderline high blood sugar level
• High LDL cholesterol level, low HDL cholesterol level, or high triglyceride level
• Cigarette smoking
• Being overweight, especially excess weight around the waist
• Family history of stroke
• Heart valve or heart muscle disease called endocarditis
• Heart disease or coronary artery disease
• Heart rhythm problems such as atrial fibrillation
• Sleep apnea
• Sickle cell anemia
• Patent foramen ovale (a heart birth defect)

Symptoms of a stroke include:

• Sudden numbness or weakness of the face, arm or leg, usually on one side of your body
• Sudden trouble walking or loss of balance
• Sudden trouble speaking or thinking clearly
• Sudden dizziness or severe headache
• Sudden trouble seeing in one or both eyes
• Nausea and vomiting

What can I expect in the hospital?

All strokes require careful observation, especially in the first 24 hours. You will need to stay in the hospital for testing and treatment after a stroke.

Several things may be done while you are in the hospital to monitor, test, and treat your condition. They include:

Monitoring

• You will be checked often by the hospital staff.
• Your heart rate, blood pressure, and temperature will be checked regularly.
• A heart (cardiac) monitor will be used to check your heartbeat.
• Your blood oxygen level will be monitored by a sensor that is attached to your finger or earlobe.
• Your fluid intake may be monitored closely by keeping track of everything you eat and drink and any IV fluids you receive.
• You may have a small tube (catheter) placed into your bladder to drain and measure urine.

Testing

Testing may include:

• Blood tests to check for healthy blood cells, anemia, fats in the blood, and the ability of the blood to clot
• Neurologic examination: Testing to check your strength, sensation, balance, reflexes, thinking, and memory. Some parts of this test may be repeated many times a day while you are in the hospital.
• Computed tomography (CT) scan: A series of X-rays is taken from different angles and arranged by a computer to show thin cross sections of the brain.
• Magnetic resonance imaging (MRI): A powerful magnetic field and radio waves are used to take pictures from different angles to show thin cross sections of the brain.
• Carotid ultrasound scan: Sound waves and their echoes are passed through your body from a small device that is held against your skin to create pictures of the inside of the arteries in the neck.
• An ECG (also called an EKG or electrocardiogram) is a painless test that shows the electrical activity of the heart.
• An echocardiogram uses sound waves (ultrasound) to see how well your heart is pumping and to check for blood clots.

Treatment

The treatment for ischemic stroke depends on the location of the stroke, your symptoms, how well you respond to treatment, your overall health, and any complications you may have.

• You will have a small tube (IV catheter) inserted into a vein in your hand or arm. This will allow medicine to be given directly into your blood and to give you fluids, if needed.
• You may receive oxygen through a small tube placed under your nose or through a mask placed over your face.
• Your provider may prescribe medicines to:
  • Dissolve or break down blood clots
  • Prevent blood clots by thinning your blood
  • Help your heart to beat normally
  • Control cholesterol levels
  • Reduce straining with a bowel movement
  • Treat other conditions that may have been a risk factor for your stroke, such as high blood pressure
• Your provider may recommend other types of therapy to help relieve pain, other symptoms, or side effects of treatment.
• You may need surgery to treat ischemic stroke. Surgery may include:
  • Angioplasty: A procedure in which your healthcare provider inserts a flexible tube called a balloon catheter into a blood vessel and moves it up to the blocked blood vessel in the neck. The balloon is inflated to widen the artery and improve blood flow to the brain. A metal mesh device called a stent is usually left in the artery to help keep the blood vessel open.
  • Clot removal (embolectomy): A procedure in which a long, thin, flexible tube (catheter) is inserted into a blood vessel and moved up to the blocked blood vessel. The clot is then removed from the artery to improve blood flow. Filters may be placed above the blockage to prevent pieces of the plaque from moving up the artery and into the brain.
  • Carotid endarterectomy: Surgery to remove plaque that is blocking blood flow in a narrowed artery in the neck, called the carotid artery. The carotid artery supplies blood to the brain.
• You may start a stroke rehabilitation program while you are in the hospital to help you regain some of the functions you may have lost due to the stroke. Most stroke rehabilitation programs include:
  • Physical therapy to help you regain muscle strength and teach you ways to move safely
  • Occupational therapy to help you relearn ways to do the tasks that you previously did
  • Speech therapy to help you if you have problems with swallowing, speaking, or understanding words
• Therapy may include skin care and training to help you control your bladder and bowels.
• You may need help with daily activities.

What can I do to help?

• You will need to tell your healthcare team if you have worsening new or worsening:
  • Weakness, numbness, or tingling in the face, arm, or leg, especially on one side of the body
  • Trouble with muscle movements, such as swallowing, moving arms and legs
  • Trouble speaking or understanding
  • Change in vision, such as double vision, blurred vision, or trouble seeing out of one or both eyes
  • Loss of bowel control
  • Loss of bladder control
  • Severe headache
  • Fainting
  • Seizures or convulsions
  • Loss of balance or coordination
  • Confusion
  • Personality changes
  • Dizziness or lightheadedness
  • Forgetfulness
• Ask questions about any medicine or treatment or information that you do not understand.

How long will I be in the hospital?

How long you stay in the hospital depends on many things, such as your general health, the treatment you need, and how well you recover. Talk with your provider about how long your stay may be.

You may need to go to a rehabilitation facility to continue your stroke rehabilitation program before going home.