Dear Alice,

What is a stroke? What causes it? How should patients who have suffered strokes be treated?

Dear Reader,

A stroke, sometimes referred to as a cerebrovascular accident or cerebrovascular disease, can occur when there is an issue with the vessels circulating blood in the brain. When the blood doesn’t circulate properly, oxygen doesn't get to the cells and tissue in the brain, causing them to die. Also, there can be buildup of cellular waste products that isn’t carried away by proper blood flow.

So, what can cause a stroke? Well, there are two kinds: An ischemic stroke (representing about 80 percent of all strokes) is caused when a clot creates a blockage in a blood vessel, cutting off the blood supply to the brain. A hemorrhagic stroke, which happen less frequently, occurs when a blood vessel in the brain ruptures and fills the brain cavity with blood. Treatment for stroke really depends on the type. No matter the type of stroke, getting immediate medical attention is recommended in order to prevent disability or further complications.

Strokes are the second leading cause of death internationally and the third most common cause of disability. The symptoms of strokes and transient ischemic attack (TIA) — a stroke that doesn’t cause brain tissue damage or injury and resolves on its own, but still requires quick medical attention — can mimic those of seizures, fainting, migraine headaches, hypoglycemia, or other conditions. However, knowing signs of stroke can help folks quickly get assistance for someone exhibiting symptoms, which can come with no warning. Symptoms of a possible stroke include sudden:

  • Numbness or weakness in the face, arm, or leg — especially on one side of the body
  • Confusion, trouble speaking, or trouble understanding speech
  • Trouble seeing in one or both eyes
  • Trouble walking, dizziness, or loss of balance or coordination
  • Severe headache with no known cause

Adapted from the National Stroke Association.

If someone is suspected to be experiencing a stroke, calling for immediate medical attention is necessary. A typical evaluation for stroke includes getting a patient’s medical history, conducting a physical exam, and performing brain imaging scans — typically CT scans. A health care provider uses this information to identify if the patient’s symptoms are caused by something other than a stroke. If all this information suggests they are indeed having a stroke, these pieces of information will help determine the type of stroke and where exactly the stroke event has occurred in the brain. In the case of an ischemic stroke, providers must restore blood flow to the brain as quickly as possible, typically by dissolving the clot with medications. For a hemorrhagic stroke, surgery may be necessary to stop the excess blood from filling the brain cavity. The goals of treatment are to minimize additional neurological complications, reducing further tissue injury, and improving patient recovery and outcomes.

Beyond the immediate care needed, a stroke can have a significant impact on the affected person’s quality of life, as well as the quality of life of their partner or caregiver(s). A recovering person may need medications, dietary changes, cognitive rehabilitation, physical rehabilitation, or other therapies to assist them in the recovery process. All the same, you have already taken the first step to possibly saving someone's life by asking about stroke and its causes.

Part of stroke awareness is also knowing about risk factors and prevention methods. Factors that may increase a person’s risk for stroke include:

  • A personal or family history of stroke, TIA, or heart attack
  • Cardiovascular diseases including heart defects, heart infections, and abnormal heart rhythm
  • High blood pressure
  • High cholesterol
  • Smoking cigarettes and exposure to second hand smoke
  • Heavy alcohol consumption
  • Use of birth control pills or other hormone therapy that include estrogen
  • Obesity or being overweight
  • Obstructive sleep apnea
  • Physical inactivity
  • Diabetes
  • Prior use of amphetamines or cocaine
  • Being 55 years of age or older
  • Race (African-Americans are at higher risk)
  • Gender (Folks assigned male at birth are at higher risk than those assigned female at birth)

Adapted from Mayo Clinic.

It’s wise for those with cardiovascular or stroke risk factors to speak with their health care provider about preventative options, as there are many effective interventions that can mitigate risk. For example, studies have found that quitting smoking decreases the risk of ischemic stroke over time, with excess tobacco-related risk in middle-aged women disappearing two to four years after quitting. There is also substantial evidence that statins (prescription medications that lower cholesterol in the blood) and lowered blood pressure under the care of a health care provider can substantially reduce the risk of cardiovascular events in patients with diabetes.

Did this response stoke your interest in more stroke information? Consider checking out the American Stroke Association. They have lots more on the condition, associated warning signs, life after stroke, as well as caregiver resources.

Alice!

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