STROKE: the attack from within
One of the most frightening medical emergencies anyone can experience is a stroke. In just a few moments, your life can change dramatically. The good news is that strokes can be treated and prevented. Fewer Americans die of stroke now than 15 years ago. Better control of risk factors, more awareness of stroke symptoms, and quicker emergency response time with appropriate treatment, could be responsible for the decline in stroke deaths.
Understanding the causes and risk factors of a stroke, knowing the symptoms, and taking quick, appropriate action, receiving proper medical treatment and comprehensive post-stroke rehabilitation can make a world of difference in the long-term effects of the stroke, the care you will require and the quality of the rest of your life.
What is a stroke?
A stroke occurs when the blood supply to part of the brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. A stroke may be caused by a blocked artery (ischemic stroke) or a leaking or burst blood vessel (hemorrhagic stroke).
A temporary disruption of blood flow through the brain is called a transient ischemic attack (TIA), sometimes called a mini-stroke.
Ischemic Stroke – About 85% of all strokes are ischemic strokes. This kind of stroke may be caused by a blood clot, which forms in one of the arteries, causing a blockage or reduction of blood flow that supplies the brain. An ischemic stroke may also be caused by a blood clot or debris that forms somewhere else in the body and travels through the bloodstream to the brain.
Hemorrhagic Stroke – When a blood vessel in the brain leaks or ruptures, the result can be a hemorrhagic stroke. This kind of stroke may be caused by uncontrolled high blood pressure, an aneurysm (a weak spot in the wall of the vessel), trauma or vascular malformations. It also may be caused by the use of blood-thinning medications.
Transient Ischemic Attack (TIA) – As with the ischemic stroke, the TIA happens when a clot briefly blocks or partially blocks blood flow to part of the brain. If you have had a TIA, you are at greater frisk of a full-blown stroke.
What are the risk factors of having a stroke?
Risk factors that are treatable or avoidable:
• High blood pressure (higher than 120/80)
• Cigarette smoking or exposure to secondhand smoke
• High cholesterol (total cholesterol level over 200)
• Overweight or obesity
• Physical inactivity
• Sleep apnea
• Cardiovascular disease: congestive heart failure, heart defects, heart infection or abnormal heart rhythm
• Use of anti-clotting medications
• Use of birth control pills or hormone therapies that include estrogen
• Heavy or binge drinking
• Use of illegal drugs such as cocaine and methamphetamines
Risk factors you cannot control:
• Personal or family history of stroke, heart attack or TIA
• Age of 55 or older
• Race – African Americans have higher risk than people of other races
• Gender – Men are at higher risk than women
What are the symptoms of a stroke?
If you or a loved one is experiencing any of the following symptoms, make note of when the first symptoms began and call for emergency assistance immediately.
Stroke symptoms may include:
Trouble walking – You may stumble or experience sudden dizziness, loss of balance or loss of coordination.
Trouble speaking and understanding – You may experience confusion and may slur your words, have difficulty forming words or have trouble understanding someone else.
Paralysis or numbness of the face, arm or leg – You may notice a sudden numbness, weakness or paralysis on one side of your body. Try to raise both arms over your head at the same time. If one arm begins to fall, you may be having a stroke. You may also notice that one side of your mouth droops when you try to smile.
Vision problems – You may suddenly have blurred or blackened vision in one or both eyes or you may see double.
Headache – You may experience a sudden, severe headache, which may be accompanied by vomiting and dizziness.
What should you do if you think you are having a stroke?
Call 911 immediately, even if the symptoms you are experiencing seem to come and go. DO NOT try to drive yourself or have a friend or family member drive you to the emergency room. Call for an ambulance. The emergency personnel will know what to do right away. They will be able to contact the emergency room so they can prepare for your arrival and will begin treatment under the direction of an emergency physician.
The longer a stroke goes untreated, the greater the potential for brain damage and disability. To maximize the effectiveness of evaluation and treatment, you’ll need to be treated at a hospital within three hours of your first symptom.
What are some complications that can be the result of a stroke?
Depending on how long blood flow in the brain was obstructed and what part of the brain is affected a stroke can cause temporary or permanent disabilities. It is important for patients to know what to expect so they understand what is happening to them and eventually can actively participate in and assist with their rehabilitation therapy and recovery. It is equally important for family members to be aware of potential complications so they understand the changes the patient is undergoing and are better prepared to support them in their rehabilitation and return to function.
Common stroke complications include:
• Paralysis or loss of muscle movement
• Difficulty talking or swallowing
• Memory loss or thinking difficulties
• Emotional problems including depression
• Pain, numbness or tingling sensations
• Changes in behavior
What should you know about rehabilitation after a stroke?
Once a patient has received emergency treatment in the first hours after a stroke, focus of their care then turns to assistance with regaining strength and function. The impact of the stroke depends on the area of the brain that is affected and the amount of permanent damage. Beginning rehabilitation therapy as soon as the patient is physically able to withstand it, usually while the patient is still in the hospital, is crucial to regaining as much function as possible. The kind of rehabilitation a patient will receive depends on several factors: the types of complications they have suffered; their overall strength and physical condition; their ability to understand why rehabilitation therapy is needed; their emotional readiness to assist with their own therapy; and their ability to communicate verbally, are just a few.
Depending on the severity of the stroke, rehabilitation options include:
• A rehabilitation unit in the hospital
• A sub-acute care unit
• A rehabilitation hospital
• Home therapy
• Home with outpatient therapy
• A long-term care facility that provides therapy and skilled nursing care
The goal in rehabilitation is to improve function so that the stroke survivor can become as independent as possible. This should be accomplished in a way that preserves dignity and motivates the patient to relearn basic skills that the stroke may have taken away – skills like eating, dressing and walking. Choose a facility that can provide the types of therapy the individual patient requires, with the level of nursing and supportive care appropriate for their level of function.
To help you choose the most appropriate rehabilitation setting for yourself or a loved one after a stroke, visit www.stroke.org.