Stroke

A Stroke is when blood flow to a part of the brain is insufficient, or there is bleeding within the brain. It is a severe medical emergency that can result in brain damage or death. Symptoms may include weakness on one side of the body, speech difficulties, vision changes, loss of consciousness, and others, and can lead to disability or death.

It is critical to identify a stroke immediately and seek prompt medical attention, as early intervention can enhance the outcome. Strokes can occur in various ways, the most prevalent being ischemic strokes, caused by a blood clot that hinders blood flow and deprives the brain of oxygen.

Hemorrhagic strokes, which arise when a blood vessel ruptures, leading to brain bleeding, are less common. Physical, occupational, and speech therapy is often used to aid patients in regaining function following a stroke.

The earlier one is identified and treated, the better the prognosis is generally.

What Are the Signs and Symptoms?

Symptoms such as numbness, weakness, vision changes, and dizziness can be among the initial indications of a stroke, and in some cases, the person experiencing the stroke may be unable to communicate, necessitating the assistance of others to call for emergency services.

The signs and symptoms can vary significantly because brain damage can affect any part of the brain, causing symptoms that are specific to the affected area.

However, it is possible to identify a few key features that can help individuals recognize the common signs and seek help promptly when necessary.

Act “FAST” to Recognize Symptoms

A shortcut for recognizing stroke symptoms is “FAST “—face, arm, speech, time—as follows:¹

• Face: The face can be affected. This can look like a lopsided face, a droopy eyelid, an uneven smile, drooling, or flattened folds on one side of the face.
• Arm: People who are having a stroke might have trouble moving one arm, hand, leg, or foot. The weak limb might be completely paralyzed, or it may drop as a person tries to lift it. Sometimes a person can feel a tingling sensation or pins and needles on one side of the body. 
• Speech: Language and communication are often impaired, with slurred speech, difficulty using the right words, struggling to get the words out, or difficulty understanding what others are saying.
• Time: Immediate medical attention is crucial. Any delay can increase the risk of death and disability.

Unique Signs of a Stroke in Women

Women have a higher probability of experiencing a stroke in their lifetime compared to men, which may be partly attributed to their longer life expectancy. Additionally, risk factors such as pregnancy, birth control pills, and postmenopausal hormone changes can further increase the likelihood of a stroke.

Although the symptoms typically do not vary by gender, women may be more prone to subtle indications of a stroke.

These subtle indications may include:

• Fatigue
• Light-headedness
• Nausea

Types

Various kinds of strokes exist, which share certain similarities resulting from a disruption of blood flow to a specific area of the brain. Nonetheless, the causes may differ, and the duration of symptoms can vary from a very brief period to a permanent state.

Ischemic Stroke

In the case of an ischemic stroke, there is a blockage or disruption in the blood flow within an artery or a small branch that supplies blood to a particular part of the brain.

Consequently, the brain cells that would usually receive oxygen and nutrients from that artery suffer from ischemic damage and, in severe cases, death.

This can result in physical or cognitive impairments that are specific to the affected region of the brain.

Hemorrhagic Stroke

A hemorrhagic stroke arises when an artery in the brain ruptures. There are two types of  Hemorrhagic strokes, intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). Hemorrhagic strokes are associated with a high mortality rate.

Outcomes

In general, these tend to have more severe outcomes compared to ischemic strokes. However, the specific outcomes can be influenced by the size and location.

Transient Ischemic Attack (TIA)

A transient ischemic attack (TIA) is a type of stroke that is reversible and occurs when there is a temporary interruption of blood flow to a particular area of the brain. The brief ischemia results in symptoms that disappear entirely within 24 hours, typically within a matter of seconds or minutes. As blood flow is spontaneously restored, there is no permanent ischemic damage.

The risk factors for a TIA are identical to those for a stroke, and a TIA can serve as an indication that an individual is at risk of experiencing one.  Although sometimes referred to as a “ministroke,” a more appropriate term for a TIA is an “almost” stroke.

Causes and Risk Factors

Many of the risk factors associated with stroke can be modified or medically managed to decrease the chances of experiencing one.

Lifestyle Factors

Engaging in certain lifestyle habits can heighten the probability of experiencing a stroke, with smoking being particularly detrimental to blood vessels and significantly increasing the likelihood.

Other lifestyle risk factors include:

• Excessive alcohol use 
• Sedentary lifestyle with minimal physical activity 
• Extreme, chronic stress 
• Unhealthy diet

Medical History

The likelihood of experiencing a stroke can be amplified by certain medical conditions, which are more prevalent in older individuals. A key risk factor is atherosclerosis, characterized by the narrowing and hardening of arteries throughout the body. Atherosclerosis in the heart, carotid arteries, and blood vessels in the brain can significantly impede blood flow to the brain, making it especially prone to stroke.

Several risk factors can contribute to the development of atherosclerosis, such as:

• High blood pressure
• Untreated heart disease, including heart valve disease, heart failure, and irregular heart rhythm like atrial fibrillation
• Untreated diabetes
• High levels of fat and cholesterol in the blood
• Being overweight or obese

Other Factors

Other factors that can increase the risk include:

• Advancing age
• Family history of stroke 
• Chronic inflammatory disease
• Severe infections 
• Vascular disease 
• Cancer 

How Are Strokes Diagnosed?

To diagnose a stroke, symptoms and a physical examination are typically used. The symptoms are typically specific to the affected region of the brain. Diagnostic testing is often necessary to confirm a stroke diagnosis. Tests may include:

• Brain imaging: A brain computed tomography (CT) scan can usually detect bleeding in a hemorrhagic stroke within the first few hours of bleeding. Brain magnetic resonance imaging (MRI) can identify early, subtle changes in an ischemic stroke.

