Can strokes be prevented?

Can strokes be prevented?

Prevention is always the best treatment, especially when the illness can be life-threatening or life-altering. Ischemic strokes are most often caused by atherosclerosis, or hardening of the arteries, and carry the same risk factors as do heart attacks (myocardial infarction, coronary artery disease) and peripheral vascular disease. These include high blood pressure, high cholesterol, diabetes, and smoking. Stopping smoking and keeping the other three under lifelong control greatly minimizes the risk of ischemic stroke.

Patients who have had a transient ischemic attack (TIA) are often prescribed medications to decrease their risk of a subsequent stroke. These include medications to lower blood cholesterol levels and control blood pressure. In addition, antiplatelet medications may be prescribed to make platelets less likely to promote blood clot formation. These include aspirin, clopidogrel (Plavix), and dipyridamole/aspirin (Aggrenox).

Patients with a TIA are usually evaluated for carotid stenosis or narrowing of the carotid artery. Surgery to open critically narrowed arteries may decrease stroke risk.

Lifelong control of high blood pressure decreases the risk of hemorrhagic stroke.

Atrial fibrillation is the most common cause of embolic stroke. Ideally the heart rhythm can be converted to normal sinus rhythm but in those patients whose hearts are chronically in atrial fibrillation, anticoagulation or “blood thinning” minimizes the risk of blood clot formation in the heart and subsequent embolization and stroke. Which drug that is used to “thin” the blood depends upon the specific patient and their individual situation. Patients who are prescribed warfarin (Coumadin), dabigatran (Pradaxa), and rivaroxaban (Xarelto) decrease the chance of a stroke but are at risk for bleeding complications.

What is stroke rehabilitation?

What is stroke rehabilitation?

The purpose of rehabilitation is to return the stroke patient as close as possible to their life and level of function before the stroke. The success of that goal depends upon the underlying health of the patient and severity of the stroke.

Rehabilitation may take weeks and months and usually requires a team approach for success. Physical therapists, occupational therapists, and speech pathologists will coordinate care with the primary health care professional and physical medicine and rehabilitation specialists.

Some of the treatments are directed to prevent life-threatening complications. For example, speech pathologists may help with swallowing to prevent aspiration pneumonia. Physical therapists may concentrate on strength and balance to prevent falls. Occupational therapists may find ways to allow the patient to perform daily activities from personal hygiene to cooking in the kitchen.

Many patients with significant stroke deficits may require admission to a rehabilitation hospital and/or longer term nursing facility prior to returning home. Unfortunately, some patients will have had too severe a stroke to be offered that opportunity.

What is the treatment for stroke?

What is the treatment for stroke?


A stroke is a medical emergency and there is now ability to intervene and restore blood supply to the brain of some stroke patients if they present for medical care early enough.

As in many emergencies, the first consideration is the ABCs (Airway, Breathing, and Circulation) to make certain that the patient can breathe and has adequate blood pressure. In severe strokes, especially those that involve the brainstem, the brains ability to control breathing, blood pressure, and heart rate may be lost.

Patients will have intravenous lines established, oxygen administered, and appropriate blood tests and CT scans performed at the same time that the health care professional is performing an assessment to make the clinical diagnosis of stroke and deciding whether TPA is an option to treat the stroke.

If the diagnosis of ischemic stroke has been made, there is a window of time when thrombolytic therapy using tPA (tissue plasminogen activator) may be an option to dissolve the clot that is blocking an artery in the brain and restore blood supply. For many patients, that time window is 3 hours after the onset of symptoms. In a select group of patients, that time frame may be extended to 4 ½ hours. In that time, the patient or family needs to recognize the stroke symptoms, get the patient to a hospital (call 9-1-1), have the patient assessed by the health care professional, get blood test results, perform a CT scan to look for other causes of stroke (including hemorrhage or tumor), consult with a neurologist, and administer the tPA or call a neurosurgeon.

Hemorrhagic strokes are difficult to treat and a specialist (neurosurgeon) should be consulted immediately to help determine if any treatment options are available to the patient (possibly aneurysm clipping, hematoma evacuation, or other techniques). Treatment for hemorrhagic strokes, in contrast to ischemic strokes, does not use tPA or other thrombolytic agents as these will likely make the hemorrhagic stroke worse or cause death. Consequently, it is important to distinguish between a hemorrhagic stroke and an ischemic stroke before treatment begins.

