What is Stroke?

Stroke is the third leading cause of death in the United States and the leading cause of disability among adults. It is a health issue everyone should know something about.A stroke occurs when a clot blocks the supply of blood to a part of the brain, or when a blood vessel leaks or bursts -- causing bleeding into or around the brain. Brain cells begin to die when they are not receiving the blood they need, or when there is bleeding in or around the brain.

Symptoms and Signs of Stroke

If you or a loved one experience one or more of these symptoms of stroke, call 911 immediately and get to the emergency room.

•Sudden numbness or weakness of face, arm or leg - especially on one side of the body
•Sudden confusion, trouble speaking or understanding speech
•Sudden trouble seeing in one or both eyes
•Sudden trouble walking, dizziness, loss of balance or coordination
•Sudden severe headache with no known cause

Types of Stroke

There are two types of stroke: ischemic and hemorrhagic. An ischemic stroke, which accounts for the vast majority of strokes, occurs when a blood vessel is blocked, cutting off the flow of blood to part of the brain. A hemorrhagic stroke occurs when there is bleeding into or around the brain. Causes of hemorrhagic stroke can include a ruptured cerebral aneurysm, an arteriovenous malformation (AVM), or arterial walls breaking open. A cerebral aneurysm (one located in the brain) is a weakened spot that has bulged or ballooned out from the side of the artery. Frequently, these “pouches” occur at the point at which a blood vessel branches. Arteriovenous malformations (AVMs) are tangles of arteries and veins.

What is a Transient Ischemic Attack?

A transient ischemic attack (TIA), presents itself with the same symptoms as a stroke. However, with a TIA there is no lasting damage and symptoms disappear relatively quickly. A TIA is also called a “mini-stroke.” About one-third of those who have a TIA will have an acute stroke in the future. Because it presents with the same symptoms as a stroke, anyone experiencing the following symptoms should call 911 and seek emergency medical attention immediately.

•Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
•Sudden confusion, trouble speaking or understanding
•Sudden trouble seeing in one or both eyes
•Sudden trouble walking, dizziness, loss of balance or coordination
•Sudden, severe headache with no known cause

Risk Factors

There are a number of factors that may put you at greater risk for stroke. While some cannot be changed, there are things you can do individually to lower your risk: eat a healthy diet, maintain a healthy weight, stop smoking and control your cholesterol, diabetes and blood pressure.

Risk factors that can be controlled, treated or changed

•High blood pressure
•High cholesterol
•Smoking
•Diabetes
•Heavy alcohol consumption
•Atrial fibrillation/other heart disease
•Poor diet and obesity

Risk Factors that cannot be changed

•Age (Over the age of 55, your risk goes up)
•Family History
•Race (African Americans, Hispanics or Asian/Pacific Islanders have a greater risk)
•Gender (Stroke is more common in males, but more women die from stroke)
•Prior stroke, TIA, or heart attack

Diagnostic Tests

Tests commonly used by doctors when diagnosing and treating strokes include:

CT scan (computed tomography) and MRI (magnetic resonance imaging) are used to create images of the brain, help locate the brain injury, and determine the extent of injury. If you have had a stroke, they also help determine the type of stroke.

Cerebral Angiogram- During this test, a special dye is injected into the blood through a catheter, which is inserted through a small incision in the groin. An x-ray is then taken. An angiogram can help locate and determine the size of any blockages, or identify an aneurysm or arteriovenous malformation.

Sometimes a magnetic resonance angiogram (MRA) – a type of MRI-- is used. Other tests may include ultrasound to evaluate blood flow and an electrocardiogram to check for heart problems.

Blood tests are also done.

Treatment

The treatment used is dependent on numerous factors including the type of stroke. For ischemic stroke the goal is to restore the flow of blood to the brain. To do so, the obstruction or blockage is removed. For hemorrhagic stroke, the goal is to prevent the rupture and bleeding from an aneurysm or arteriovenous malformation.

Treatments for Ischemic Stroke

For a limited time period following the onset of symptoms, tissue plasminogen activator (t-PA) -- a clot buster -- is used to try to break up the blockage.

If t-PA does not work, or if the window for its use has passed, alternative methods to remove the clot may be utilized. This can include use of clot retrieval devices to remove blockages from the large vessels of the brain that are causing an acute ischemic stroke.

Preventative treatments for ischemic stroke include anticoagulants/antiplatelets, carotid endarterectomy, and the use of angioplasty and stents. A carotid endarterectomy involves the surgical removal of a blockage from the carotid artery. With angioplasty and stenting, a balloon is used endovascularly to open the blockage and a stent is placed in the artery to keep it open.

Treatments for Hemorrhagic Stroke

Treatment for hemorrhagic stroke focuses on dealing with the source of the rupture or bleeding. For a ruptured aneurysm, treatment can involve the “clipping” of the aneurysm surgically or through “coiling” which involves the insertion of coils into the aneurysm using an endovascular approach.



Other Resources
American Stroke Association: A Division of American Heart Association
7272 Greenville Avenue
Dallas, TX 75231-4596
strokeassociation@heart.org
http://www.strokeassociation.org
Tel: 1-888-4STROKE (478-7653)
Fax: 214-706-5231

National Stroke Association
9707 East Easter Lane
Suite B
Centennial, CO 80112-3747
info@stroke.org
http://www.stroke.org
Tel: 303-649-9299 800-STROKES (787-6537)
Fax: 303-649-1328

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The information provided on these educational pages is for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical condition. And, if experiencing a medical emergency call 9-1-1.

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