Filed under: Brain & Nervous System
A stroke occurs when the blood supply to part of your brain is interrupted or severely reduced, depriving brain tissue of oxygen and food. Within minutes, brain cells begin to die.
A stroke is a medical emergency. Prompt treatment is crucial. Early action can minimize brain damage and potential complications.
The good news is that strokes can be treated and prevented, and many fewer Americans now die of stroke than was the case even 15 years ago. Better control of major stroke risk factors — high blood pressure, smoking and high cholesterol — is likely responsible for the decline.
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Watch for these signs and symptoms if you think you or someone else may be having a stroke. Note when signs and symptoms begin, because the length of time they have been present may guide treatment decisions.
When to see a doctor
Seek immediate medical attention if you notice any signs or symptoms of a stroke, even if they seem to fluctuate or disappear. Call 911 or your local emergency number right away. Every minute counts. Don't wait to see if symptoms go away. The longer a stroke goes untreated, the greater the potential for brain damage and disability. To maximize the effectiveness of evaluation and treatment, it's best that you get to the emergency room within 60 minutes of your first symptoms.
If you're with someone you suspect is having a stroke, watch the person carefully while waiting for emergency assistance. You may need to:
©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.
A stroke disrupts the flow of blood through your brain and damages brain tissue. There are two chief types of stroke. The most common type — ischemic stroke — results from blockage in an artery. The other type — hemorrhagic stroke — occurs when a blood vessel leaks or bursts. A transient ischemic attack (TIA) — sometimes called a ministroke — temporarily disrupts blood flow through your brain.
Ischemic stroke
Almost 90 percent of strokes are ischemic strokes. They occur when the arteries to your brain are narrowed or blocked, causing severely reduced blood flow (ischemia). Lack of blood flow deprives your brain cells of oxygen and nutrients, and cells may begin to die within minutes. The most common ischemic strokes are:
Hemorrhagic stroke
Hemorrhage is the medical term for bleeding. Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. Brain hemorrhages can result from a number of conditions that affect your blood vessels, including uncontrolled high blood pressure (hypertension) and weak spots in your blood vessel walls (aneurysms). A less common cause of hemorrhage is the rupture of an arteriovenous malformation (AVM) — an abnormal tangle of thin-walled blood vessels, present at birth. There are two types of hemorrhagic stroke:
Transient ischemic attack (TIA)
A transient ischemic attack (TIA) — sometimes called a ministroke — is a brief episode of symptoms similar to those you'd have in a stroke. The cause of a transient ischemic attack is a temporary decrease in blood supply to part of your brain. Many TIAs last less than five minutes.
Like an ischemic stroke, a TIA occurs when a clot or debris blocks blood flow to part of your brain. But unlike a stroke, which involves a more prolonged lack of blood supply and causes permanent tissue damage, a TIA doesn't leave lasting effects because the blockage is temporary.
Seek emergency care even if your symptoms seem to clear up. If you've had a TIA, it means there's likely a partially blocked or narrowed artery leading to your brain, putting you at a greater risk of a full-blown stroke that could cause permanent damage later. And it's not possible to tell if you're having a stroke or a TIA based only on your symptoms. Up to half of those whose symptoms appear to go away are actually having a stroke that's causing brain damage.
©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.
Many factors can increase your risk of a stroke. A number of these factors can also increase your chances of having a heart attack. Stroke risk factors include:
Because the risk of stroke increases with age, and women tend to live longer than men, more women than men have strokes and die of them each year. Blacks are more likely to have strokes than are people of other races.
©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
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A stroke can sometimes cause temporary or permanent disabilities, depending on how long the brain suffers a lack of blood flow and which part was affected. Complications may include:
As with any brain injury, the success of treating these complications will vary from person to person.
©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.
A stroke in progress is usually diagnosed in a hospital emergency room. If you're having a stroke, your care will focus on minimizing brain damage and helping you recover and avoid another stroke in the future. If you haven't yet had a stroke but are worried about your future risk, you can discuss your concerns with your doctor at your next scheduled appointment.
What to expect from your doctor
In the emergency room, you may see an emergency medicine specialist or a neurologist as well as nurses and medical technicians. Your emergency team's first priority will be to stabilize your symptoms and overall medical condition. Then your care will focus on determining if you are having a stroke and, if so, which type. There are different treatments for ischemic strokes caused by artery blockage and hemorrhagic strokes caused by blood vessel rupture.
If you are seeking your doctor's advice during a scheduled appointment, your doctor will evaluate your risk factors for stroke and heart disease. Your discussion will focus on quitting smoking if you are a smoker and on lifestyle strategies or medications to control high blood pressure, cholesterol, and other risk factors. In some cases, your doctor may recommend certain tests and procedures to better understand your risk or to treat underlying conditions that raise risk.
©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.
To determine the best treatment for your stroke, your emergency team must figure out what type of stroke you're having and what parts of your brain it's affecting. Other possible causes of your symptoms, such as a brain tumor or a drug reaction, also need to be ruled out. Your doctor may also use some of these tests to determine your risk of stroke.
©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.
Emergency treatment for stroke depends on whether you are having an ischemic stroke blocking an artery — the most common kind — or a hemorrhagic stroke involving bleeding into the brain.
Ischemic stroke
To treat an ischemic stroke, doctors must quickly restore blood flow to your brain.
