A stroke is a "brain attack" that happens when a part of the brain experiences a problem with blood flow. This disruption in blood flow cuts off the supply of oxygen to the cells in that part of the brain, and these cells begin to die.
· Stroke caused by a blockage in the artery supplying blood to a particular region of the brain (called cerebral infarction) This is the most common type of stroke.
· Stroke caused by bleeding within the brain (called intarcerberal hemorrhage)
· Mini-stroke, in addition, some people experience brief warning signals that a major stroke is going to happen in the future. The medical term to describe these symptoms is transient ischemic attack or TIA. Sometimes called “mini-stroke”, TIAs are exactly like a stroke, but they last only a few minutes (or sometimes as long as an hour) and leave no disability.
In many cases, a stroke will affect only one side of the body:
. A stroke that damages the right side of the brain will affect the left side of the body.
. A stroke that damages the left side of the brain will affect the right side of the body.
About 85 percent of all strokes happen because not enough blood gets to the brain. Blood flow stops when an artery carrying blood to the brain becomes blocked. The technical name for this type of brain attack is cerebral infarction. It is also called ischemic stroke. "Ischemic" refers to a condition caused by a decreased supply of oxygenated blood to a body part.
The blockage also can be caused by a small piece of tissue, usually a blood clot, that has traveled through the bloodstream from elsewhere in the body.
In ischemic stroke, one of two major arteries is usually involved:
The carotid artery (most commonly involved site)
The basilar artery
The carotid arteries start at the aorta (just above the heart) and lead up through the neck, around the windpipe, and into the brain. The basilar artery is formed at the base of the skull from the arteries that run up along the spine, and branches off in the brain.
2. Stroke Caused By Bleeding In The Brain
The other 15 percent of strokes happen when an artery carrying blood to the brain bursts suddenly. The bursting can happen because of a weak spot in the wall of an artery called an aneurysm. This type of brain attack is called a hemorrhagic stroke.
Two kinds of stroke are caused by bleeding in the brain:
A subarachnoid hemorrhage occurs when a blood vessel on the brain bursts and bleeds into the fluid-filled space between the brain and the skull. This type of stroke can happen at any age.
An intracerebral hemorrhage occurs when an artery bursts inside the brain, flooding the surrounding brain tissue with blood. This type of stroke is often associated with high blood pressure.
A "mini-stroke" is exactly like a stroke, but it lasts only a short time and leaves no disability. The term for this event is transient ischemic attack or TIA.
General recovery guidelines for stroke show:
· 10 percent of stroke survivors recover almost completely
· 25 percent recover with minor impairments
· 40 percent experience moderate to severe impairments requiring special care
· 10 percent require care in a nursing home or other long-term care facility
· 15 percent die shortly after a stroke
Facts About Stroke:
· Nearly 4 million people in the United States have survived a stroke and are living with the after-effects.
· Each year, more than 500,000 Americans have a stroke.
· Although stroke is still the third leading killer in the United States, the death rate from strokes has been cut nearly in half over the last two decades.
· A stroke is always serious. Cells in the brain that become damaged cannot be repaired or regenerated. But other areas of the brain may take over the work of the damaged portion.
· Most people know they should seek emergency medical help immediately if they are having symptoms of a heart attack. But the average stroke patient waits more than 12 hours before going to a hospital emergency department, losing precious time that could be critical to treatment.
· Stroke was first recognized more than 2,400 years ago by Hippocrates, the father of medicine, who described a condition marked by the sudden onset of paralysis.
· There are steps you can take to help prevent a stroke. Healthy living is very important in stroke prevention. There also are successful treatments if it does happen.
. Sudden weakness or numbness of the face, arm, and leg on one side of the body
. Sudden loss of vision or dimmed vision, particularly in one eye
. Loss of speech, or trouble talking or understanding speech
. Sudden, severe headaches with no apparent cause
. Unexplained dizziness, unsteadiness, or sudden falls, especially if accompanied by any of the previous symptoms
How-To Information:
A headache caused by a stroke:
Will come on very suddenly, without the aura that sometimes precedes migraines Has been described by stroke survivors as "the worst headache of my life"
Will build up to a peak within a minute or two
May be accompanied by vomiting and a stiff neck
What Do Different Parts Of The Brain Do?
When a person is right handed, the left side of the brain is dominant. About 90 percent of left-handed people have the right side of the brain dominant.
Nice To Know:
In general, the right side of the brain processes:
Music
Art
Mathematics
Memory
Hearing
Sight
Movement
In general, the left side of the brain processes:
Writing
Reading
Speaking
Understanding
Memory
Hearing
Sight
Movement
Anybody can have a stroke, but certain factors place a person at higher risk. Some factors that increase the risk of stroke cannot be changed, while others are linked to lifestyle.
