Stroke

About four million Americans have had a stroke -- the interruption of
oxygen flowing to the brain -- and are living with the effects, which can
range from mild to severe. Many people die of strokes, the third leading
cause of death in the United States after heart disease and cancer. But
more than a third of the people who have strokes recover with few or
minor impairments and lead normal lives for years afterward. In addition,
some people may be able to reduce their risk of a stroke by making
changes in their lifestyle.

What is a stroke?
A stroke occurs when something interrupts the normal flow of blood that carries
oxygen to the brain. This interruption usually causes some brain cells to die or
become permanently damaged, which can affect the abilities controlled by the
brain, such as speech and movement. Doctors call a stroke a cerebrovascular
accident (CVA) because it involves a part of the brain called the cerebrum and the
blood vessels or vascular system that supply it with oxygen.
A stroke may seem to occur as suddenly as any other “accident.” But it often
results from changes that have been taking place in the body for years. Strokes
can occur at any age, but are most common in people over 65.

What causes a stroke?
Many things can cause the flow of blood to the brain to become interrupted,
leading to a stroke. Some of them are:
•Thrombosis. A thrombosis is the most common cause of a stroke. It occurs when a
blood clot called a thrombus blocks the flow of blood in an artery bringing
blood to the brain. The clot typically begins in an artery with a build-up of
cholesterol and fats, a condition known as atherosclerosis or “hardening of the
arteries.”
•Embolism. An embolism resembles a thrombosis in that it involves a clot, in this
case called an embolus. But the clot does not begin in the wall of a brain artery.
The embolus begins in another part of the body, such as the heart, and travels
through the blood stream until it blocks a narrow artery in the brain.
•Hemorrhage. A hemorrhage occurs when a blood vessel bursts and bleeds into
aneurysm, a bulge at a weak spot in an artery that is often caused by high blood
pressure or atherosclerosis.
•Other factors. Strokes can also result from other things that affect the arteries of
the brain, including inflammation, an infection, and drugs such as cocaine and
amphetamines.
Sometimes the brain gets too little blood for a short time, and this affects its
ability to function during that time. This condition is known as a transient
ischemic attack (TIA) and can result from a temporary spasm in an artery that
restricts the flow of blood to the brain. Some people refer to TIAs as “small
strokes.” But if the spasm is short enough to cause no permanent damage, it
technically isn’t a stroke. TIAs can be warning signs of a stroke or isolated events
that never lead to a stroke.

Stroke risk factors
Some people have a higher risk of strokes than others. African-Americans face a
greater risk of strokes than whites, and men generally have a slightly higher risk
than women. Other people with a higher risk of strokes are those who:
- are over age 65
- are overweight
- have a family history of stroke
- have high blood pressure, especially if it is untreated or uncontrolled
- have had earlier strokes or TIAs
- have diabetes
- have heart disease, especially atrial fibrillation (AF)
- smoke cigarettes
- drink too much alcohol (more than two glasses a day for men or one glass a
day for women)

Warning signs of a stroke
Sometimes people have strokes so small they don’t know they’ve had them until
they have medical tests for another condition. In other cases the signs of a stroke
are easy to recognize. They may come on very suddenly and include:
- numbness or weakness, especially on one side of the body
- trouble speaking or understanding speech
- double vision, or trouble seeing with one or both eyes
- trouble walking, a loss of balance, or unexplained falls
- confusion, dizziness, or unsteadiness
- changes in personality or mental ability
- very severe and unexplainable headache (sometimes described as “the worst
headache ever”)
It’s essential to get medical help immediately if you have any of these signs. Go
to an emergency room, call 911, or have someone call for you. These signs can
be symptoms of a stroke, a transient ischemic attack, or another problem. But
only a doctor can determine the cause of the problem. Getting help within the
first minutes after a stroke can often mean the difference between life and death
or reduce the permanent damage that may result.
If you have any of the warning signs, your doctor may be able to diagnose a
stroke based on a brief physical or neurological exam or it may be necessary to
do other tests like blood tests, arteriography or angiography, computed
tomagraphy (CT) scans, Doppler ultrasound, or magnetic resonance imaging
(MRI).

Stroke treatment
The treatment for a stroke depends on the cause and the resulting effects. One of
the most common effects is a weakness or paralysis on one side of the body. A
stroke that occurs on the right side of the brain typically leads to left-sided
weakness and may result in personality changes. A stroke on the left side of the
brain leads to right-sided weakness and may cause problems with speaking or
understanding speech. In both cases people may have personality changes or act
differently and may lose memory, vision, or hearing.
In the first few months after a stroke, many people spontaneously get back some
of the abilities they lost. But there are no guarantees, so doctors will begin
treatment right away to reduce the risk of long-term problems. The three
general categories of treatment for a stroke are prevention, treatment
immediately after a stroke, and rehabilitation in the months or weeks after a
stroke.

Prevention
You can’t control some of the things that increase your risk of a stroke, such as
your age. The best way to lower the odds of having a stroke is to follow your
doctor’s advice about reducing the risk factors that you can control.
One of the most important things you can do to reduce your risk of having a
stroke is maintaining a healthy blood pressure. Have regular medical checkups
that include a blood pressure test, and if you have high blood pressure, follow
your doctor’s advice very carefully. Your doctor may advise you to eat a low-fat
diet, get more exercise, quit smoking, take medication, or check your blood
pressure at home. Remember that if you have high blood pressure, you’ll need to
watch this carefully throughout your lifetime, so be sure to ask your doctor
about any special precautions you may need to take if, for example, you go on
vacation or experience a major change in your lifestyle.
If you drink or use drugs, your doctor may recommend that you lower your
alcohol consumption or join a substance-abuse program. People who’ve had one
stroke or TIA are 10 times more like than other people to have another stroke or
TIA, so you may need to take extra steps if you’ve had one of these.

Treatment immediately after a stroke
It’s vital to get medical help immediately if you may be having a stroke, because
doctors can sometimes prevent further damage to the body by acting quickly.
For example, if a blood clot has caused the stroke, doctors may be able to prevent
or reverse paralysis by administering drugs to break up the clot.
Doctors don’t usually treat strokes with surgery. But if a brain artery is severely
blocked, they may recommend removing the blockage to prevent future strokes.
In some cases, they may prescribe medication to reduce pressure on the brain or
to relieve other problems that can accompany a stroke.
Sometimes feelings of depression follow a stroke, especially if it involved a loss of
important abilities. If you have mood changes, it’s important to let your doctor
know. Your doctor may recommend that you take antidepressant medications or
look into counseling or another form of therapy.

Rehabilitation
A well-planned rehabilitation program helps many people overcome some of the
effects of a stroke. Although a stroke damages part of the brain, other parts of the
brain may be able to take over some of the functions of the damaged part.
Rehabilitation usually begins as soon as vital signs, such as pulse and blood
pressure, have stabilized. After leaving the hospital, many people benefit from a
stay in a nursing home or rehabilitation hospital with special facilities to aid
recovery.
Getting the most from a rehabilitation program requires a strong commitment
to working closely with doctors, nurses, and other health workers, such as
physical or occupational therapists. This process takes time and patience, and
you may find it easier to stick to a program if you join a support group for
people who have had strokes and understand the challenges you face. Support
groups can provide both emotional support and practical tips on coping with the
day-to-day realities of life after a stroke. You may be able to find a support group
through the neurology or social work department of a hospital or mental health
center. If you can’t attend meetings, you may want to join an online support
group run by a national organization for people who have had strokes.