What is a Stroke?

Stroke is damage to the brain, spinal cord, or retina due to a disturbance in blood flow. More than 700,000 strokes occur per year in the United States and make up more than half of all hospital admissions for neurologic disease. Stroke is the leading cause of serious long-term disability and is consistently one of the leading causes of death in our country. Billions of dollars are spent yearly caring directly for the care of stroke patients. Many of those who suffer stroke are also unable to return to work leading to enormous indirect costs and lost wages.

Identifying stroke symptoms and acting quickly to be evaluated by emergency medical personnel is the first step in the treatment of any type of stroke. Calling 911 is a must and has been shown to reduce the time it takes for the stroke patient to receive life saving treatment.

Next, emergency staff will need to determine if a stroke is occurring and if so which major type of stroke is present. Primary stroke centers have been created in many hospitals, which consist of acute stroke teams, which are present 24/7 in order to work with emergency staff to help treat stroke patients.

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What Causes a Stroke?

There are two major types of stroke. Non-bleeding strokes are the most common type of strokes. These are also called ischemic strokes. Bleeding or hemorrhagic strokes are less common and are often associated with the rupture of an artery.

Non-bleeding strokes are often due to arteries suddenly closing and subsequently being unable to carry oxygenated blood cells to that part of the brain, spinal cord, or retina. Arteries becoming narrow with plaque development over many years due to the effects of high blood pressure or diabetes can cause this. A common place that plaque can form is in the carotid arteries found in the neck. Narrow carotid arteries are associated with increased stroke risk. Ischemic strokes can also be caused by blood clots forming in organs such as the heart, which can then travel to the nervous system and obstruct blood flow causing damage.

Bleeding strokes are associated with arteries which rupture and cause damage. High blood pressure is one risk factor associated with bleeding strokes. Arteries can also enlarge and balloon in size forming aneurysms, which can rupture, and cause bleeding in the subarachnoid layer around the brain. Identifying brain aneurysms prior to their rupture can prevent subarachnoid hemorrhages.

What are the Symptoms of a Stroke?

Abrupt changes in vision, speech, strength, or an unexplained severe headache are common stroke symptoms. Changes in vision can be in one or both eyes and associated with either loss of vision or double vision. Speech difficulty can often be slurred speech or simply difficulty getting words out. Weakness is often on one side of the body and can be as severe as paralysis or as mild as clumsiness.

Are There Warning Signs of a Stroke?

A transient ischemic attack or TIA is a warning sign of stroke. Symptoms of TIA’s are the same as those for stroke and often only last minutes. While only a small proportion of strokes are preceded by a TIA, these symptoms are very important since strokes can occur within days after a TIA occurs.

A TIA requires an urgent evaluation to prevent stroke. A TIA Clinic is present at Western Neuro to more quickly evaluate a patient with TIA. A typical TIA evaluation will include a neurological exam, lab tests, and imaging of the brain, blood vessels, and heart.

How Do I Know if I Am At Risk of a Stroke?

High blood pressure, elevated cholesterol, and diabetes are conditions that increase an individual’s risk for stroke. Atrial fibrillation, a heart rhythm disorder increases stroke risk. Smoking and excessive use of alcohol are also risk factors. Age also plays a role in stroke risk. While stroke occurs in all age groups, the increased risk for stroke in men often begins in their 60’s while women tend to see increased stroke risk in their 70’s. Stroke risk in younger adults can be associated with trauma to the head or neck, blood clotting disorders, and types of migraine headache. Finally, those that have suffered TIA’s and prior stroke are at increased risk for stroke.

Can A Stroke Be Prevented?

Yes. Identifying and treating high blood pressure, elevated cholesterol, and diabetes can reduce the risk of both non- bleeding and bleeding strokes. Blood thinner medications can reduce the risk of stroke due to atrial fibrillation. Exercise and weight loss can also help prevent stroke. Imaging studies can identify plaque in the carotid arteries or aneurysms in the brain. There are also both surgical and non-surgical treatments for the treatment of carotid artery plaque formation and brain aneurysms.

In addition, following a stroke, medications can be given to reduce the risk of plaque formation on arteries. Often, there are multiple risk factors present, and a comprehensive prevention plan with a neurologist and/or neurosurgeon working together with one’s primary care physician can help reduce the risk of stroke.

Stroke Treatment

Non-bleeding strokes can be treated with a FDA approved clot- busting drug called t-PA. Quick investigation in the emergency center can determine if a patient with stroke symptoms is able to receive this drug. T-PA can be associated with severe bleeding complications and therefore can only be used within 3 hours of stroke symptom onset. In rare instances this drug may be used after this time window however best results are associated with its use as a clot buster as soon after stroke symptoms develop.

While not every stroke patient can receive t-PA, patients with stroke are admitted to the hospital and other treatments are implemented. Treatments can include control of vital signs, fluid and electrolyte management, and even surgical treatments to relieve pressure in the nervous system that can result from large strokes. Multiple tests are also performed to help identify the location and cause of the stroke so that the best preventative strategy can be implemented to reduce the risk of recurrent strokes.

In rare circumstances specialists at Western Neuro can recommend that a stroke patient be evaluated for retrieval of clot found in a major artery may be causing stroke. Such clots may not respond quickly enough for t-PA to work and may require the expertise of a vascular neurosurgeon to perform an invasive catheter procedure to help treat stroke.

Bleeding strokes often require close observation in the neurological intensive care unit to identify changes in neurological function that may lead to surgical intervention. Subarachnoid hemorrhages will need their aneurysms treated with either surgical or non-surgical treatment.

Hospital Stay After a Stroke

This answer varies on the type and severity of stroke. Generally, stroke patients can expect a 2-3 day hospital stay to allow initial treatment and investigation of stroke to occur. Patients will often leave the hospital with new medications to help prevent stroke. Following this, factors, which determine when a stroke patient may return home, include what form of rehabilitation are needed and how much assistance they will need. Physical, occupational, and speech therapy are forms of therapy used to help treat stroke patients. Many stroke patients require temporary inpatient hospital rehabilitation or transition to a nursing facility that has supportive therapies.

Resolution of Stroke Symptoms

Depending on the severity and location of one’s stroke recovery of symptoms will vary. There are types of stroke that are associated with very good outcome. It is important to realize that the recovery process is often gradual with the greatest improvement seen in the first 6 months following a stroke. Following up with your doctor and specialists will be important in helping to further prevent stroke and obtaining further assistance to aide in recovery.

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