Some risk factors for stroke cannot be changed:
· Age - The older a person gets, the greater the risk of stroke.
· Sex - Men are more likely to have a stroke than women are.
· Race - Blacks have a greater risk of stroke than whites do.
· Diabetes- People with diabetes mellitus are more at risk.
· A history of migraine headaches- Recent studies indicate that women who experience migraines are at higher risk for ischemic stroke (stroke caused by a blockage in a blood vessel).
· A prior stroke -Someone who has had a stroke has a slightly increased risk for another.
Risk Factors That Can Be Changed With Medical Treatment
The major risk factors for stroke that medical treatment can change are:
· TIAs, or "mini-strokes" - A surprising number of people ignore the symptoms of TIAs, which are warning signs that a stroke may be about to happen. But people who have had TIAs can take steps to help prevent a major stroke.
· Berry aneurysms - These are small, sac-like areas within the wall of a cerebral artery. Some people are born with berry aneurysms. They occur most often at the junctures of vessels at the base of the brain. Berry aneurysms may rupture without warning, causing bleeding within the brain.
· Cardiovascular disease - Certain disorders of the heart and/or blood vessels, such as atherosclerosis and atrial fibrillation, can produce blood clots that may break loose and travel to the brain.
Atrial fibrillation is a heart disorder in which the heart beats quickly and in an irregular manner. As a result, the heart's chambers do not completely empty themselves of blood. Blood that remains in these chambers can become stagnant, and clots can form. These clots can then travel in the bloodstream to the brain and cause a stroke.Individuals with atrial fibrillation often need to take anticoagulant drugs ("blood-thinners"). These medications help prevent the formation of blood clots.
Risk Factors That Can Be Changed By Lifestyle Modifications
· Cigarette smoking - Cigarette smoking has been linked to heart attacks, strokes, artery disease in the legs, and lung cancer. Nicotine raises blood pressure, carbon monoxide reduces the amount of oxygen the blood can carry to the brain, and cigarette smoke makes the blood thicker and more likely to clot. It is never too late to give up smoking.
· Taking birth control pills if you are a smoker - Research has proven that smoking and taking birth control pills significantly increases a woman's risk for stroke. Together, they can cause blood clots to form. Women who take birth control pills should not smoke.
· Drinking large amounts of alcohol - Frequent intoxication can make a person more likely to experience bleeding in the brain. Also, alcohol in large amounts can raise blood pressure.
· Obesity - Being overweight increases your risk of having a stroke, along with other health problems.
· Lack of exercise - Moderate exercise can help keep blood pressure and cholesterol levels within normal ranges.
· Poor diet - A diet high in fat can cause conditions within the body that can contribute to a stroke
A stroke is a medical emergency, regardless of whether it is a major stroke or a short-lasting TIA. A person suffering a stroke should be taken immediately to a hospital emergency department.
If a stroke is caused by a blocked artery, medications are now available to reverse damage to the brain and significantly increase the odds of survival. However, these medications are effective only if they are given within a few hours of the time when the first stroke symptoms begin.
Scans of the brain are performed to confirm a diagnosis of stroke and to determine the type of stroke. This is important since the treatment of different types of stroke differs.
· Computed tomography scan (CT scan) is generally the first diagnostic test done after a person suspected of having a stroke arrives in the emergency department. The test uses low-dose x-rays to take pictures of the inside of the brain.
· Magnetic resonance imaging (MRI) is an advanced diagnostic tool that uses the principals of magnetism to view the inner body. An MRI of the brain can show small blood vessels that may be blocked or bleeding. .
· Transcranial doppler (TCD) is a new, noninvasive ultrasound procedure that uses a small probe placed against the skull to track the blood flow through the vessels in the brain.
· SPECT imaging uses low doses of a harmless radioactive substance injected into a vein in the arm, then uses a specialized camera to view the blood flow in the brain.
· Drug therapy is a relatively recent approach to the treatment of stroke. If the
Medication can be given to reduce swelling of brain tissue.
Surgical Procedures
A procedure called carotid endarterectomy can be used to remove a buildup of plaque from inside the carotid artery, one of the major sources of blood to the head and neck. Carotid endarterectomy can be used to treat people who have had a stroke and also as a preventive measure for people at risk for stroke.
An artery within the brain sometimes can be "clipped" to prevent further bleeding.
