Risk Factors for Stroke

Hypertension (high blood pressure)

Heart disease - coronary artery disease, valve disease, arrhythmias (A-Fib)
Diabetes
Previous stroke
Family history of stroke
moking
!besity
"lood coagulation disorder
!ral contraceptives

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Health Topic: Stroke
Definition
A stroke is an interruption of the blood supply to any part of
the brain. A stroke is sometimes called a "brain attack."
Causes, Incidence, and Risk Factors
Every 45 seconds, someone in the United tates has a
stroke. A stroke can happen when!
A blood vessel carrying blood to the brain is blocked by a blood clot. "his is called an
ischemic stroke.
A blood vessel breaks open, causing blood to leak into the brain. "his is a hemmorhagic
stroke.
#f blood flow is stopped for longer than a few seconds, the brain cannot get blood and o$ygen.
%rain cells can die, causing permanent damage.
Ischemic Stroke
"his is the most common type of stroke. Usually this type of stroke results from clogged arteries,
a condition called atherosclerosis. &atty deposits and blood platelets collect on the wall of the
arteries, forming a sticky substance called pla'ue. (ver time, the pla'ue builds up. (ften, the
pla'ue causes the blood to flow abnormally, which can cause the blood to clot. "here are two
types of clots!
A clot that stays in place in the brain is called a cerebral thrombus.
A clot that breaks loose and moves through the bloodstream to the brain is called an
cerebral embolism.
Another important cause of cerebral embolisms is a type of arrhythmia called atrial fibrillation.
(ther causes of ischemic stroke include endocarditis and the use of a mechanical heart valve. A
clot can form on the artificial valve, break off, and
travel to the brain. &or this reason, those with
mechanical heart valves must take blood thinners.
Hemorrhagic Stroke
A second ma)or cause of stroke is bleeding in the brain,
known as hemorrhagic stroke. "his can occur when
small blood vessels in the brain become weak and
burst. ome people have defects in the blood vessels of
the brain that make this more likely. "he flow of blood
after the blood vessel ruptures damages brain cells.
Stroke Risks
*igh blood pressure is the number one cause of stroke.
"he risk of stroke is also increased by age, family
history of stroke, smoking, diabetes, high cholesterol,
and heart disease.
+ertain medications increase the chances of clot formation, and therefore chances for a stroke.
%irth control pills can cause blood clots, especially in woman who smoke and who are older than
,5.
-en have more strokes than women. %ut, women have a risk of stroke during pregnancy and the
weeks immediately after pregnancy.
+ocaine use, alcohol abuse, head in)ury, and bleeding disorders also increase the risk of bleeding
into the brain.
Symptoms
"he symptoms of stroke depend on what part of the brain is damaged. Usually, a U..E/
development of one or more of the following indicates a stroke!
0eakness or paralysis of an arm, leg, side of the face, or any part of the body
/umbness, tingling, decreased sensation
1ision changes
lurred speech, inability to speak or understand speech, difficulty reading or writing
wallowing difficulties or drooling
2oss of memory
1ertigo 3spinning sensation4
2oss of balance or coordination
5ersonality changes
-ood changes 3depression, apathy4
.rowsiness, lethargy, or loss of consciousness
Uncontrollable eye movements or eyelid drooping
#f one or more of these symptoms is present for less than 64 hours, it may be a transient ischemic
attack 3"#A4. A "#A is a temporary loss of brain function and a warning sign for a possible future
stroke.
Signs and Tests
#n diagnosing a stroke, knowing how the symptoms developed is important. "he symptoms may
be severe at the beginning of the stroke, or they may progress or fluctuate for the first day or two.
(nce there is no further deterioration, the stroke is considered completed.
.uring physical e$am, a doctor will look for specific neurologic, motor, and sensory deficits.
"hese often correspond closely to the location of the in)ury in the brain. An e$amination may
show changes in vision or visual fields, abnormal refle$es, abnormal eye movements, muscle
weakness, decreased sensation, and other changes. A "bruit" 3an abnormal sound heard with the
stethoscope4 may be heard over the carotid arteries of the neck. "here may be signs of atrial
fibrillation.
Treatment
A stroke is a medical emergency. .octors have begun to call it a "brain attack" to stress that
getting treatment immediately can save lives and reduce disability. "reatment varies, depending
on the severity and cause of the stroke. "he goal is to get the person to the emergency room
immediately, determine if he or she is having a bleeding stroke or a stroke from a blood clot, and
start therapy 77 all within , hours of when the stroke began.
IMMDI!T Treatment
"hrombolytic medicine, like t5A, breaks up blood clots and can restore blood flow to the damaged
area. 5eople who receive this medicine are more likely to have less long7term impairment.
*owever, to receive thrombolytics a person must be evaluated and treated by a speciali8ed
stroke team within , hours of when the symptoms start. #f the stroke is caused by bleeding rather
than clotting, t5A can make the damage worse 77 so care is needed to diagnose the cause before
giving treatment.
#n other circumstances, blood thinners such as heparin and coumadin are used to treat strokes.
Aspirin and other anti7platelet agents may be used as well.
&or hemorrhagic stroke, surgery is often re'uired to remove pooled blood from the brain and to
repair damaged blood vessels.
"pectations #$rognosis%
"he long7term outcome from a stroke depends on the e$tent of damage to the brain, the
presence of any associated medical problems, and the likelihood of recurring strokes.
(f those who survive a stroke, many have long7term disabilities, but about 9:; of those who
have had a stroke recover most or all function. &ifty percent are able to be at home with medical
assistance while 4:; become residents of a long7term care facility like a nursing home.
Complications
5roblems due to loss of mobility
3)oint contractures, pressure
sores4
5ermanent loss of movement or
sensation of a part of the body
%one fractures
-uscle spasticity
5ermanent loss of brain functions
<educed communication or social
interaction
<educed ability to function or
care for self
.ecreased life span
ide effects of medications
Aspiration
-alnutrition
$re&ention
"o help prevent a stroke!
=et screened for high blood pressure at least every two years, especially if there is a
family history of high blood pressure.
=et regular cholesterol checks.
"reat high blood pressure, diabetes, high cholesterol, and heart disease if present.
&ollow a low7fat diet.
>uit smoking.
E$ercise regularly.
2ose weight 3if overweight4.
Avoid e$cessive alcohol use 3no more than 9 to 6 drinks per day4.
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