Stroke

A stroke happens when blood flow to a part of the brain stops. A stroke is sometimes called a " brain attack ".

If blood flow is stopped for longer than a few seconds, the brain cannot get blood and oxygen. Brain cells can die, causing permanent damage.

There are two major types of stroke : ischemic stroke and hemorrhagic stroke.

Ischemic stroke occurs when a blood vessel that supplies blood to the brain is blocked by a blood clot. This may happen in two ways :

1. A clot may form in an artery that is already very narrow. This is called a thrombotic stroke.
2. A clot may break off from another place in the blood vessels of the brain, or from some other part of the body, and travel up to the brain. This is called cerebral embolism, or an embolic stroke.

Ischemic strokes may be caused by clogged arteries. Fat, cholesterol, and other substances collect on the artery walls, forming a sticky substance called plaque.

A hemorrhagic stroke occurs when a blood vessel in part of the brain becomes weak and bursts open, causing blood to leak into the brain. Some people have defects in the blood vessels of the brain that make this more likely.

STROKE RISK FACTORS

High blood pressure is the number one risk factor for strokes. The other major risk factors are :

1. Artrial fibrillation
2. Diabetes
3. Family history of stroke
4. High cholesterol
5. Increasing age, especially after age 55

People who have heart disease or poor blood flow in their legs caused by narrowed arteries are also more likely to have a stroke.

The chance of stroke is higher in people who live an unhealthy lifestyle by :

1. Being overweight or obese
2. Drinking heavily
3. Eating too much fat or salt
4. Smoking

OVERWEIGHT

Birth control pills can increase the chances of having blood clots. The risk is highest in woman who smoke and are older than 35.

The symptoms of stroke depend on what part of the brain is damaged. In some cases, a person may not know that he or she has had a stroke.

Symptoms usually develop suddenly and without warning. Or, symptoms may occur on and off for the first day or two. Symptoms are usually most severe when the stroke first happens, but they may slowly get worse.

A headache may occur, especially if the stroke is caused by bleeding in the brain. The headache :

1. Starts suddenly and may be severe
2. Occurs when you are lying flat
3. Wakes you up from sleep
4. Gets worse when you change positions or when you bend, strain, or cough

Other symptoms depend on how severe the stroke is and what part of the brain is affected. Symptoms may include :

1. Change in alertness ( including sleepiness, unconsciousness, and coma )
2. Changes in hearing
3. Changes in taste
4. Changes that affect touch and the ability to feel pain, pressure, or different temperatures
5. Clumsiness
6. Confusion or loss of memory
7. Difficulty swallowing
8. Difficulty writing or reading
9. Dizziness or abnormal feeling of movement ( vertigo )
10. Lack of control over the bladder or bowels
11. Loss of balance
12. Loss of coordination
13. Muscle weakness in the face, arm, or leg ( usually just on one side )
14. Numbness or tingling on one side of the body
15. Personality, mood, or emotional changes
16. Problems with eyesight, including decreased vision, double vision, or total loss of vision
17. Trouble speaking or understanding others who are speaking
18. Trouble walking

A complete exam should be done.

1. Check for problems with vision, movement, feeling, reflexes, understanding, and speaking. Your doctor and nurses will repeat this exam over time to see if your stroke is getting worse or improving.
2. Listen for an abnormal sound, called a " bruit ", when using a stethoscope to listen to the carotid arteries in the neck. A bruit is caused by abnormal blood flow.
3. Check your blood pressure, which may be high.

Tests can help your doctor find the type, location, and cause of the stroke and rule out other disorders.

1. Angiogram of the head can show which blood vessel is blocked or bleeding
2. Carotid duplex ( ultrasound ) can show if the carotid arteries in your neck have narrowed
3. CT scan of the brain is often done soon after symptoms of a stroke begin. An MRI scan of the brain may be done instead or afterwards
4. Echocardiogram may be done if the stroke could have been caused by a blood clot from the heart
5. Magnetic resonance angiography ( MRA ) or CT angiography may be done to check for abnormal blood vessels in the brain

Other tests include :

1. Lab tests will include :
1. Bleeding time
2. Blood cholesterol and sugar
3. Blood clotting tests ( prothrombin time or partial thromboplastin time )
4. Complete blood count ( CBC )
2. Electrocardiogram ( ECG ) and heart rhythm monitoring -- to show whether an irregular heartbeat ( such as atrial fibrillation ) caused the stroke

A stroke is a medical emergency. Immediate treatment can save lives and reduce disability.

It is very important for people who are having stroke symptoms to get to a hospital as quickly as possible. If the stroke is caused by a blood clot, a clot-busting drug may be given to dissolve the clot.

Most of the time, patients must reach a hospital within 3 hours after symptoms begin. Some people may be able to receive these drugs for up to 4 - 5 hours after symptoms begin.

Treatment depends on how severe the stroke was and what caused it. Most people who have a stroke need to stay in a hospital.

POSSIBLE COMPLICATION

• Breathing food into the airway ( aspiration )
• Dementia
• Falls
• Loss of mobility
• Loss of movement or feeling in one or more parts of the body
• Muscle spasticity
• Poor nutrition
• Pressure sores
• Problems speaking and understanding
• Problems thinking or focusing