If the bleeding has occurred in the subarachnoid space, pooled blood (hematoma) can dangerously increase pressure on the brain and damage delicate tissue. If it is feasible, surgery may be necessary to drain blood from within the area of damaged brain tissue.
Several types of interventional radiology also are available to treat stroke. These procedures have been in existence for some time, but they have been improved and refined in recent years. However, not all hospitals are equipped to offer interventional radiology.
· The catheters can be used to widen areas of blood vessels that have become narrowed because of a buildup of plaque.
· The catheters can be used to place stents made of a fine, tubular wire mesh to hold a blood vessel open.
After the initial tests to determine the type of stroke and the best treatment, other procedures may be necessary to find the cause of the stroke. These procedures may include tests of the heart or the arteries to the brain.
Q: My father had all the signs of a stroke, but he waited more than six hours before getting to the hospital. Even though his stroke was caused by a blocked artery, doctors did not give him "clot-busting" medicines. Why not?
A: TPA drugs are powerful blood thinners that can help dissolve a clot and restore blood flow, but the FDA requires that they be given within three hours after stroke symptoms first begin. When TPA is given more than three hours after stroke onset, there is a greater risk that it will cause uncontrollable bleeding. It is very important that this guideline is followed and that everyone is made aware of the critical importance of seeking help immediately if experiencing stroke symptoms.
A stroke affects different people in different ways. While some people make a full recovery, others may find that some problems do persist. These may include:
Some people have difficulty with speech. When stroke has damaged the part of the brain that controls the muscles used to produce speech, speech may become slurred. The survivor understands words and conversation but cannot speak distinctly. This condition is called dysarthria.
· Avoid distractions. Do not have many other people in the room, turn off the television or radio when someone is speaking.
· Have a one-on-one conversation. Do not allow more than one person to speak at one time.
· Give the person a lot of time to speak.
· Allow the person to speak for himself or herself if someone else asks a question; don't try to answer it yourself.
Stroke may affect vision on one side (usually the same side that has been weakened by the stroke). When talking to someone with impaired vision, always stand or sit on the "good" side. Consider that the person may ignore people or objects on the other side and may bump into them.
Memory and concentration may be affected after a stroke. In the early stages, individuals may not be able to concentrate for very long and may become easily distracted. They may have problems with particular tasks, such as finding the way about the house or getting dressed, yet have no other major difficulties.
Paralysis
· A person who suffers a stroke in the left side of the brain may show right-sided paralysis.
· A person who suffers a stroke in the right side of the brain may show paralysis on the left side of the body.
Paralyzed limbs may recover their strength but may remain clumsy or stiff. Some types of muscular stiffness (a condition called spasticity) can be helped with medication. People with weak hands often are given a soft ball to squeeze to help improve their grip.
Damage to certain areas of the brain can cause difficulty eating and swallowing. This condition is called dysphagia. Therapy to help the brain relearn these skills has shown great success. Until a person is able to eat again, he or she can receive sustenance intravenously (with an IV that delivers nourishment directly into the bloodstream). Most people who have had a stroke will recover their ability to swallow safely.
The days and months after experiencing a stroke are a stressful time. The stroke survivor may be unable to return to work immediately and may lose independence for a while. After the immediate shock, a stroke survivor may feel anxiety, anger, and frustration. A lack of information may contribute to the anxiety. Anxiety and frustration can be reduced by support from doctors, therapists, and other caregivers.
Q: My wife just hasn't been herself since her stroke. She seems to have lost interest in many things and no longer seems to be enjoying life, even though her recovery is progressing well. What could be wrong?
A: Your wife could be suffering from depression. After recovery from a stroke, many people do feel depressed. This depression is normal, and usually disappears within three months after the brain attack. Medication is available to relieve symptoms of depression.
Because a stroke affects each person differently, there may be other physical challenges:
· The sensitivity of the skin may be altered after a stroke. Some people experience numbness while others feel as if their skin is extra sensitive.
· Certain individuals experience pain, uncomfortable numbness, or strange sensations after a stroke. These sensations may be caused by many factors, including damage to the sensory regions of the brain.
· Control of bowels and bladder may be lost temporarily after a stroke, but most people do recover function
Many people begin to recover from a stroke almost immediately after it has occurred.
· The ability to sit up and balance while sitting, then
· The ability to stand, and then
· The ability to walk.
· The leg usually starts to improve before the hand.
Successful recovery after a stroke depends on the extent of brain damage, the person's attitude, the skill of the medical team, and the cooperation of family and friends. Not all people recover on their own. For them, rehabilitation therapy can be invaluable.