• Angiogram: An angiogram is an imaging test that examines blood vessels. Cerebral vessel angiograms may include computed tomography angiography (CTA) or magnetic resonance angiography (MRA). These tests can detect structural abnormalities or blood clot in the brain’s blood vessels.

• Blood tests: Although a stroke is not diagnosed with a blood test, blood tests can often identify risk factors such as high cholesterol or diabetes.

• Electrocardiogram (EKG/ECG): An EKG is a quick and noninvasive test that examines heart rhythm. It can detect abnormalities associated with an irregular heart rhythm, heart attack, or heart failure.

• Echocardiogram: An echocardiogram or echo is a noninvasive test that examines the heart’s structure and movement. It can detect heart problems that increase the risk.

• Carotid ultrasound: A carotid ultrasound is a noninvasive test that examines the neck arteries that supply blood to the brain. Narrowing or disease of these arteries can cause a stroke.

Detecting Previous Strokes

Sometimes brain imaging tests also detect previous asymptomatic (without symptoms) strokes. Having multiple strokes can lead to changes in independence and personality—even if the individual strokes were asymptomatic.

Treatment

The effective management of stroke begins with a timely assessment to determine the type and the immediate administration of appropriate treatment. Medical stabilization is vital for all types, which involves maintaining optimal blood pressure, blood sugar, and fluid levels.

Direct intervention may be required in some cases, such as:

• Intravenous (IV) administration of blood thinners for an ischemic stroke

• Injection of blood thinners directly into a blood clot for certain types of ischemic strokes

• Thrombectomy, a procedure in which a thin tube (catheter) is inserted through blood vessels into the brain clot and mechanically removed.

• Surgical intervention to remove blood in the case of a hemorrhagic stroke

• Craniotomy, which involves the removal of a small area of the skull to alleviate severe swelling Following a stroke, close monitoring of neurological functioning, fluid and electrolyte concentrations, blood pressure, and blood glucose is necessary over the first few days. Seizures can occur due to brain damage from a stroke, requiring treatment with antiepileptic medication.

Once stabilized, the recovery process can begin, and the assessment of risk factors is necessary for preventing future ones.

Recovering

Recovery after is often gradual. Some people fully recover, but most people have some degree of impairment after a stroke. Immediate medical care and consistent therapy can improve long-term outcomes. It’s important to be patient throughout recovery because improvement doesn’t always follow a smooth and steady path.

Complications

Sometimes complications can be prevented by taking proactive measures. Choking or pneumonia, which may occur due to difficulty swallowing, is an especially concerning risk.

Weakness and sensory changes can increase the risk of bedsores and blood clots. Weakness and vision changes may lead to falling after a stroke.

Rehabilitation

Rehabilitation should be tailored to specific deficits that occur after a stroke:

• Many people need physical therapy to help with improving muscle control and strength.
• Speech and swallow therapy is crucial to avoid choking and aspiration pneumonia.
• Occupational therapy teaches a person how to maintain self-care and day-to-day tasks safely and with as much independence as possible.

How Long Does Recovery Take?

In some cases, symptoms may deteriorate during the first few days before stabilizing, and gradual improvement may occur if prompt medical care is initiated within the first few hours of a stroke.

The recovery process is typically gradual over the following weeks, and for some individuals, it may continue for up to a year after.

Recovery is usually faster for individuals who are otherwise healthy and who experienced a small stroke, with greater improvement compared to those who suffered a larger stroke, have underlying health issues, or have a history of strokes.

Tips for Caregivers

Caring for someone after a stroke can be a daunting task. The extent of disability may require significant assistance with day-to-day activities. In some cases, individuals may not be fully aware of their limitations, making it more challenging to care for them. Seeking guidance and instructions is crucial to ensure the safety of your loved one. Caring for a stroke survivor can be time-consuming, demanding, and emotionally draining, emphasizing the importance of seeking assistance from professionals trained in caregiving for individuals who have experienced one. Enlisting help from friends and family members can alleviate some of the burden. Additionally, support groups can provide practical advice and emotional support.

How to Prevent

Stroke prevention is a critical aspect of overall health maintenance for everyone. Undergoing recommended screening tests can help identify potential risk factors, and treatment for these risk factors can effectively reduce the likelihood of a first or recurrent stroke.

It is never too late to begin prevention, as a recurrent stroke can exacerbate the level of disability caused by a previous one.

Prevention strategies mainly involve treating and managing risk factors, such as:

• Stopping smoking if you are a smoker

• Taking medication to lower high blood pressure (hypertension)

 • Maintaining optimal blood sugar levels if you have diabetes

• Managing high cholesterol and fat levels through diet and medication

• Receiving treatment for heart disease, such as heart rhythm abnormalities, heart failure, or coronary artery disease

• Receiving treatment for carotid artery disease

• Maintaining treatment for chronic inflammatory conditions Most risk factors do not exhibit any noticeable symptoms and can lead to a stroke without warning.

Regular check-ups are crucial for identifying risk factors.

Outlook for Stroke

The outlook after a stroke can vary significantly, as there are various types with differing severities. Adjustments to daily life may be necessary after, such as using a walker, ceasing driving, or avoiding certain foods that pose a choking risk.

Effective identification and management of risk factors can significantly reduce the likelihood of experiencing another stroke.

In the United States, about 25% of strokes are recurrent. The risk of recurrence after surviving is around 12% within five years, although the risk is greater following large strokes and hemorrhagic strokes compared to small ischemic strokes.

Sources

TGH Urgent Care powered by Fast Track uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles.

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