Stroke Management

A stroke occurs when the blood supply to part of your brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients. Brain cells begin to die in minutes.

A stroke is a medical emergency, and prompt treatment is crucial. Early action can reduce brain damage and other complications.

The good news is that many fewer Americans die of stroke now than in the past. Effective treatments can also help prevent disability from stroke.

If you or someone you're with may be having a stroke, pay particular attention to the time the symptoms began. Some treatment options are most effective when given soon after a stroke begins.

Signs and symptoms of stroke include:

  • Trouble speaking and understanding what others are saying. You may experience confusion, slur your words or have difficulty understanding speech.
  • Paralysis or numbness of the face, arm or leg. You may develop sudden numbness, weakness or paralysis in your face, arm or leg. This often affects just one side of your body. Try to raise both your arms over your head at the same time. If one arm begins to fall, you may be having a stroke. Also, one side of your mouth may droop when you try to smile.
  • Problems seeing in one or both eyes. You may suddenly have blurred or blackened vision in one or both eyes, or you may see double.
  • Headache. A sudden, severe headache, which may be accompanied by vomiting, dizziness or altered consciousness, may indicate that you're having a stroke.
  • Trouble walking. You may stumble or lose your balance. You may also have sudden dizziness or a loss of coordination.

Seek immediate medical attention if you notice any signs or symptoms of a stroke, even if they seem to come and go or they disappear completely.

Think "FAST" and do the following:

  • Face. Ask the person to smile. Does one side of the face droop?
  • Arms. Ask the person to raise both arms. Does one arm drift downward? Or is one arm unable to rise?
  • Speech. Ask the person to repeat a simple phrase. Is his or her speech slurred or strange?
  • Time. If you observe any of these signs, call 911 or emergency medical help immediately.

Call your local emergency number right away. Don't wait to see if symptoms stop. Every minute counts. The longer a stroke goes untreated, the greater the potential for brain damage and disability.

If you're with someone you suspect is having a stroke, watch the person carefully while waiting for emergency assistance.

Ischemic stroke

This is the most common type of stroke. It happens when the brain's blood vessels become narrowed or blocked, causing severely reduced blood flow (ischemia). Blocked or narrowed blood vessels are caused by fatty deposits that build up in blood vessels or by blood clots or other debris that travel through your bloodstream and lodge in the blood vessels in your brain.

Hemorrhagic stroke

Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. Brain hemorrhages can result from many conditions that affect your blood vessels. Factors related to hemorrhagic stroke include:

  • Uncontrolled high blood pressure
  • Overtreatment with blood thinners (anticoagulants)
  • Bulges at weak spots in your blood vessel walls (aneurysms)
  • Trauma (such as a car accident)
  • Protein deposits in blood vessel walls that lead to weakness in the vessel wall (cerebral amyloid angiopathy)
  • Ischemic stroke leading to hemorrhage
  • A less common cause of bleeding in the brain is the rupture of an abnormal tangle of thin-walled blood vessels (arteriovenous malformation).

Transient ischemic attack (TIA)

A transient ischemic attack (TIA) - sometimes known as a ministroke - is a temporary period of symptoms similar to those you'd have in a stroke.

A TIA doesn't cause permanent damage. They're caused by a temporary decrease in blood supply to part of your brain, which may last as little as five minutes.

Many factors can increase your stroke risk. Potentially treatable stroke risk factors include:

Lifestyle risk factors

  • Being overweight or obese
  • Physical inactivity
  • Heavy or binge drinking
  • Use of illegal drugs such as cocaine and methamphetamine

Medical risk factors

  • High blood pressure
  • Cigarette smoking or secondhand smoke exposure
  • High cholesterol
  • Diabetes
  • Obstructive sleep apnea
  • Cardiovascular disease, including heart failure, heart defects, heart infection or abnormal heart rhythm, such as atrial fibrillation

Other factors associated with a higher risk of stroke include:

  • Age - People age 55 or older have a higher risk of stroke than do younger people.
  • Race - African Americans have a higher risk of stroke than do people of other races.
  • Sex - Men have a higher risk of stroke than women. Women are usually older when they have strokes, and they're more likely to die of strokes than are men.
  • Hormones - Use of birth control pills or hormone therapies that include estrogen increases risk.

A stroke can sometimes cause temporary or permanent disabilities, depending on how long the brain lacks blood flow and which part was affected. Complications may include:

  • Paralysis or loss of muscle movement.
  • Difficulty talking or swallowing.
  • Memory loss or thinking difficulties.
  • Emotional problems. .
  • Pain. Pain, numbness or other unusual sensations may occur in the parts of the body affected by stroke. For example, if a stroke causes you to lose feeling in your left arm, you may develop an uncomfortable tingling sensation in that arm.
  • Changes in behavior and self-care ability. People who have had strokes may become more withdrawn. They may need help with grooming and daily chores.

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 transient ischemic attack (TIA), these measures might help prevent another stroke. The follow-up care you receive in the hospital and afterward also may play a role.

Many stroke prevention strategies are the same as strategies to prevent heart disease. In general, healthy lifestyle recommendations include:

  • Controlling high blood pressure (hypertension).
  • Lowering the amount of cholesterol and saturated fat in your diet.
  • Quitting tobacco use.
  • Managing diabetes.
  • Maintaining a healthy weight.
  • Eating a diet rich in fruits and vegetables.
  • Exercising regularly.
  • Drinking alcohol in moderation, if at all.
  • Treating obstructive sleep apnea (OSA).
  • Avoiding illegal drugs.

If you've had an ischemic stroke or TIA, your doctor may recommend medications to help reduce your risk of having another stroke. These include:

  • Anti-platelet drugs.
  • Anticoagulants.
  • Several newer blood-thinning medications (anticoagulants) are available for preventing strokes in people who have a high risk.

Things will move quickly once you get to the hospital, as your emergency team tries to determine what type of stroke you're having. That means you'll have a CT scan or other imaging test soon after arrival. Doctors also need to rule out other possible causes of your symptoms, such as a brain tumor or a drug reaction.

Some of the tests you may have include:

  • A physical exam.
  • Blood tests.
  • Computerized tomography (CT) scan.
  • Magnetic resonance imaging (MRI).
  • Carotid ultrasound.
  • Cerebral angiogram.
  • Echocardiogram.

Stroke recovery and Rehabilitation

After emergency treatment, you'll be closely monitored for at least a day. After that, stroke care focuses on helping you 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.

If your stroke affected the right side of your brain, your movement and sensation on the left side of your body may be affected. If your stroke damaged the brain tissue on the left side of your brain, your movement and sensation on the right side of your body may be affected. Brain damage to the left side of your brain may cause speech and language disorders.

Most stroke survivors go to a rehabilitation program. Your doctor will recommend the most rigorous therapy program you can handle based on your age, overall health and degree of disability from your stroke. Your doctor will take into consideration your lifestyle, interests and priorities, and the availability of family members or other caregivers.

Rehabilitation may begin before you leave the hospital. After discharge, you might continue your program in a rehabilitation unit of the same hospital, another rehabilitation unit or skilled nursing facility, as an outpatient, or at home.

Every person's stroke recovery is different. Depending on your condition, your treatment team may include:

  • Doctor trained in brain conditions (neurologist)
  • Rehabilitation doctor (physiatrist)
  • Rehabilitation nurse
  • Dietitian
  • Physical therapist
  • Occupational therapist
  • Recreational therapist
  • Speech pathologist
  • Social worker or case manager
  • Psychologist or psychiatrist

For more information