Rehabilitation - teaching an individual certain skills that might have been lost - can consist of one or more of the following:
· Physical therapy - Teaches walking, sitting, and lying down, switching from one type of movement to another.
· Occupational therapy - To relearn eating, drinking, swallowing, dressing, bathing, cooking, reading, writing, toileting.
· Speech therapy - To relearn language and communication skills.
· Psychological/psychiatric therapy - To help relieve some mental and emotional problems.
Depending on the severity of the stroke, rehabilitation options include:
· A rehabilitation unit in the hospital
· A subacute care unit
· A rehabilitation hospital
· Home therapy
· Home with outpatient therapy
· A long-term care facility that provides therapy and skilled nursing care
Avoiding Another Stroke
Many survivors are afraid that they will have another brain attack. However, with proper medical treatment, it is quite unlikely that a person who has had a stroke will experience another. The risk of a second stroke is higher for people who are not receiving proper medical treatment for their first stroke.
Effective treatment to reduce the risk of another stroke includes making lifestyle changes to decrease risk factors and taking medication, such as aspirin, as directed by a doctor.
Q: I had a stroke nearly a year ago, and I still have a strange sensation of pain on my left side. My doctor has tried a variety of drugs, but nothing seems to work. What else can I do?
A: This type of pain, called central post-stroke pain, is uncommon and can be difficult to deal with. There are a variety of medications you can try, including antidepressants and anticonvulsants. You also may want to consider complementary therapies such as acupuncture. Other options include transcutaneous nerve stimulation (TENS), which is a small device that sends an electrical current to a certain area of the body in order to block the sensation of pain. Surgery to interrupt the nerves that carry this abnormal sensation (stereotactic surgery) also is a possibility, but it does have some risk.
The best way to prevent stroke is to reduce your risk factors and take control of your own health:
· Lower your cholesterol level if it is elevated - some people can do this by modifying diet; others need to take medication. Lowering cholesterol levels has been proven by researchers to reduce the risk of stroke. .
· If you smoke, stop smoking - Many excellent smoking cessation programs are available today; your doctor can advise you about tools you can use, such as the nicotine patch. .
· Drink alcohol in moderation - A drink or two a day is considered acceptable.
· Keep your weight within normal limits.
· Get a moderate amount of exercise at least five days a week.
· Eat a healthy diet that is high in fruits and vegetables and low in fats.
· If you have cardiovascular disease, work with your doctor to treat it. Certain types of problems with the heart and blood vessels, such as atherosclerosis and atrial fibrillation can cause blood clots to form. These clots can block an artery in the brain and cause a stroke (or can block a blood vessel in the heart and cause a heart attack).
· If you have diabetes, keep it under good control.
· If you have high blood pressure be sure to take your medication regularly.
· Know the warning signs of TIAs and strokes, and get help right away if you experience them.
Medications For Prevention
Certain medications have been shown to reduce the risk of stroke. These drugs fall under two major categories. They aim to prevent the formation of dangerous blood clots:
. Antiplatelet agents such as aspirin - These drugs work by preventing or reducing platelet aggregation in the bloodstream. Platelets are tiny blood cells that cause blood to coagulate or clot. When a blood vessel is damaged or injured, platelets will migrate to the area to begin a healing process. However, large numbers of platelets can clump together or aggregate and form a clot that is essentially a plug in an artery. Antiplatelet agents help prevent this clumping.
· Anticoagulants - These drugs work by thinning the blood and preventing clotting. Common anticoagulants are heparin and warfarin.
Antiplatelet and anticoagulant drugs can also be used to treat heart disease, so taking one medicine can help reduce your risk of both heart attack and brain attack. Your doctor can advise you on what medications are right for you.
The medical community first became aware of aspirin's protective effects for stroke in 1978, and since then, several large studies have shown that aspirin reduces the risk of stroke. But aspirin isn't the only antiplatelet medicine available. If you can't take aspirin because of allergy or the risk of stomach ulcers, other drugs are available.
Surgery For Prevention
Carotid endarterectomy - the same procedure that can sometimes be used to treat strokes caused by a blockage - can also be used to help prevent such strokes from happening in the first place.
The procedure involves removing plaque buildup in the carotid artery . It is performed when the artery is blocked by more than 70 percent.
· It has been proven that for certain individuals who have had minor strokes or TIAs, and the carotid artery in the neck is more than 70 percent blocked (i.e. severely blocked), this procedure can reduce the risk of future strokes.
· It also is beneficial for individuals with blocked carotid arteries who have not had previous symptoms of stroke.
Carotid endarterectomy takes about an hour to perform. A tube is placed to transport blood around the area to be treated. After the surgeon has scraped away the built-up plaque, the artery is sewn back together and blood flow is restored.
