Stroke

Defined

Stroke is a disease that affects the arteries leading to and within the brain. It is the No. 5 cause of death and a leading cause of disability in the United States.

A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts (or ruptures). When that happens, part of the brain cannot get the blood (and oxygen) it needs, so it and brain cells die.

Stroke can be caused either by a clot obstructing the flow of blood to the brain (called an ischemic stroke) or by a blood vessel rupturing and preventing blood flow to the brain (called a hemorrhagic stroke). A TIA (transient ischemic attack), or "mini stroke", is caused by a temporary clot.

The brain is an extremely complex organ that controls various body functions. If a stroke occurs and blood flow can't reach the region that controls a particular body function, that part of the body won't work as it should.

https://www.stroke.org/en/about-stroke

Diagnosis

Things will move quickly once you get to the hospital, as your emergency team tries to determine what type of stroke you're having. That means you'll have a CT scan or other imaging test soon after arrival. Doctors also need to rule out other possible causes of your symptoms, such as a brain tumor or a drug reaction.

Some of the tests you may have include:

  • A physical exam. Your doctor will do a number of tests you're familiar with, such as listening to your heart and checking your blood pressure. You'll also have a neurological exam to see how a potential stroke is affecting your nervous system.

  • Blood tests. You may have several blood tests, including tests to check how fast your blood clots, whether your blood sugar is too high or low, and whether you have an infection.

  • Computerized tomography (CT) scan. A CT scan uses a series of X-rays to create a detailed image of your brain. A CT scan can show bleeding in the brain, an ischemic stroke, a tumor or other conditions. Doctors may inject a dye into your bloodstream to view your blood vessels in your neck and brain in greater detail (computerized tomography angiography).

  • Magnetic resonance imaging (MRI). An MRI uses powerful radio waves and magnets to create a detailed view of your brain. An MRI can detect brain tissue damaged by an ischemic stroke and brain hemorrhages. Your doctor may inject a dye into a blood vessel to view the arteries and veins and highlight blood flow (magnetic resonance angiography or magnetic resonance venography).

  • Carotid ultrasound. In this test, sound waves create detailed images of the inside of the carotid arteries in your neck. This test shows buildup of fatty deposits (plaques) and blood flow in your carotid arteries.

  • Cerebral angiogram. In this uncommonly used test, your doctor inserts a thin, flexible tube (catheter) through a small incision, usually in your groin, and guides it through your major arteries and into your carotid or vertebral artery. Then your doctor injects a dye into your blood vessels to make them visible under X-ray imaging. This procedure gives a detailed view of arteries in your brain and neck.

  • Echocardiogram. An echocardiogram uses sound waves to create detailed images of your heart. An echocardiogram can find a source of clots in your heart that may have traveled from your heart to your brain and caused your stroke.

https://www.mayoclinic.org/diseases-conditions/stroke/diagnosis-treatment/drc-20350119

Treatment

Proper medical evaluation and prompt treatment are vital to recovering from a stroke. According to the American Heart Association, “Time lost is brain lost.” Call 911 as soon as you realize you may be having a stroke, or if you suspect a loved one is having a stroke.

 

Treatment for stroke depends on the type of stroke:

 

Ischemic stroke and TIA

These stroke types are caused by a blood clot or other blockage in the brain. For that reason, they’re largely treated with similar techniques, which include:

Antiplatelet and anticoagulants

Over-the-counter aspirin is often a first line of defense against stroke damage. Anticoagulant and antiplatelet drugs should be taken within 24 to 48 hours after stroke symptoms begin.

 

Clot-breaking drugs

Thrombolytic drugs can break up blood clots in your brain’s arteries, which still stop the stroke and reduce damage to the brain.

One such drug, tissue plasminogen activator (tPA), or Alteplase IV r-tPA, is considered the gold standard in ischemic stroke treatment. It works by dissolving blood clots quickly, if delivered within the first 3 to 4.5 hours after symptoms of your stroke began. People who receive a tPA injection are more likely to recover from a stroke, and less likely to have any lasting disability as a result of the stroke.

 

Mechanical thrombectomy

During this procedure, the doctor inserts a catheter into a large blood vessel inside your head. They then use a device to pull the clot out of the vessel. This surgery is most successful if it’s performed 6 to 24 hours after the stroke begins.

 

Stents

If your doctor finds where artery walls have weakened, they may perform a procedure to inflate the narrowed artery and support the walls of the artery with a stent.

 

Surgery

In the rare instances that other treatments don’t work, your doctor may perform surgery to remove a blood clot and plaques from your arteries. This may be done with a catheter, or if the clot is especially large, your doctor may open an artery to remove the blockage.

