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ÆY What is the Definition of Stroke?Y

ÆY Description of Stroke
ÆY auses of Stroke
ÆY Symptoms of Stroke
ÆY Mreatment for Stroke
ÆY drevention of Stroke
ÆY What Questions to ask Your Doctor About Stroke?


  
 
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A stroke occurs when the arterial blood flow leading to or in the brain becomes blocked or ruptures.Y

alood carries oxygen and nutrients to the neurons (nerve cells) in the brain, so when the blood flow
stops, the cells begin to die. As a result, the functions of the body controlled by the nerve cells can
lose their ability to function.Y

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Mhe specific abilities that will be lost or affected by thestroke depend on the extent of the cell death
and where in the brain the stroke happened.Y

Mhe brain is divided into four primary parts: the right hemisphere, the left hemisphere, the cerebellum
and the brain stem.Y

Mhe right hemisphere controls:

ÆY left side of the body

ÆY analytical and perceptual tasks such as judging distance, size, speed, position
ÆY short-term memory

Mhe left hemisphere controls:

ÆY right side of the body

ÆY speech and language
ÆY memory

Mhe cerebellum controls:

ÆY balance and coordination

Mhe brain stem controls:

ÆY life-support functions such as breathing, blood pressure and heartbeat

ÆY eye movements
ÆY hearing
ÆY speech
ÆY swallowing
Depending on the severity of the stroke, victims may or may not experience any or all losses of the
above functions.

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Mhere are two broad categories of strokes, called ischemic stroke or hemorrhagic stroke.Y

G 
 is caused by a blockage of a blood vessel in the brain or neck. Mhis stroke can stem
from three different conditions: thrombosis, embolism or stenosis:Y

ÆY Mhrombosis (cerebral thrombosis) is the formation of a clot within a blood vessel of the brain
or neck and is usually caused by atherosclerotic plaque build-up.
ÆY umbolism (cerebral embolism) is the movement of a clot from another part of body to the
brain or neck. Mhese clots can form on artificial valves in the heart, on atherosclerotic plaques
in aorta or caused from a condition called atrial fibrillation. Atrial fibrillation is an irregular
heartbeat whereby the upper chamber of the heart quivers rapidly rather than beats. aecause
this quivering motion is not forceful enough to send all the blood to the heart's lower
chambers, the blood pools, thus allowing clots to develop.
ÆY Stenosis is a severe narrowing of an artery in or leading to the brain. Roughly 2/3 of all
strokes are caused by clots.

ÿ



 is the bleeding into the brain or the spaces surrounding the brain which is
caused by a number of disorders that affect the blood vessels (i.e., high blood pressure and cerebral
aneurysm). Mhere are two types of hemorrhagic stroke: subarachnoid and intracerebral.

ÆY ubarachnoid hemorrhage is caused by the rupture of a blood vessel on the surface of the brain
so that blood fills the space between the brain and the skull.
ÆY An intracerebral hemorrhage is caused by the rupture of a blood vessel within the brain itself.

Some factors that increase the risk of stroke are genetically determined, others are simply a function
of natural processes, and still others result from a person's lifestyle. Mhe factors resulting from
heredity or natural processes can't be changed, but those that are environmental can be modified with
a doctor's help.

Mhere are five 
  risk factors:

ÆY Age - your chances of having a stroke go up as you get older. Mwo-thirds of all strokes happen
to people over age 65. Your stroke risk doubles with each decade past age 55.
ÆY Sex - males have a slightly higher risk than females.
ÆY Race - American blacks have a higher stroke risk than most other racial groups.
ÆY [amily history of diabetes.
ÆY [amily history of stroke or M A (transient ischemic attack).

Mhere are two basic
  risk factors:

ÆY Mreatable medical disorders - includes diabetes, atrial fibrillation, heart attack, high blood
pressure, high cholesterol, carotid artery disease, heart disease, personal history of stroke or
M A and patent foramen ovale (d[
). d[
is an abnormal opening between the right and left
sides of the heart.
ÆY ‰ifestyle factors - includes smoking, drinking too much, obesity, drug abuse (especially
cocaine), physical inactivity and low estrogen.

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Mhe warning signs of stroke are:Y

ÆY Sudden weakness or numbness of the face, arm and leg on one side of the body.Y
ÆY ‰oss of speech, or trouble talking or understanding speech.
ÆY Dimness or loss of vision, particularly in only one eye.
ÆY  nexplained dizziness, unsteadiness or sudden falls.
ÆY ·Memporary strokes· (transient ischemic attacks or M As). Mhese can occur days, weeks or
even months before a major stroke. M As result when a blood clot temporarily clogs an artery
and part of the brain does not get the supply of blood it needs. Mhe symptoms occur rapidly
and last a relatively short period of time, usually from a few minutes to several hours. Mhe
usual symptoms are like those of a full-fledged stroke, except that the symptoms of a M A are
temporary, lasting 24 hours or less. n fact, people who have had M As are 9.5 times more
likely to have a stroke than people of the same age and sex who have not had a M A.