Hospital emergency department doctors and nurses are trained to act quickly in caring for stroke patients. The most common delay that prevents tPA from being administered is due to patient delay in seeking medical attention. A CT of the head is done emergently to help distinguish an ischemic from a hemorrhagic stroke. This may also cause a delay in a few instances.

The decision to administer tPA in the appropriate patient (there are many reasons that the drug is not indicated even if the patient arrives in time) is one that is discussed with the patient and family, since there is risk of bleeding in the brain with the use of tPA. While there is great benefit, because the blood vessels are fragile, there is a 6% risk that an ischemic stroke can turn into a hemorrhagic stroke with bleeding into the brain. This risk is minimized the earlier the drug is given and if the appropriate patient is selected.

In certain types of strokes involving the vertebrobasilar system and posterior circulation, the time frame may be extended.

If tPA is given, the patient will be admitted to an intensive care bed for monitoring. As well, depending upon circumstances, the patient may be transferred to a stroke center.

In some patients, instead of intravenous tPA, an option may exist to perform an angiogram where dye is injected into the arteries of the brain, identify the area of blockage, and inject tPA directly into the clot. It is also possible to suck the clot out of the artery. These procedures require the skill of a specially trained neuroradiologist or neurosurgeon.

In those patients where tPA and other interventions are not possible or are not indicated, the patient is usually admitted to the hospital for observation, supportive care, and referral for rehabilitation.

How is a stroke diagnosed?

How is a stroke diagnosed?

Time is of the essence since the longer a stroke remains unrecognized and untreated, the longer brain cells are deprived of oxygen-rich blood and the greater number of brain cells that die.

It recommend that everybody be aware of FAST in recognizing stroke: Face Drooping, Arm Weakness, Speech Difficulty, Time to Call 9-1-1
First responders, EMTs and paramedics may use the Cincinnati Prehospital Stroke Scale to recognize a stroke and alert the emergency department to prepare for their arrival. This scale addresses the same three components as the FAST: speech, arm strength, and speech.

In the emergency department, nurses and doctors may use the National Institute of Health Stroke Scale to perform a more in depth and standardized neurologic examination.
The clinical diagnosis of stroke is usually made after the health care professional performs a history and physical examination. While speed is important in making the diagnosis, it is also important to learn about the circumstances that brought the patient to be seen. For example, the patient just started slurring words about an hour ago versus the patient has been slurring his words since last evening.

There is urgency to make the diagnosis and determine whether treatment with thrombolytic medications (clot-busting drugs) to “reverse” the stroke is a possibility. The time frame to intervene is narrow and may be as short as 3 to 4 ½ hours after onset of symptoms. For that reason, family members or bystanders may be needed to confirm information, especially if the patient is not fully awake or has a speech deficit.

History may include asking about what symptoms are present, when they began, and if they are improving, progressing, or remaining the same. Past medical history will look for stroke risk factors, medications, allergies, and any recent illnesses or surgeries.

Physical examination includes assessing vital signs and patient wakefulness. A neurologic examination is performed, usually using the standardized stroke scale. Heart, lungs, and abdomen are also assessed.

If an acute stroke is still a consideration, blood tests and CT of the head are indicated. However, the tests are not used to make the diagnosis, but are used to help plan treatment. Nonetheless, a CT is often used to differentiate an ischemic from a hemorrhagic stroke because the treatment plans are quite different.

The CT is used to look for bleeding or masses in the brain.

In certain circumstances, an MRI of the brain may be possibly indicated, but not all hospitals have this technology readily available.

Blood tests may include a complete blood count (CBC), especially to measure platelets, international normalized ratio (INR), prothrombin time (PT) and partial thromboplastin time (PTT), and tests to measure blood clotting capabilities, electrolytes, blood glucose, and kidney function. Other blood tests may be indicated based upon the patient's specific situation.

An EKG may be performed to check the heart's rate and rhythm.

