severe headache. (Stroke symptoms usually come on suddenly.)
or paralysis on one or both sides of the face or body.
and tingling in one or both arms or legs.
difficulty or loss; slurred speech.
blindness or partial loss of vision, double vision, dilated
pupils, or crossed eyes due to partial inability to move
mental confusion, or sudden loss of consciousness.
to walk or coordinate limbs.
When To Call Your Doctor
an ambulance immediately if you or someone in your presence
exhibits stroke symptoms.
What Is It?
A stroke is a medical emergency caused either by
obstruction of an artery carrying blood to the brain or by rupture
of one of the cerebral arteries. Because brain cells cannot regenerate,
lack of oxygen from blockage of the blood supply may quickly
lead to cell death and permanent brain damage.
Strokes are more likely to occur when arteries
have been substantially narrowed by atherosclerosis (a buildup
of plaques in the walls of the arteries). Blood flow through
narrow arteries is reduced, and blood clots are more likely to
form along the uneven surface of the plaque. A clot formed in
a carotid artery in the neck or a cerebral (brain) artery can
block the artery at that site. Clots may also form elsewhere,
become detached, and ultimately block a cerebral artery, causing
About 80 percent of strokes are ischemic strokes
due to blockage in either an artery in the brain or in one of
the carotid arteries in the neck. The remaining 20 percent result
from a rupture of a brain artery. This type of stroke called
a hemorrhagic stroke is generally the most life-threatening,
primarily because of the excessive pressure the bleeding exerts
on brain tissue.
Although incidence is highest among those over
age 65, a stroke may afflict anyone at any age. Symptoms often
come on suddenly and vary depending on the portion of the brain
affected. Some patients will have temporary stroke-like episodes
known as transient ischemic attacks (TIAs) prior to a stroke,
which resolve in minutes to a few hours. Strokes are the third
leading cause of death in the United States, but the leading
cause of disability. Prevention is key.
What Causes It?
that obstruct a carotid or cerebral artery are the most common
cause of stroke.
(a fragment of plaque, tissue, or blood clot) may develop in
the heart and travel to the brain to cause a stroke. Emboli are
most likely to develop in association with arrhythmias (especially
atrial fibrillation), valvular heart disease, heart attacks,
or cardiomyopathy (disease of the heart muscle).
(a balloon-like weak spot in an arterial wall) in a cerebral
artery may burst or leak, resulting in a stroke.
is the greatest risk factor for stroke.
arteries due to atherosclerosis increase the risk of stroke.
Use of cocaine
or amphetamines may boost blood pressure to dangerously high
levels and cause a stroke.
Risk is high
among those who have experienced one or more TIAsa temporary
blockage in an artery that lasts for less than 24 hours (usually
only a few minutes) and causes no permanent brain damage.
A family history
of stroke, early or premature heart attacks (before age 55 in
men; age 65 in women), atherosclerosis, or high blood pressure
increases the risk of stroke.
abuse, high blood cholesterol levels, a diet high in fat (especially
animal fat), obesity, lack of exercise, diabetes, and oral contraceptive
use all may increase the risk of stroke.
Eat a diet
low in fat, cholesterol, and salt.
moderate, regular exercise. Check with a doctor before beginning
an exercise program.
if you are more than 20 percent overweight.
Have no more
than two alcoholic drinks a day.
doses of aspirin or other antiplatelet drugs (such as ticlopidine,
clopidogrel, and dipyridamole) may be prescribed to reduce the
chances of blood clot formation in those who have had a TIA or
are otherwise at high risk for stroke.
must be treated aggressively.
warfarin may be prescribed for those with atrial fibrillation
and some other conditions to prevent blood clot formation.
show evidence of substantial atherosclerotic narrowing in the
carotid arteries (the two main blood vessels in the neck supplying
blood to the brain) may be good candidates for carotid endarterectomy,
a surgical procedure to clear away plaque deposits in these arteries.
is often made immediately upon examination by a doctor or emergency
(computed tomography) scans or MRI (magnetic resonance
imaging) may be used to locate an abnormal blood vessel or
an area of brain damage.
of carotid arteries reveal narrowing due to atherosclerotic plaque.
may be performed to locate the arterial blockage or aneurysm.
In this procedure a tiny catheter is inserted into an artery
in the groin and threaded up to the carotid artery in the neck.
A contrast material is injected to produce a clear x-ray image
of the carotid and cerebral arteries.
(ECG) is performed to detect arrhythmias or heart damage from
a heart attack.
A cardiac ultrasound
(echocardiography) may locate a source of blood clots in the
How To Treat It
and immediate hospitalization is necessary. Life support measures
may be required.
If a stroke
is caused by arterial blockage due to a blood clot, thrombolytic
(clot-dissolving) drugs, such as tPA, or anticoagulants, such
as heparin or warfarin, should be initiated within three hours
of the onset of symptoms.
If the stroke
is the result of a brain hemorrhage, physicians will immediately
take measures to reduce the blood pressure of hypertensive patients
in order to minimize the flow of blood from the ruptured artery.
following a stroke may include antiplatelet medications, such
as aspirin, or anticoagulant medications, such as warfarin, to
prevent future clots.
braces, canes, wheelchairs, or other devices may be necessary
to help increase mobility for those with partial paralysis.
occupational, and emotional therapy helps patients and their
families cope with major lifestyle changes.
extensive disabilities may need a period of in-hospital rehabilitation
or professional in-home medical care.
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