 

Hemorrhagic stroke

Strokes caused by bleeds or leaks in the brain require different treatment strategies. Treatments for hemorrhagic stroke include:

 

Medications

Unlike with an ischemic stroke, if you’re having a hemorrhagic stroke, the treatment goal is to make your blood clot. Therefore, you may be given medication to counteract any blood thinners you take.

You may also be prescribed drugs that can reduce blood pressure, lower the pressure in your brain, prevent seizures, and prevent blood vessel constriction.

 

Coiling

During this procedure, your doctor guides a long tube to the area of hemorrhage or weakened blood vessel. They then install a coil-like device in the area where the artery wall is weak. This blocks blood flow to the area, reducing bleeding.

 

Clamping

During imaging tests, your doctor may discover an aneurysm that hasn’t started bleeding yet or has stopped. To prevent additional bleeding, a surgeon may place a tiny clamp at the base of the aneurysm. This cuts off blood supply and prevents a possible broken blood vessel or new bleeding.

 

Surgery

If your doctor sees that an aneurysm has burst, they may do surgery to clip the aneurysm and prevent additional bleeding. Likewise, a craniotomy may be needed to relieve the pressure on the brain after a large stroke.

In addition to emergency treatment, healthcare providers will advise you on ways to prevent future strokes.

 

Stroke medications

Several medications are used to treat strokes. The type your doctor prescribes depends largely on the type of stroke you had. The goal of some medications is to prevent a second stroke, while others aim to prevent a stroke from happening in the first place.

The most common stroke medications include:

  • Tissue plasminogen activator (tPA). This emergency medication can be provided during a stroke to break up a blood clot causing the stroke. It’s the only medication currently available that can do this, but it must be given within 3 to 4.5 hours after symptoms of a stroke begin. This drug is injected into a blood vessel so the medication can start to work as quickly as possible, which reduces the risk of complications from the stroke.

  • Anticoagulants. These drugs reduce your blood’s ability to clot. The most common anticoagulant is warfarin (Jantoven, Coumadin). These drugs can also prevent existing blood clots from growing larger, which is why they may be prescribed to prevent a stroke, or after an ischemic stroke or TIA has occurred.

  • Antiplatelet drugs. These medications prevent blood clots by making it more difficult for the blood’s platelets to stick together. The most common antiplatelet drugs include aspirin and clopidogrel (Plavix). They can be used to prevent ischemic strokes and are especially important in preventing secondary stroke. If you’ve never had a stroke before, you should only use aspirin as a preventive medication if you have a high risk of atherosclerotic cardiovascular disease (e.g., heart attack and stroke) and a low risk of bleeding.

  • Statins. Statins, which help lower high blood cholesterol levels, are among the most commonly prescribedTrusted Source medications in the United States. These drugs prevent the production of an enzyme that can turn cholesterol into plaque — the thick, sticky substance that can build up on the walls of arteries and cause strokes and heart attacks. Common statins include rosuvastatin (Crestor), simvastatin (Zocor), and atorvastatin (Lipitor).

  • Blood pressure drugs. High blood pressure can cause pieces of plaque buildup in your arteries to break off. These pieces can block arteries, causing a stroke. As a result, controlling high blood pressure can help prevent a stroke.

 

Your doctor may prescribe one or more of these drugs to treat or prevent a stroke, depending on factors such as your health history and your risks.

 

Recovering from a stroke

Stroke is a leading cause of long-term disability in the United States. However, the National Stroke Association reports that 10 percent of stroke survivors make an almost-complete recovery, while another 25 percent recover with only minor impairments.

It’s important that recovery and rehabilitation from a stroke start as soon as possible. In fact, stroke recovery should begin in the hospital. There, a care team can stabilize your condition, assess the effects of the stroke, identify underlying factors, and begin therapy to help you regain some of your affected skills.

Stroke recovery focuses on four main areas:

 

Speech therapy

A stroke can cause speech and language impairment. A speech and language therapist will work with you to relearn how to speak. Or, if you find verbal communication difficult after a stroke, they’ll help you find new ways of communication.

 

Cognitive therapy

After a stroke, many survivors have changes to their thinking and reasoning skills. This can cause behavioral and mood changes. An occupational therapist can help you work to regain your former patterns of thinking and behavior and to control your emotional responses.

 

Relearning sensory skills

If the part of your brain that relays sensory signals is affected during the stroke, you may find that your senses are “dulled” or no longer working. That may mean that you don’t feel things well, such as temperature, pressure, or pain. A therapist can help you learn to adjust to this lack of sensation.

 

Physical therapy

Muscle tone and strength may be weakened by a stroke, and you may find you’re unable to move your body as well as you could before. A physical therapist will work with you to regain your strength and balance, and find ways to adjust to any limitations.

 

Rehabilitation may take place in a rehabilitation clinic, a skilled nursing home, or your own home.

 

https://www.healthline.com/health/stroke#stroke-recovery

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