As discussed in Understanding Strokes – Part 1, a stroke is what happens when the blood supply to a portion of the brain is blocked. Without a blood supply, brain cells are deprived of oxygen and begin to die.
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There are two kinds of strokes.
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An ischemic stroke occurs when a blood clot lodges in an artery of the brain. The blood clot may have traveled from elsewhere in the body, or it may have formed in the brain artery itself as a result of atherosclerosis, or hardening of the arteries.
A hemorrhagic stroke occurs when there’s a hemorrhage or bleeding in the brain. This bleeding may be a result of high blood pressure, or less commonly an aneurysm - a weakened blood vessel wall that eventually bursts. Rarely, a stroke can be caused by low blood pressure that is itself a result of a major injury or illness.
How a Stroke Is Diagnosed
A stroke is suspected whenever there’s sudden impairment of a part of the body, such as loss of function or sensation on one side, blindness in one eye, or loss of speech. Other symptoms include dizziness, vomiting, headache, seizures, nausea, and altered mental status.
Remember that time is of the essence. It’s important to seek medical care as soon as possible after the onset of any symptoms. The more quickly that treatment is received, the better chance of minimizing the damage from a stroke.
Transient ischemic attacks (TIAs) are mini-ischemic strokes that usually cause only temporary damage. However, they’re warning signs that the person is at risk for a major stroke.
According to the National Stroke Association:
- Up to 40% of all people who have experienced a TIA will go on to have an actual stroke
- Studies show that nearly 50% of all strokes occur within the first two days after a TIA
- 10% - 15% of people will have a stroke within three months after a TIA
A doctor will examine a patient and diagnose a stroke based on the available signs and symptoms, medical history, a physical exam, and a series of test results.
Some of the areas the doctor will explore are:
1. Whether or not there is a family history of TIAs and strokes
2. The patient’s personal history focusing on previous TIAs , strokes, high blood pressure, heart disease, and history of smoking
3. The current signs and symptoms that the patient experienced
In evaluating TIAs, the doctor will usually run a series of tests that evaluate heart function, as well as the degree of blockage in the carotid artery - the main artery that goes to the brain. A cerebral angiogram may be performed to measure the degree of narrowing of the cerebral arteries. However, it’s important to note that this procedure itself may increase the risk of stroke, especially in older people with diabetes.
The same techniques may be used in diagnosing a major stroke. A CT or CAT scan can also help diagnose a hemorrhagic stroke quickly. Evidence of an ischemic stroke will also show up on a CT scan after a few days. Earlier diagnoses of ischemic strokes are becoming possible as advances in magnetic resonance imaging (MRI) occur. Another test for ischemic stroke is a cardiac evaluation using an electrocardiogram and echocardiogram. If a patient has atrial fibrillation, there’s a good chance that a stroke has occurred.
Remember that time is of the essence. It’s important to seek medical care as soon as possible after the onset of any symptoms. The more rapid treatment is received, the better chance for minimizing the effects of the stroke.
How a Stroke Is Treated
The course of treatment the doctor selects depends on whether you have experienced an ischemic or hemorrhagic stroke.
Treatment for a transient ischemic attack (TIA) depends on its cause, how much time has passed since symptoms began, and whether you have any other medical conditions.
Strokes and TIAs are medical emergencies. If you or someone you know are experiencing stroke symptoms, call 9 -1-1 immediately. Don’t drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin lifesaving treatment on the way to the emergency room. During a stroke, every minute counts.
Once you receive initial treatment, your doctor will try to treat your stroke risk factors and prevent complications.
New treatments for stroke are developing regularly. Doctors realize that speed in diagnosing and beginning treatment is crucial to the outcome. Those with ischemic strokes who are treated within 12 hours may suffer less permanent damage than those who are not.
If identified and treated within 4 hours from the start of symptoms, a medication called tPA
(tissue plasminogen activator) can be effective in breaking up blood clots in the arteries of the brain. In a case where a person can’t be given tPA, an alternative treatment is antiplatelet medicine. The antiplatelet medicines can be helpful in preventing platelets from clumping together and forming blood clots.
Other treatment options may include anticoagulants, or “blood thinners.” These medicines can help to keep blood clots from growing in size, as well as to prevent the development of new clots.
Blood thinning drugs such as heparin and ordinary aspirin may be administered immediately, unless the stroke is a hemorrhagic stroke. New drug therapies offer hope that the brain cell damage that normally occurs after a stroke can be reduced or even halted.
Surgery to repair narrowed carotid arteries may be beneficial in restoring normal blood flow and reducing the risk of future strokes. However, there’s a risk that the surgery itself will produce a stroke, and that risk varies from one hospital to another. An experimental treatment for ischemic stroke is the same kind of balloon angioplasty that’s performed on blocked coronary arteries - a catheter is threaded into the blocked artery and a balloon is inflated to widen the opening so that blood can pass through.
In the case of a hemorrhagic stroke, surgery may be performed to repair the aneurysm causing the bleeding. New technologies and procedures make this type of surgery a promising treatment for future hemorrhagic strokes.
Recovery from stroke involves retraining undamaged brain cells to take over as much of the function of the damaged cells as possible. Physical therapy is usually started as soon as the patient is stable - as early as two days after the stroke. Patients make the biggest improvements in the first days after a stroke, but continue to improve for six months or longer.
The healthcare team aiding the rehabilitation may include speech, occupational and physical therapists, a doctor specializing in rehabilitation, a nurse, case manager, and nutritionist. Drug therapy is helpful for certain side effects of stroke.
Informational Source: Parlay International
Take a Proactive Approach - The Life You Save Can Be Yours
Here are some well-known risk factors for strokes that can be treated before a stroke hits.
- High blood pressure
- Hypertension
- Heart disease
- Physical inactivity
- Obesity
- Cigarette smoking
- Warning signs or a history of transient ischemic attack (TIA) or stroke
- Diabetes
- Cholesterol imbalance
Why not call your doctor today to schedule a physical!
Disclaimer
The information in this article is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient provider relationship, and should not be used as a substitute for professional diagnosis and treatment.
Please consult your health care provider for an appointment, before making any healthcare decisions or for guidance about a specific medical condition.
Additional Information
For more information, or to request an initial consultation, please contact:
Linda Ziac, LPC, LADC, BCPC, CEAP, CCM, CDP
The Caregiver Resource Center
Greenwich, CT
203-861-9833
