Five Things You Need to Know About Stroke

1- What is a stroke?

There are two kinds of stroke:
Ischemic (“is-keem-ik”): this type of stroke occurs when a blood vessel in the brain
is blocked and brain cells are damaged because they don’t get enough oxygen and
nutrients. A Transient Ischemic attack (TIA) resembles an ischemic stroke but consists of
temporary stroke symptoms caused by a temporary blood vessel blockage.

Hemorrhagic (“hem-o-raj-ik”): this type of stroke occurs when a blood vessel in the
brain ruptures and brain cells are damaged by the pressure of the blood. Aneurysms
and arteriovenous malformations are specific problems that cause this type of stroke.

The problems experienced after a stroke are the result of this brain damage. The specific
problems you feel are related to the parts of the brain damaged by your stroke.

2- Warning signs and symptoms of stroke

Sudden numbness or weakness of the face, arm,or leg, especially on one side of the body.

Sudden confusion, trouble speaking or understanding.

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.


3- What to do if you’re having symptoms and when to call for help

• Not all the warning signs occur in every stroke. Don’t ignore signs of stroke, even if they go away!

• Check the time. When did the first warning sign or symptom start? You, or the person who is with you will be asked this important question later. This is very important! The treatments for stroke are much more effective if used early. Some of these treatments must be started in as little as 3 hours from the time your symptoms begin.

• If you have one or more stroke symptoms that last more than a few minutes, don’t delay! Immediately call 9-1-1 or your local emergency medical service (EMS) number so an ambulance can quickly be sent for you. Do not drive yourself.

• If you are with someone who may be having stroke symptoms, immediately call 9-1-1 or your local EMS. Expect the person to resist going to the hospital. Don’t take no for an answer because “Time Lost is Brain Lost.”

• When communicating with EMS staff or the hospital, make sure to use the word “STROKE.”

4- What increases your risk for stroke

High blood pressure
High blood pressure or hypertension is the number one cause of stroke. High blood pressure can damage the small blood vessels of the brain. High blood pressure is the most important controllable risk factor for stroke. Many people believe the effective treatment of high blood pressure is a key reason for the fast decline in the deaths from strokes.

Cigarette smoking
Tobacco use in any form, especially cigarette smoking, is bad for your health. In recent years, studies have shown cigarette smoking to be an important risk factor for stroke. The nicotine and carbon monoxide in cigarette smoke damage the cardiovascular system in many ways. The use of oral contraceptives combined with cigarette smoking greatly increases stroke risk in women. Talk to your doctor about help with quitting smoking.

Diabetes
Diabetes is a risk factor for stroke. Many people with diabetes also have high blood pressure, high blood cholesterol and are overweight; all of these increase their risk even more. While diabetes is treatable, having the disease still increases your risk of stroke. Diabetes causes disease of small blood vessels in the brain and can lead to a stroke.


Carotid or other artery disease
The carotid arteries in your neck supply blood to your brain. A carotid artery narrowed by fatty deposits from atherosclerosis (plaque build-ups in artery walls) may become blocked by a blood clot. Peripheral arterial disease occurs when the blood vessels that carry blood to leg and arm muscles become narrow. It is also caused by fatty build-ups of plaque in artery walls. People with peripheral artery disease have a higher risk of carotid artery disease, which raises their risk of stroke. Causes of carotid artery disease are high
blood pressure, diabetes, a diet high in fat, high cholesterol, and smoking.

Atrial fibrillation
This heart rhythm disorder raises the risk for stroke. The heart’s upper chambers quiver instead of beating regularly, which can let the blood pool and clot. If a clot breaks off, enters the bloodstream and lodges in an artery leading to the brain, a stroke will happen.

Other heart disease
People with coronary heart disease or heart failure have a higher risk of stroke than those with hearts that work normally. Dilated cardiomyopathy (an enlarged heart), heart valve disease, and some types of congenital heart defects also raise the risk of stroke.

High blood cholesterol
People with high blood cholesterol have an increased risk for stroke. High blood cholesterol can be reduced by eating right (avoid fried, fatty foods) and exercising regularly. It may also require medication.

Poor diet
Diets high in saturated fat, trans fat, and cholesterol can raise blood cholesterol levels. Diets high in sodium (salt) can contribute to increased blood pressure. Diets with excess calories can contribute to obesity. A diet containing five or more servings of fruits and vegetables per day may reduce the risk of stroke.

Physical inactivity and obesity
Being inactive, obese, or both can increase your risk of high blood pressure, high blood cholesterol, diabetes, heart disease, and stroke. So go on a brisk walk, take the stairs, and do whatever you can to make your life more active. Check with your doctor first, but try to get at least 30 minutes of moderate physical activity five days of the week,
or 20 minutes of vigorous physical activity, three days a week.


Age
The chance of having a stroke more than doubles for each decade of life after age 55. While stroke is common among the elderly, a lot of people under 65 also have strokes.

Heredity (family history) and race
Your stroke risk is greater if a parent, grandparent, sister, or brother has had a stroke. African Americans have a much higher risk of death
from a stroke than Caucasians. This is partly due to higher rates of high blood pressure and diabetes in this group.

Sex (gender)
Stroke is more common in men than in women. In most age groups, more men than women will have a stroke in a given year. However, more than half of total stroke deaths occur in women. At all ages, more women than men die of stroke. Women who take birth control pills, or are pregnant, have special risks for stroke.

Prior stroke, TIA or heart attack
The risk of stroke for someone who has already had one is far greater than someone who has not had a stroke. Transient ischemic attacks (TIAs) are “warning strokes” that produce stroke-like symptoms but no lasting damage. TIAs are strong predictors of stroke. A person who’s had one or more TIAs is almost 10 times more likely to have a stroke than someone of the same age and sex who hasn’t. Recognizing and treating TIAs can reduce your risk of a major stroke.

5- What to do after you leave the hospital:
follow-up care

• You need to continue the medications prescribed after you leave the hospital in order to reduce your risk of stroke or other cardiovascular issue. Medications must be taken as prescribed by your doctor in order for them to be effective. The medicines are most effective when they help you lower each of the risk factors for stroke. Therefore, the doses of these medicines will likely need to be adjusted in order for them to work correctly, based on blood tests and other measurements made by your doctor after you
leave the hospital. Don’t stop your medications without speaking to your physician first.

• It is important that you receive regular medical care after you leave the hospital. This is how the doctors can check to see if your treatments are working and make sure that your medicines are adjusted properly.

• Make sure you have a plan for which doctor(s) you will see and when to see them after you leave the hospital and be sure to have your list of medications with you for all doctor visits.

• Recovery after a stroke may continue for many months. You may benefit from working with rehabilitation therapists during your recovery. If a therapy program has not been arranged, please discuss this option with your health care providers.

Source: Dartmouth-Hitchcock Medical Center