A stroke occurs when the blood supply to part of your brain is interrupted or severely reduced, depriving brain tissue of oxygen and food. Within minutes, brain cells begin to die.
A stroke is a medical emergency. Prompt treatment is crucial. Early action can minimize brain damage and potential complications.
The good news is that strokes can be treated and prevented, and many fewer Americans now die of stroke than was the case even 15 years ago. Better control of major stroke risk factors — high blood pressure, smoking and high cholesterol — is likely responsible for the decline.
Watch for these signs and symptoms if you think you or someone else may be having a stroke. Note when signs and symptoms begin, because the length of time they have been present may guide treatment decisions.
When to see a doctor
If you're with someone you suspect is having a stroke, watch the person carefully while waiting for emergency assistance. You may need to:
A stroke disrupts the flow of blood through your brain and damages brain tissue. There are two chief types of stroke. The most common type — ischemic stroke — results from blockage in an artery. The other type — hemorrhagic stroke — occurs when a blood vessel leaks or bursts. A transient ischemic attack (TIA) — sometimes called a ministroke — temporarily disrupts blood flow through your brain.
Transient ischemic attack (TIA)
Like an ischemic stroke, a TIA occurs when a clot or debris blocks blood flow to part of your brain. But unlike a stroke, which involves a more prolonged lack of blood supply and causes permanent tissue damage, a TIA doesn't leave lasting effects because the blockage is temporary.
Seek emergency care even if your symptoms seem to clear up. If you've had a TIA, it means there's likely a partially blocked or narrowed artery leading to your brain, putting you at a greater risk of a full-blown stroke that could cause permanent damage later. And it's not possible to tell if you're having a stroke or a TIA based only on your symptoms. Up to half of those whose symptoms appear to go away are actually having a stroke that's causing brain damage.
Ischemic stroke occurs when a blood clot (thrombus) blocks or plugs an artery leading to the brain. A blood clot often forms in arteries damaged by buildup of plaques (atherosclerosis). It can occur ...
Many factors can increase your risk of a stroke. A number of these factors can also increase your chances of having a heart attack. Stroke risk factors include:
Because the risk of stroke increases with age, and women tend to live longer than men, more women than men have strokes and die of them each year. Blacks are more likely to have strokes than are people of other races.
A stroke can sometimes cause temporary or permanent disabilities, depending on how long the brain suffers a lack of blood flow and which part was affected. Complications may include:
As with any brain injury, the success of treating these complications will vary from person to person.
Preparing for your appointment
A stroke in progress is usually diagnosed in a hospital emergency room. If you're having a stroke, your care will focus on minimizing brain damage and helping you recover and avoid another stroke in the future. If you haven't yet had a stroke but are worried about your future risk, you can discuss your concerns with your doctor at your next scheduled appointment.
What to expect from your doctor
If you are seeking your doctor's advice during a scheduled appointment, your doctor will evaluate your risk factors for stroke and heart disease. Your discussion will focus on quitting smoking if you are a smoker and on lifestyle strategies or medications to control high blood pressure, cholesterol, and other risk factors. In some cases, your doctor may recommend certain tests and procedures to better understand your risk or to treat underlying conditions that raise risk.
Tests and diagnosis
To determine the best treatment for your stroke, your emergency team must figure out what type of stroke you're having and what parts of your brain it's affecting. Other possible causes of your symptoms, such as a brain tumor or a drug reaction, also need to be ruled out. Your doctor may also use some of these tests to determine your risk of stroke.
Treatments and drugs
Emergency treatment for stroke depends on whether you are having an ischemic stroke blocking an artery — the most common kind — or a hemorrhagic stroke involving bleeding into the brain.
Emergency treatment with medications. Therapy with clot-busting drugs must start within 4.5 hours — and the sooner, the better. Quick treatment not only improves your chances of survival, but may also reduce the complications from your stroke. You may be given:
Emergency procedures. Doctors sometimes treat ischemic strokes with procedures that must be performed as soon as possible.
Other procedures. To decrease your risk of having another stroke or TIA, your doctor may recommend a procedure to open up an artery that's moderately to severely narrowed by plaques. Doctors also sometimes recommend these procedures to prevent a stroke. Options may include:
Emergency measures. If you take warfarin (Coumadin) or antiplatelet drugs such as clopidogrel (Plavix) to prevent blood clots, you may be given drugs or transfusions of blood products to counteract their effects. You may also be given drugs to lower your blood pressure, prevent seizures or reduce your brain's reaction to the bleeding (vasospasm). People having a hemorrhagic stroke can't be given clot-busters such as aspirin and TPA because these drugs may worsen bleeding.
Once the bleeding in your brain stops, treatment usually involves bed rest and supportive medical care while your body absorbs the blood. Healing is similar to what happens while a bad bruise goes away. If the area of bleeding is large, surgery may be used in certain cases to remove the blood and relieve pressure on the brain.
Surgical blood vessel repair. Surgery may be used to repair certain blood vessel abnormalities associated with hemorrhagic strokes. Your doctor may recommend one of these procedures after a stroke or if you're at high risk of spontaneous aneurysm or arteriovenous malformation (AVM) rupture:
Stroke recovery and rehabilitation
Most stroke survivors receive treatment in a rehabilitation program. Your doctor will recommend the most rigorous program you can handle based on your age, overall health and your degree of disability from your stroke. The recommendation will also take into account your lifestyle, interests and priorities, and availability of family members or other caregivers.
Your rehabilitation program may begin before you leave the hospital. It may continue in a rehabilitation unit of the same hospital, another rehabilitation unit or skilled nursing facility, an outpatient unit, or your home.
Every person's stroke recovery is different. Depending on your complications, the team of people who help in your recovery could include these professionals:
Coping and support
A stroke is a life-changing event that can affect your emotional well-being as much as your physical function. Feelings of helplessness, frustration, depression and apathy aren't unusual. Diminished sex drive and mood changes also are common.
Maintaining your self-esteem, connections to others and interest in the world are an essential part of your recovery. These strategies may help both you and your caregivers:
Knowing your stroke risk factors, following your doctor's recommendations and adopting a healthy lifestyle are the best steps you can take to prevent a stroke. If you've had a stroke or a TIA, these measures may also help you avoid having another one. Many stroke prevention strategies are the same as for preventing heart disease. In general, a healthy lifestyle means that you:
Last Updated: 2010-07-01
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