Emergency treatment with medications. Therapy with clot-busting drugs must start within 4.5 hours — and the sooner, the better. Quick treatment not only improves your chances of survival, but may also reduce the complications from your stroke. You may be given:
Aspirin. Aspirin is the best-proven immediate treatment after an ischemic stroke to reduce the likelihood of having another stroke. In the emergency room, it's likely you'll be given a dose of aspirin. The dose may vary, but if you already take a daily aspirin for its blood-thinning effect, you may want to make a note of that on an emergency medical card so that the doctors will know if you've already had some aspirin.
Other blood-thinning drugs, such as warfarin (Coumadin), heparin and clopidogrel (Plavix) also may be given, but they aren't used as commonly as aspirin for emergency treatment.
Emergency procedures. Doctors sometimes treat ischemic strokes with procedures that must be performed as soon as possible.
Other procedures. To decrease your risk of having another stroke or TIA, your doctor may recommend a procedure to open up an artery that's moderately to severely narrowed by plaques. Doctors also sometimes recommend these procedures to prevent a stroke. Options may include:
Hemorrhagic stroke
Emergency treatment of hemorrhagic stroke focuses on controlling bleeding and reducing pressure in your brain. Surgery may also be used to help control future risk.
Emergency measures. If you take warfarin (Coumadin) or antiplatelet drugs such as clopidogrel (Plavix) to prevent blood clots, you may be given drugs or transfusions of blood products to counteract their effects. You may also be given drugs to lower your blood pressure, prevent seizures or reduce your brain's reaction to the bleeding (vasospasm). People having a hemorrhagic stroke can't be given clot-busters such as aspirin and TPA because these drugs may worsen bleeding.
Once the bleeding in your brain stops, treatment usually involves bed rest and supportive medical care while your body absorbs the blood. Healing is similar to what happens while a bad bruise goes away. If the area of bleeding is large, surgery may be used in certain cases to remove the blood and relieve pressure on the brain.
Surgical blood vessel repair. Surgery may be used to repair certain blood vessel abnormalities associated with hemorrhagic strokes. Your doctor may recommend one of these procedures after a stroke or if you're at high risk of spontaneous aneurysm or arteriovenous malformation (AVM) rupture:
Stroke recovery and rehabilitation
Following emergency treatment, stroke care focuses on helping you regain your strength, recover as much function as possible and return to independent living. The impact of your stroke depends on the area of the brain involved and the amount of tissue damaged. Harm to the right side of your brain may affect movement and sensation on the left side of your body. Damage to brain tissue on the left side may affect movement on the right side; this damage may also cause speech and language disorders. In addition, if you've had a stroke, you may have problems with breathing, swallowing, balancing and hearing. You may also experience loss of vision and loss of bladder or bowel function.
Most stroke survivors receive treatment in a rehabilitation program. Your doctor will recommend the most rigorous program you can handle based on your age, overall health and your degree of disability from your stroke. The recommendation will also take into account your lifestyle, interests and priorities, and availability of family members or other caregivers.
Your rehabilitation program may begin before you leave the hospital. It may continue in a rehabilitation unit of the same hospital, another rehabilitation unit or skilled nursing facility, an outpatient unit, or your home.
Every person's stroke recovery is different. Depending on your complications, the team of people who help in your recovery could include these professionals:
©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.
A stroke is a life-changing event that can affect your emotional well-being as much as your physical function. Feelings of helplessness, frustration, depression and apathy aren't unusual. Diminished sex drive and mood changes also are common.
Maintaining your self-esteem, connections to others and interest in the world are an essential part of your recovery. These strategies may help both you and your caregivers:
Communication challenges
One of the most frustrating effects of stroke is that it can affect speech and language. Here are some tips to help both stroke survivors and caregivers cope with communication challenges:
©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.
Knowing your stroke risk factors, following your doctor's recommendations and adopting a healthy lifestyle are the best steps you can take to prevent a stroke. If you've had a stroke or a TIA, these measures may also help you avoid having another one. Many stroke prevention strategies are the same as for preventing heart disease. In general, a healthy lifestyle means that you:
Preventive medications
If you've had an ischemic stroke or TIA, your doctor may recommend medications to help reduce your risk of having another. These include:
Anti-platelet drugs. Platelets are cells in your blood that initiate clots. Anti-platelet drugs make these cells less sticky and less likely to clot. The most frequently used anti-platelet medication is aspirin. Your doctor can help you determine the right dose of aspirin for you.
Your doctor may also consider prescribing Aggrenox, a combination of low-dose aspirin and the anti-platelet drug dipyridamole, to reduce blood clotting. If aspirin doesn't prevent your TIA or stroke or if you can't take aspirin, your doctor may instead prescribe an anti-platelet drug such as clopidogrel (Plavix) or ticlopidine (Ticlid).
Anticoagulants. These drugs include heparin and warfarin (Coumadin). They affect the clotting mechanism in a different manner than do anti-platelet medications. Heparin is fast acting and is used over the short term in the hospital. Slower acting warfarin is used over a longer term.
Warfarin is a powerful blood-thinning drug, so you'll need to take it exactly as directed and watch for side effects. Your doctor may prescribe these drugs if you have certain blood-clotting disorders; certain arterial abnormalities; an abnormal heart rhythm, such as atrial fibrillation: or other heart problems.
©1998-2012 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

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