Stroke

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stroke

The brain is a delicate organ that is constantly supplied with oxygen by the flow of blood through a complex network of arteries and capillaries – until, suddenly, it isn’t.

A stroke is the interruption of blood flow to the brain, and it can have catastrophic effects on speech, mental function, and motor skills. Every moment without oxygen reaching the brain worsens the effect of this kind of brain injury, so knowing the warning signs – and being able to call 911 at their first appearance – is crucial.

Strokes (also called cerebrovascular accidents, or CVAs) are the fourth most deadly killer in the United States, causing almost 130,000 deaths every year, in addition to another 650,000 stroke survivors who must live with the disability such an injury leaves in its wake.

Certain risk factors are known to increase the risk of stroke – some of which are avoidable, and some of which are not. Advancing age is an inescapable risk, as is having a close relative who has experienced a stroke. Those who have recently undergone surgery are in greater danger of having a stroke, as are women who are or have recently been pregnant, due to the blood vessel damage and increased risk of blood clotting that can occur.

Another compounding factor is having already had one stroke, or a transient ischemic attack (a similar loss of blood flow that, in contrast to a stroke, causes minimal damage). While other health issues such as high blood pressure and cholesterol, diabetes, and heart disease may increase the risk of a stroke, managing and controlling these conditions with lifestyle choices can help. Losing weight via exercise and a healthy diet can mitigate the risk, as can quitting smoking.

The earliest noticeable warning signs of a stroke include facial weakness, slurred speech, and “arm drift” – when a patient is asked to hold both arms up in the air, one arm will start to move downward despite her best efforts. (The acronym FAST is often used to remember the symptoms of Face, Arm, and Speech, as well as the all-important factor of Time.)

Someone having a stroke may also experience blurred or double vision, a sudden sensation of facial numbness, sluggish and uncoordinated limbs, or an intense headache that starts in a split second.

A little-known fact is that there are actually two different kinds of stroke. While both cause the same symptoms and the same enduring damage to the brain by depriving it of needed blood, they have opposite causes that require opposite treatments: choosing the wrong treatment plan is likely to be fatal.

Ischemic strokes account for about 87% of strokes, and are caused by a blood clot that blocks the flow of blood through an artery. This type of stroke is best treated by the administration of blood thinners and anti-clotting agents such as t-PA (tissue plasminogen activator) to destroy the blockage.

Hemorrhagic strokes, on the other hand, occur when a blood vessel that supplies the brain suddenly bursts. The blood leaking out of the vessel begins to fill the empty space in the brain, and as it accumulates it begins to crush and damage the surrounding tissues. This type of stroke is treated by giving the patient medication to lower the blood pressure, and may also require surgery to relieve the pressure on the brain.

Giving blood thinners to a patient with a hemorrhagic stroke can cause the bleeding rate to increase and worsen the brain damage, while lowering the blood pressure of a patient suffering an ischemic stroke can reduce the blood supply even further and starve the brain of even more oxygen. Fortunately, a CT scan of the head can readily distinguish between the two types of stroke, which is why this procedure is often performed as soon as possible after a patient arrives in the emergency department.

While the immediate treatment for a stroke differs based on its cause, the long-term care plan is the same in either case. Stroke patients face a difficult recovery full of physical, occupational, and speech therapies depending on the extent of their injuries.

They may experience lasting paralysis or pain in the affected area of the body, memory and mental processing difficulties, and lose the ability to care for themselves or even to eat unassisted. About half of stroke survivors find themselves dependent on relatives or home health providers in order to manage day-to-day life. The sooner a 911 call is placed after the onset of symptoms, though, the more of a patient’s brain tissue can be saved.

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