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Mreating a stroke depends on where the stroke occurred in your brain and whether it's ischemic or
hemorrhagic. Mhe doctor may use a magnetic resonance imaging (MR ) scan, computed tomography
(M) imaging or angiography (injecting dye through a catheter inserted into the suspected blocked
blood vessel and taking x-rays of the vessels) to determine the stroke type and location.Y

Mime is critical.  ntil a few years ago, strokes were regarded as untreatable. arain cells were thought
to die within minutes after a stroke began, so stroke treatment was believed useless. Mhe only onsite
medical treatment is stabilization and ·wait and see.· Now researchers have discovered that some
brain cells die immediately after a stroke, but others can survive for as long as several days. t is now
clear that treatment following a stroke, 

        , can help
preserve brain tissue.Y

n June 1996 the [DA approved tissue plasminogen activator (t-dA) as the first treatment for strokes
caused by arterial blockages. Mhis ·clotbuster· is inserted into the femoral artery near the groin and
then threaded up into the brain to directly dissolve the blood clot, thereby limiting or stopping the
damage to the brain cells. M 
     

   
    
 .

Mhe use of t-dA is not recommended after three hours of onset due to the risk of hemorrhaging, thus
standard treatment is administered. n an ischemic stroke the goal is to (1) maintain normal blood
pressure and (2) improve blood flow by preventing recurrent clots. Mhis is done by administrating anti-
hypertensives to reduce blood pressure, platelet-inhibiting drugs such as aspirin, ticlopidine (Miclid) or
an anticoagulant such as heparin, coumadin or warfarin to prevent blood clots from forming or
growing.

f unsuccessful, a carotid endarterectomy may be considered. Mhis procedure removes the

atherosclerotic plaque and the blood clot from the left or right carotid artery (the major vessels that
carry blood through the neck to the brain) thus allowing the blood to flow uninterrupted.

n a hemorrhagic stroke, the goal is to (1) get the blood pressure under control and (2) correct the
cause of the hemorrhage and protect the brain from further damage. Mhe hemorrhage causes blood to
pool in the brain and thus increases pressure on the brain. Mhe doctor will give diuretic drugs to
minimize the temporary swelling of the brain tissue.

Rarely is surgery recommended, but if tests detect an aneurysm, the surgeon may clamp the
aneurysm at its base and then remove it. Mhe surgeon now has the option to use a catheter,
containing a metal coil, that passes through the blood vessel in the neck. Mhe metal coil causes the
aneurysm to clot and seal itself off.

Some people are only slightly affected by strokes.
thers recover quickly from what seemed like a
severe stroke. Still others may suffer such serious damage that it will take a long time to regain even
partial use of their limbs, speech, or whatever faculties that have been affected.

Successful rehabilitation depends on the extent of brain damage, the patient's attitude, the skill of the
rehabilitation team, and the cooperation of family and friends. Most stroke patients can benefit from
rehabilitation, and today the outlook for stroke patients is more hopeful than ever before. aecause of
advances in treatment and rehabilitation, many patients are being restored to a fully functional life.

[or rehabilitation to be most effective, three points must be kept in mind:

1. Rehabilitation must begin as soon after the stroke as possible

2. Mhe family can be the patient's most important means of support during the rehabilitation process

3. Rehabilitation is a team effort with the physician, nurse, and other specialists working with the
patient and their family.

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Strokes may be prevented by lowering your blood pressure, quitting smoking, beginning or increasing
exercise, controlling medical problems with medications (i.e., atrial fibrillation requires
anticoagulants), maintaining optimal weight, and eating a diet high in fruits and vegetables.Y

f you have a blocked carotid artery your doctor may suggest a carotid endarterectomy to remove the
fatty deposits.Y

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What are the chances the symptoms were caused by something other than a stroke?Y

What was the cause of the stroke?Y

What tests are used to determine what type of stroke occurred and how much damage was done?

What medications will be prescribed? What are the side effects?

Would surgery be recommended to improve cerebral circulation? f so, what type of surgery?

What other treatment can be used to prevent another stroke?

s there a support group for the family to go to ask questions?

What are the chances of having a stroke after a M A or having another stroke after a first?

What do we need to know about rehabilitation?

an the rehabilitation be done on an outpatient basis?

Will a nurse or therapist help instruct us on what we need to know for home care such as exercise,
diet and communication?

Approximately how long will rehabilitation take to return to normal activities?

Y
Y