Stroke Symptoms

Stroke Symptoms

Each year about 500,000 people in the United States suffer a first stroke, and a further 200,000 people have a recurrent stroke. Stroke is the third leading cause of death in the U.S., and also is a major cause of disability and loss of independence and quality of life. Up to 40% of strokes are fatal, but the risks of death from a stroke and the degree of disability can both be significantly reduced by prompt treatment.

Strokes result from impaired oxygen delivery to brain cells via the bloodstream. The oxygen-deprived brain cells die and result in various neurological impairments, depending on the area of the brain that is involved. A stroke is also referred to as a cerebrovascular accident or CVA. The blood supply to the brain can be interrupted both by a blockage in one of the arteries that supply blood to the brain, or a rupture of a blood vessel within the brain. Stroke caused by blockage of an artery is called ischemic stroke, while stroke caused by rupture of an artery is called a hemorrhagic stroke. Ischemic stroke is much more common than hemorrhagic stroke.

The risk factors for stroke include high blood pressure, diabetes, cigarette smoking , a family history of stroke, heart disease, prior history of stroke, alcohol abuse, and increasing age. Learning to recognize the signs and symptoms of a stroke is vital in order to ensure that the victim receives immediate medical attention. According to The U.S. National Institute of Neurological Disorders and Stroke, these are the five major signs of stroke:

Sudden numbness or weakness of the face, arm or leg, especially on one side of the body. The loss of voluntary movement and/or sensation may be complete or partial. There may also be an associated tingling sensation in the affected area.

• Sudden confusion, trouble speaking or understanding. Sometimes weakness in the muscles of the face can cause drooling.
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden, severe headache with no known cause

Cerebral haemorrhage is a type of stroke

Cerebral haemorrhage is a type of stroke

A cerebral haemorrhage is a type of stroke caused by bleeding from a ruptured blood vessel in the brain. It is sometimes called a haemorrhagic stroke. Without prompt medical treatment, this can result in death. A person who survives is often left with permanent disabilities.

Causes include weakened blood vessel walls, head trauma or congenital conditions (conditions that are present at birth). A cerebral haemorrhage is a life-threatening emergency. Approximately one in 10 strokes is caused by cerebral haemorrhage. This type of stroke (haemorrhagic stroke) is usually much more severe than ischaemic stroke, although symptoms are similar.

The major risk factor for cerebral haemorrhage is long-standing high blood pressure (hypertension) that weakens the walls of blood vessels, which then may split under the pressure.

Treatment of cerebral haemorrhage

After admission to hospital, treatment depends on the location and severity of the haemorrhage, but may include:

• medications to lower blood pressure after onset of haemorrhage
• treatment for underlying causes, such as long-term use of antihypertensive medications
• certain surgical procedures.

Any suspected signs and symptoms of cerebral haemorrhage require urgent medical attention. Dial triple zero (000) to call an ambulance to take the person to the nearest hospital emergency department.

How stroke affects the brain

How stroke affects the brain

The brain can be considered as a four-part organ, which includes the right and left hemispheres, the cerebellum and the brain stem. A stroke has different effects, depending on which part of the brain is targeted during the attack.

Right hemisphere
Some of the major functions of the right hemisphere include perception and control of the left side of the body. A stroke which affects the right hemisphere can cause many changes, including:

• the inability to judge distances, which can lead to falls or loss of hand-to-eye coordination
• short-term memory loss
• neglecting or ignoring anything situated on the left of the body
• impulsive behaviour
• paralysis of the left side of the body (‘left hemiplegia’).

Left hemisphere
Some of the major functions of the left hemisphere include speech and control of the right side of the body. A stroke affecting the left hemisphere can cause many changes, including:

• paralysis of the right side of the body (‘right hemiplegia’)
• various problems with speech and communication
• short-term memory loss.

Cerebellum
Some of the major functions of the cerebellum include coordination and balance. A stroke affecting the cerebellum can cause many changes, including:

• dizziness
• nausea and vomiting
• loss of coordination
• a tendency to unbalance and fall
• slurred speech.

Brain stem
Some of the major functions of the brain stem include breathing, heart rate and blood pressure. A stroke that affects the brain stem can cause many changes, including:

• complete paralysis
• coma
• double vision
• swallowing difficulties
• death.