Stroke

What's is it?

A stroke occurs when vital blood flow and oxygen to the brain is interrupted. When blood flow to the heart is blocked, it's called a heart attack; similarly, a stroke sometimes is called a "brain attack." A stroke can injure the brain just as a heart attack can injure the heart. Another name that doctors often use for stroke is "cerebrovascular accident" or CVA.

Types of stroke include:

  • Ischemic stroke — This is the most common type of stroke. It occurs when there is a sudden lack of blood flow to some part of the brain, usually due to a blood clot blocking an artery or blood vessel in the brain. Often, the artery already is clogged with plaque and fatty deposits (atherosclerosis).
  • Hemorrhagic stroke — This type of stroke, also called bleeding in the brain, is caused by a broken or leaking blood vessel in the brain. A bleeding (hemorrhagic) stroke may be due to an aneurysm — a thin or weak spot in an artery that balloons out and bursts.

Approximately nine out of every 10 strokes are blocked-vessel (ischemic) strokes; the rest are bleeding (hemorrhagic) strokes. Both types of stroke cause brain cells to die. Two million brain cells die every minute during a stroke, increasing the risk of permanent brain damage, disability or death. This brain damage may cause you to lose control of certain functions, such as speech, movement and memory.

Recognizing the symptoms and acting FAST to get medical attention can save a life and limit disabilities. A stroke is an emergency and should be treated as quickly as possible by calling 911. Some treatments only are effective if given within three hours of when the attack begins.

What is a "mini-stroke" or TIA?

A "mini-stroke" refers to a transient ischemic attack, or TIA. In a TIA, there is a short-term reduction in blood flow to the brain. This may cause stroke symptoms, such as weakness or tingling in an arm or leg, or sudden temporary loss of vision in one eye (sometimes described as having a "nightshade" pulled over the eye). Symptoms may last from just a few minutes to a day, and may even go unnoticed.

TIAs are important warning signs that you are at increased risk of having a stroke in the future. One in ten people who have a TIA will have a stroke within 90 days, half within the first 48 hours. In addition, people who have a TIA have a 20 percent chance of having a stroke within the next 10 years, and more than a 40 percent chance of dying of stroke or heart attack in the next 10 years. If you suspect you have had a TIA, seek medical care right away to prevent a full stroke.

What are the symptoms?

The following are warning signs of stroke. They may be present, disappear and then return.

Most common signs of a stroke are:

  • Sudden numbness or weakness of face, arm or leg, especially on only one side of the body
  • Sudden confusion or trouble speaking or understanding speech
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, or loss of balance or coordination
  • Sudden severe headache with no known cause

Non-traditional signs that may indicate a stroke include sudden face, arm or leg pain, nausea, tiredness, chest pain, shortness of breath, or a pounding or racing heartbeat.

The National Stroke Association coined " FAST" to help identify stroke:

  • Face:
    Ask them to smile. Does one side of the face droop?
  • Arms:
    Ask them to raise both arms. Does one arm drift downwards?
  • Speech:
    Ask them to repeat a simple sentence (for example, "The sky is blue"). Are the words slurred? Can they say the sentence correctly?
  • Time:
    Stroke is an emergency: call 911 if the person experiences any of the above symptoms.

How is it treated?

A person thought to be having a stroke will have a physical and neurological exam, blood tests, and one or more imaging tests, including:

  • A CT scan or MRI to determine if the stroke is caused by a blockage or by bleeding in the brain.
  • Angiography to produce a picture of the blood vessels in the brain and how the blood is flowing through them.
  • Ultrasound blood flow tests such as the carotid Doppler ultrasound to determine if the stroke was caused by blockages in the neck arteries that supply blood to the brain, and a transcranial Doppler ultrasound to look directly at blood flow in the arteries in the brain.

Strokes caused by blood clots can be treated with clot-busting drugs such as tPA (tissue plasminogen activator). tPA must be given within three hours of the start of a stroke to be effective.

A CT scan must be done first to make sure that a stroke is not caused by bleeding in the brain. This is why it is so important for a person having a stroke to call 911 and get to a hospital fast. In some centers, tPA may be injected directly into a blocked blood vessel in the brain for up to six hours after a stroke; this is done by specialized doctors during angiography.

Other medicines also are used to treat and prevent stroke. Anticoagulants such as warfarin and antiplatelet agents such as aspirin interfere with the blood's ability to clot and can play an important role in preventing a stroke.

Procedures to open blocked blood vessels leading to the brain are sometimes used to treat or prevent stroke. For example, carotid stenting is a procedure using angiography for guidance to insert a special mesh tube called a stent in a narrowed neck artery and prop it open to eliminate blockage.

Carotid endarterectomy is the surgical removal of fatty deposits clogging the carotid artery in the neck that could lead to a stroke. For bleeding (hemorrhagic) stroke, surgical treatment may include placing a metal clip at the base of an aneurysm or removing abnormal blood vessels.

What is Lee Memorial Health System's approach?

Lee Memorial Health System doctors use advanced technology and detailed imaging tests to diagnose strokes or other cerebrovascular conditions, to determine the cause of symptoms and to determine the most appropriate treatment.

Our doctors are trained in blood vessel and brain conditions (vascular neurology), blood vessel conditions and imaging (endovascular surgical neuroradiology), blood vessel conditions, physical medicine and rehabilitation, emergency medicine, and other areas. This multidisciplinary team works together to promptly diagnose and treat people who have had strokes, and to prevent strokes in people who are at risk of strokes. Doctors work with you and your family to develop your treatment plan.

As the largest health system in the region, Lee Memorial Health System is involved in the latest treatment and research, actively studing stroke causes, risk factors, prevention, diagnostic tests and treatment options and conducting clinical trials.

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