Stroke

A stroke is an interruption of the blood supply to any part of the brain. A stroke is sometimes called a "brain attack."

A stroke happens when blood flow to a part of the brain is interrupted because a blood vessel in the brain is blocked or bursts open. If blood flow is stopped for longer than a few seconds, the brain cannot get blood and oxygen. Brain cells can die, causing permanent damage.

There are two major types of stroke: ischemic stroke and hemorrhagic stroke.

ISCHEMIC STROKE

Ischemic stroke occurs when a blood vessel that supplies blood to the brain is blocked by a blood clot. This may happen in two ways:

• A clot may form in an artery that is already very narrow. This is called a thrombus. If it completely blocks the artery, it is called a thrombotic stroke.
• A clot may break off from somewhere in the body and travel up to the brain to block a smaller artery. This is called an embolism. It causes an embolic stroke.

Ischemic strokes may result from clogged arteries, a condition called atherosclerosis. This may affect the arteries within the brain or the arteries in the neck that carry blood to the brain. Fat cholesterol, and other substances collect on the wall of the arteries, forming a sticky substance called plaque. Over time, the plaque builds up. This often makes it hard for blood to flow properly, which can cause the blood to clot.

HEMORRHAGIC STROKE

Hemorrhagic stroke occurs when a blood vessel in part of the brain becomes weak and bursts open, causing blood to leak into the brain. Some people have defects in the blood vessels of the brain that make this more likely. The flow of blood that occurs after the blood vessel ruptures damages brain cells.

STROKE RISKS

High blood pressure is the number one risk factor for strokes. The following also increase your risk for stroke:

• Diabetes
• Family history of stroke
• Heart disease
• High cholesterol

• Increasing age

Symptoms

The symptoms of stroke depend on what part of the brain is damaged. In some cases, a person may not even be aware that he or she has had a stroke.

Symptoms usually develop suddenly and without warning, or they may occur on and off for the first day or two. Symptoms are usually most severe when the stroke first happens, but they may slowly get worse.

A headache may occur, especially if the stroke is caused by bleeding in the brain. The headache:

• Starts suddenly and may be severe
• Occurs when lying flat
• Wakes you up from sleep
• Gets worse when you change positions or when you bend, strain, or cough

Other symptoms depend on the severity of the stroke and what part of the brain is affected. Symptoms may include:

• Muscle weakness in the face, arm or leg (usually just one side)
• Numbness or tingling on one side of the body
• Trouble speaking or understanding others who are speaking
• Problems with eyesight, including decreased vision, double vision or total loss of vision
• Sensation changes that affect touch and the ability to feel pain, pressure, different temperatures or other stimuli
• Changes in hearing
• Change in alertness (including sleepiness, unconsciousness, and coma)
• Personality, mood or emotional changes
• Confusion or loss of memory
• Difficulty swallowing
• Changes in taste
• Difficulty writing or reading
• Loss of coordination
• Loss of balance
• Clumsiness
• Trouble walking
• Dizziness or abnormal sensation of movement (vertigo)
• Lack of control over the bladder or bowels

Contact your healthcare provider immediately if you have symptoms of a stroke.

Treatment:

A stroke is a medical emergency. Immediate treatment can save lives and reduce disability. Call 911 or your local emergency number or seek immediate medical care at the first signs of a stroke.

It is important to get the person to the emergency room immediately to determine if the stroke is due to bleeding or a blood clot so appropriate treatment can be started within 3 hours of when the stroke began.

Treatment depends on the severity and cause of the stroke. A hospital stay is required for most strokes.

TREATMENT IN THE HOSPITAL

Clot-busting drugs (thrombolytic therapy) may be used if the stroke is caused by a blood clot. Such medicine breaks up blood clots and helps restore blood flow to the damaged area. However, not everyone can receive this type of medicine.

• For these drugs to work, a person must be seen and treatment must begin within 3 hours of when the symptoms first started. A CT scan must be done to see whether the stroke is from a clot or from bleeding.

• If the stroke is caused by bleeding rather than clotting, clot-busting drugs (thrombolytics) can cause more bleeding.

Other treatments depend on the cause of the stroke:

• In some situations, a special stroke team and skilled radiologists may be able to use angiography to highlight the clogged blood vessel and open it up.
• For hemorrhagic stroke, surgery may be required to remove blood from around the brain and to repair damaged blood vessels. Some patients may be candidates for a minimally invasive therapy to coil the damaged blood vessel endovascularly.
• Surgery on the carotid artery may be needed.
• Nutrients and fluids may be necessary, especially if the person has swallowing difficulties. These may be given through a vein (intravenously) or a feeding tube in the stomach (gastrostomy tube). Swallowing difficulties may be temporary or permanent.

Physical therapy, occupational therapy, speech therapy and swallowing therapy will all begin in the hospital.

LONG-TERM TREATMENT

The goal of long-term treatment is to help the patient recover as much function as possible and prevent future strokes. The recovery time and need for long-term treatment differs from person to person. Depending on the symptoms, rehabilitation may include:

• Occupational therapy
• Physical therapy
• Speech therapy

Therapies such as repositioning and range-of-motion exercises can help prevent complications related to stroke, such as infection and bed sores. Those who have had a stroke should try to remain as active as physically possible.

Alternative forms of communication such as pictures, verbal cues and other techniques may be needed in some cases.

Sometimes, urinary catheterization or bladder and bowel control programs may be needed to control incontinence.

Support Groups:

Additional support and resources are available. Visit the Texas Health Heart blog to connect with others that may be going through similar situations or call 1-877-THR-WELL to determine if there is a support group at a Texas Health hospital near you.

Texas Health is committed to providing quality care to heart and vascular patients throughout North Texas and beyond. While various technologies and services are discussed here, not all of our hospitals offer every treatment and diagnostic technology highlighted. Call 1-877-THR-WELL to learn more about heart and vascular services at a Texas Health hospital near you.