Stroke

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KEY POINTS

• A stroke happens when blood flow to part of the brain is suddenly slowed or stopped. The part of the brain that loses its blood supply may be damaged and stop working. You may have trouble using the part of the body that is controlled by the injured part of the brain.
• Strokes need to be treated in a hospital. Treatment may include medicine or surgery.
• To prevent a stroke, it helps if you quit smoking, learn to manage stress, exercise as your provider recommends, eat a healthy diet, and keep a healthy weight. Follow your provider’s instructions for treatment of high blood pressure or high cholesterol. If you have diabetes, keep good control of your blood glucose (sugar).

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What is a stroke?

A stroke happens when blood flow to part of the brain is suddenly slowed or stopped. The part of the brain that loses its blood supply stops working. You may have trouble using the part of the body that is controlled by the part of the brain that is damaged.

A small stroke may cause little damage. Sometimes you may have problems right after a stroke, but they may then go away completely within less than a day. These types of small strokes are called transient ischemic attacks, or TIAs. Bigger strokes can cause life-long damage. Sometimes they cause death.

How much you recover from a stroke depends on how much of the brain was damaged. Some people recover fully from a stroke. Others keep having problems, like weakness or paralysis in an arm or leg on one side or an inability to speak. Full recovery from a stroke is more likely if you get medical care right away.

A stroke is also called a cerebral vascular accident, or CVA.

What is the cause?

A stroke can be caused by anything that stops or slows down blood flow to part of the brain. Blood can be kept from reaching brain tissue when a blood vessel gets blocked (an ischemic stroke) or bursts (a hemorrhagic stroke).

• An ischemic stroke is the most common kind of stroke. A blood vessel in the brain can be blocked in different ways.
  • Fatty deposits called plaque may build up in blood vessels that bring blood to the brain. The plaque makes the blood vessels narrower. The narrowing decreases the amount of blood flow to the brain. Small pieces of plaque may break off from the wall of a blood vessel and completely block a smaller blood vessel.
  • Blood clots or plaque from other parts of the body may travel to the brain or neck and block a blood vessel in the brain.
• A hemorrhagic stroke happens when an artery in the brain tears open and causes bleeding into the brain. A hemorrhage often happens without warning. High blood pressure can cause hemorrhagic strokes. Sometimes a blood vessel defect present since birth can cause this type of stroke.

Your risk of having a stroke is higher if you:

• Are over the age of 55
• Have a family member who has had a stroke
• Are African American
• Are male
• Have already had a stroke, TIA, or heart attack

You are more likely to have a stroke if you have a medical condition that puts a strain on your heart and blood vessels such as:

• High blood pressure
• Diabetes or metabolic syndrome
• High cholesterol
• Blood vessel disease
• Heart rhythm or heart valve problems
• Sickle cell anemia
• Sleep apnea

Some unhealthy lifestyle habits can increase your risk for a stroke. You are more likely to have a stroke if you:

• Smoke
• Eat an unhealthy diet
• Are overweight
• Don't get enough exercise
• Use illegal drugs or drink too much alcohol

What are the symptoms?

It helps to think of the word FAST (face, arm, speech, and time) to remember stroke symptoms and what to do. Remember that Stroke symptoms come on FAST and may include:

• Face/Head
  • Weakness, numbness, drooping, or tingling of face (may just be on one side)
  • Trouble seeing (one or both eyes)
  • Severe headache
  • Trouble thinking
  • Trouble swallowing
  • Feeling dizzy along with one or more of the symptoms listed above
• Arm/Leg
  • Weakness, numbness, or tingling in your arm or leg (may be on just one side of your body)
  • Trouble walking or moving your arm or leg
• Speech
  • Trouble talking or understanding speech
• Time
  • Call 911 for emergency help right away if you have symptoms of a stroke.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. Tests may include:

• MRI, which uses a strong magnetic field and radio waves to show detailed pictures of the brain and blood vessels
• CT scan, which uses X-rays and a computer to show detailed pictures of the brain and blood vessels
• Ultrasound, which uses sound waves to show pictures of the blood vessels in the neck and brain
• EEG (electroencephalogram), which uses small wires pasted or taped to your head to measure and record the electrical activity of your brain
• An ECG (also called an EKG or electrocardiogram), which measures and records your heartbeat. You may have an ECG while you are resting or while you exercise on a treadmill. You may also be asked to wear a small portable ECG monitor for a few days or longer.
• An echocardiogram, which uses sound waves (ultrasound) to see how well your heart is pumping and to find blood clots in your heart
• Blood tests

How is it treated?

A stroke is a medical emergency. If you think that you or someone near you is having a stroke, call 911 right away. Don't do anything else before you call 911.

Don't take aspirin if you think you are having a stroke unless a healthcare provider tells you to do so. Aspirin can make a hemorrhagic stroke much worse.

Strokes need to be treated in a hospital. The treatment depends on what kind of stroke you are having.

• A stroke caused by blood clots may be treated with clot-dissolving medicine or a procedure to remove the clot.
• When a stroke is caused by bleeding in the brain, you may need a procedure to try to stop the bleeding and fix the torn blood vessel causing the problem, or have surgery to remove a blood clot.

How can I take care of myself?

Follow the treatment plan your provider recommends.

After a stroke, you will likely need to start a rehabilitation program to help you recover and adapt to problems caused by the stroke. Depending on how the stroke has affected you, this may include physical therapy, occupational therapy, or speech therapy.

• Physical therapy can help your muscles get strong again. Not all muscles weakened by stroke will recover completely. You will need to learn ways to move safely with weak or paralyzed muscles.
• Occupational therapy may help if you have problems doing things like feeding yourself and getting dressed.
• Speech therapy may help if you have problems with swallowing, speaking, or understanding words.

You will also learn about diet, exercise, and other ways to improve your health and help prevent another stroke.

Ask your provider:

• How and when you will get your test results
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

How can I help prevent a stroke?

Some of the risks for a stroke cannot be prevented, such as age, race, and family history. Other risks, such as high blood pressure, high cholesterol, diabetes, and heart disease can be controlled with the help of your healthcare provider. Lifestyle changes can also help prevent a stroke:

• Don't smoke.
• Lose weight if you need to and keep a healthy weight.
• Be physically active.
• Eat a healthy diet.
• Limit your use of alcohol.

You can get more information from:

• American Stroke Association
  1-888-4-STROKE
  http://www.strokeassociation.org