Research suggests that vitamin E helps prevent arteries from clogging by blocking the conversion of cholesterol into its most dangerous form. Vitamin E is also a powerful anti-clotting agent. It helps the blood flow more easily through arteries when fatty plaques are present. It also is an antioxidant, which means it helps prevent cell damage. Ask a doctor about the proper amount of this vitamin to take daily.
What Is The Long Term Outlook?
Today, the outlook for people who have had a brain attack is more hopeful than ever before. Because of advances in treatment and rehabilitation, many people can return to a fulfilling life.
A stroke survivor's family plays a vital role in recovery. Family members need to understand what the person is going through, what to expect, and how to handle problems that will arise. A person's will to recover and desire to be independent play a big part in recovery; the family can help by providing a warm, supportive, and encouraging atmosphere.
Among those new therapies are drugs that make the brain less susceptible to the damaging effects of a stroke. Called neuroprotective agents, these drugs include citicoline and lazaroid compounds. They currently are under evaluation in clinical trials.
1 - Gastrodia
2 - Chuanxiong
3 – Ginkgo biloba
4 – Ashwagandha root
5 - Huperzine A
6 – Wolfberry
Frequently Asked Questions
Here are some frequently asked questions related to stroke.
Q: Can a stroke just happen out of the blue?
A: A stroke, which also is referred to as a "brain attack," often does happen without any prior warning. However, the conditions that lead to a stroke have usually been present for many years. Maintaining the healthiest lifestyle possible, therefore, is very important in stroke prevention.
Q: My father suffered a stroke three months ago but insists he is capable of driving. Should I worry?
A: A stroke can affect eyesight, coordination, the movement and strength of arms and legs, balance, reaction time, concentration, speed of thought, memory, awareness of where objects are in relation to each other, and even the awareness that anything is wrong at all. A difficulty in any one of these areas carries with it the possibility of making driving unsafe. Your father's doctor can provide the best advice on whether he should be driving.
Q: Ever since his stroke, my husband has been reluctant to have sex, even though he seems to have made a full recovery. Is this normal?
A: There are many myths about having sex after a heart attack or stroke. The most common one is that sexual activity will bring on another heart attack or stroke and cause sudden death. This simply isn't true. There's no reason why someone who has had a heart attack or stroke can't resume usual sexual activity as soon as he or she feels ready to do so. For some men, fear about performance can greatly reduce sexual interest and ability to have an erection. An understanding partner, patience, and open discussion with a doctor or therapist are extremely helpful in resuming sexual intercourse.
Q: At what age should I seriously consider taking aspirin to help reduce my risk of having a stroke?
A: The need for aspirin therapy depends on individual risk factors and is different for everybody. Most health care providers suggest that after age 50, you and your doctor should make a decision about aspirin therapy. Some people benefit from taking aspirin before age 50.
Here is a summary of the important facts and information related to stroke.
• A brain attack or stroke happens when a part of the brain is damaged by a change in blood flow. This change can happen if something blocks the flow of blood to the brain or if a blood vessel bursts and causes bleeding in the brain.
• In many cases, a stroke can happen without warning. But some people do experience "mini-strokes," called TIAs, which are exactly like a stroke but last only a short time. A TIA, like a stroke, is considered a medical emergency and should never be ignored.
• The signs of stroke are sudden weakness or numbness on one side of the body, sudden loss of vision or speech, sudden severe headaches, or unexplained dizziness that comes on quickly.
• Some risk factors for stroke, such as age and race, cannot be changed. But there are steps you can take to reduce other risk factors, such as high blood pressure, high cholesterol, and cigarette smoking.
• If a brain attack does happen, medical treatments can be given in the hospital emergency department. These treatments have shown great success in minimizing damage to the brain. The key is to get medical help immediately. Too often, people having a stroke wait for hours before seeking help.
• A stroke can cause trouble speaking or seeing, memory difficulties, paralysis or weakness, difficulty eating, and mood changes. The good news is that therapies are available to help teach the brain skills it might have lost. Many people can make a full recovery and resume a fulfilling life after a stroke.
• The best way to prevent stroke is to reduce risk factors - improve diet, keep diabetes under control, quit smoking, and get enough exercise. Medication is also available to help prevent stroke. The most frequently used preventive medication is aspirin, which helps prevent blood clots.
• The long-term outlook for people who have had a stroke is more hopeful than ever before. Because of advances in treatment, more people are surviving strokes, and because of advances in rehabilitation, more people are conquering the disabilities that can be caused by a stroke.
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