Understanding Strokes

With one person dying every 4 minutes, stroke is the 5^th leading cause of death in the United States. Every year, about 800,000 people have a stroke. When the oxygen-rich blood supply to the brain is blocked off, a “brain attack” or a stroke can occur. When the brain cells are deprived of oxygen, they begin to die, and the abilities controlled by that area of the brain are lost.

A stroke is a medical emergency and should be treated as such. Early recognition and action can lessen the amount of brain damage and potential complications that can result.

Types of Strokes

There are three types of strokes:

Ischemic stroke
Hemorrhagic stroke
Transient ischemic attacks (TIAs), also known as ‘mini-strokes’

Causes of Stroke

Each of the different stroke types has a different cause.

Ischemic strokes are most common and account for about 85% of all strokes. These type of strokes are triggered by blockages or narrowing of the arteries that provide blood to the brain. These blockages cause severely reduced blood flow or ischemia. This type of stroke is triggered by a thrombus (stationary clot) or embolus (a clot that travels through the bloodstream) blocking a blood vessel carrying blood to the brain.

A hemorrhagic stroke occurs when the arteries in the brain either leak or burst open. The blood flowing into the brain puts pressure on the brain cells and damages them. Blood vessels that burst in the middle of the brain, or near the surface can send blood into the space between the skull and the brain. A hemorrhagic stroke typically results in an excruciating headache, and sometimes followed by loss of consciousness.

Transient ischemic attacks (TIAs) differ from the other two types because the flow of blood to the brain is interrupted only briefly. Clots and other debris cause these ‘mini-strokes’. TIAs should be treated like a medical emergency like any other stroke. TIAs indicate a partially blocked artery or clot, and also serve as a warning for future strokes. Over a third of people who experience a TIA will have a major stroke within a year if they have not received treatment.

Symptoms of Stroke

If you think that you or someone else may be having a stroke, watch for the following symptoms. If you or someone exhibits signs of stroke, it is important to seek immediate medical attention. If the symptoms occur and pass quickly, it could be a TIA, and that still needs to be treated as a medical emergency.

Sudden weakness or numbness in the face, arm, leg or on one side of the body
Trouble seeing in one or both eyes
Trouble with speaking or understanding, including confusion and slurring of words
Sudden and severe headaches, may be followed by unconsciousness
Trouble walking that may include loss of balance or coordination or dizziness

Because time is of the essence with strokes, you can use the acronym F.A.S.T. to help you remember and identify the signs of a stroke:

Face drooping: has their face fallen on one side? Can they smile?
Arm weakness: can they raise both arms and keep them there, or does one drift downward?
Speech difficulty: is the person’s speech slurred?
Time to call 911: if any of these signs are observed, seek emergency medical assistance.

Diagnosing a Stroke

Ischemic and hemorrhagic strokes require different kinds of treatment, however, it is only possible to confirm which type of stroke someone had with a computerized tomography (CT) scan of their brain.

Your emergency medical team will not only find out what type of stroke you are having, but also look at the areas affected by the stroke. Using a series of various tests, they will rule out other possible causes of your symptoms, and determine what the best course of action regarding treatment is. Some of these tests will include:

A doctor will perform a physical examination that includes medical history, evaluation of your medications, personal family history, check your blood pressure, and listen to your heart. They may also check for clots in the blood vessels in the back of your eyes.
There are a number of blood tests that can be run to determine how fast your blood clots, blood sugar levels, check for critical blood chemical levels and whether or not you have an infection.
A computerized tomography (CT) scan will use a series of x-rays to create a detailed image of your brain. A CT scan can show a hemorrhage, tumor, stroke and other conditions.
Doctors may use magnetic resonance imaging (MRI) to create a detailed view of your brain that can show them tissue damage that may be from an ischemic stroke, or brain hemorrhaging.
A carotid ultrasound will use sound waves to create images of the carotid arteries in your neck. This test will be able to show plaque buildup and blood flow in your carotid arteries.
An echocardiogram will create a detailed image of your heart using sound waves and may be able to show your medical team how a clot may have traveled from your heart to your brain, causing your stroke.

Treatment Options for a Stroke

Stroke treatment is dependent upon stroke type, stroke location, and the extent of the brain damage.

For ischemic strokes, you will be given clot-dissolving medicines to increase your chance of recovery. If the clot cannot be removed with medicine, it may be removed with a medical device. You may also receive aspirin to prevent further blood clotting.

For hemorrhagic stroke, treatment will be given to control the bleeding, reduce pressure in the brain and stabilize blood pressure, along with other vital signs. Your medical team will closely monitor the pressure on your brain, looking for signs of restlessness, confusion or headaches. If the bleeding in your brain was due to a ruptured brain aneurysm, surgery may be done to repair an aneurysm. Medications can be given to control brain swelling, blood sugar levels and prevent seizures.

These treatment options are all called, acute care, and will be done at the hospital or hospital-like facility, but depending on how damaging the stroke was, more will need to be done to recover from the stroke. Stroke recovery includes treatment and rehabilitation.