Stroke

 Stroke is a condition of blood arteries goint to and in the brain, in which, becomes blocked and the blood supply is no longer to transverse the artery.  As the blood does not reach its intended brain cells, the cells begin to die due to the lack of oxygen within minutes (CDC, 2023)(Cleveland Clinic, 2023).  Globally, stroke is the second most common cause of death (Cleveland Clinic, 2023).  Stroke is additionally a leading cause of disability.

There are two types of strokes: Ischemic stroke and Hemorragic stroke.  A Transient Ischemic Attack (TIA), which are at times referred to as mini strokes, are medical emergencies as are stokes, however, are differentiated from strokes as it lasts for five minutes or less (CDC, 2023).  Ischemic strokes occurs when either blood clots, fatty deposits (plaques), or other particles block the blood arteries (CDC, 2023).  These types of strokes account for 87% of strokes (ASA, 2023).  Hemorrhagic strokes occur when a blood artery ryptures or leaks blood and accounts for 13% of strokes (CDC, 2023)(ASA, 2023).  Two types of blood vessel malformations that can cause hemorragic strokes are aneurysms and arteriovenous malformations (AVMs) (ASA, 2023).  Uncontrolled hypertention is the most common cause of hemorrhagic stroke.  Hemorrhagic strokes can be either intracerebral, within the brain, or subarachnoid, between the inner and outer layer of dura that covers the brain (ASA, 2023).

Because death to brain cells can occur within minutes, it is important to recognize the signs and symptoms of stroke quickly and obtain treatment even quicker.  Symptoms of stroke include:

• Trouble speaking
• Trouble understanding what people are saying
• Paralysis or numbness of face, arm or leg
• Loss of muscle control on one side of face
• Blurry or blackened vision
• Sudden partial or total loss of one or more of senses
• Neck stiffness
• Emotional instability
• Dizzines
• Nausea
• Vomiting (Cleveland Clinic, 2023)(Mayo Clinic, 2023)

There are several risk factors for stroke.  They can be divided into Lifestyle, Medical and other types of risk factors and include:

• Lifestyle
• Obesity
• Physical inactivity
• Heavy or binge drinking
• Illegal drug use
• Medical
• Hypertension
• High Cholesterol
• Smoking
• Second hand smoke exposure
• Diabetes
• Obstructive Sleep Apnea
• Cardiovascular Disease
• Personal or family history of stroke
• COVID - 19 infection
• Clotting Disorders
• Atrial Fibrillation
• Migraine Headaches - there is an increased risk with migraines, especially if migraines are preceeded by auras
• Other
• Age - people 55 years of age and older are at greater risk
• Race or ethnicity -  African Americans and Hispanics have a greater risk
• Sex - men have a higher risk than women
• Hormones -  birth control pills or hormonal therapy with estrogen can increase risk (Mayo Clinic, 2023)(Cleveland Clinic, 2023)

Once diagnosed, it is important to treat a stroke as quickly as possible.  Regardless of what type of stroke is being treated, Blood Pressure management should be part of the treatment plan.  When treating an Ischemic Stroke, it is important to restore blood flow to the brain.  For Ischemic Strokes, treatments include:

• tissue plasminogen activator (TPA) - must be given within 4 1/2 hours from the start of symptoms.  Helps to dissolve blood clot.
• Emergency Endovascular procedures - medications can be delivered directly to the brain through a catheter that is inserted into the artery in order to deliver the medication directly to where the stroke is occuring,
• Removing clot with stent remover - useful with large clots and can be done with or without TPA
• Carotid Endarterectomy - removes plaques that are specifically blocking carotid arteries
• Angioplasty and stents - catheter is inserted into artery.  Stent can be placed to help support section of narrowed artery that was expanded.  (Cleveland Clinic, 2023)(Mayo Clinic, 2023)

With Hemmorhagic strokes, treatments include:

• Blood thining medications
• Medications to decrease pressure in the brain
• Surgery -  with large bleeds, blood vessels may be repaired
• Surgical Clipping - clamps can be placed the base of aneurysms to stop blood flowing to it
• Surgical AVM removal - when accesible, smaller AVMs can be removed
• Stereotactic Radiosurgery - multiple beams of highly focused radiation can be used to repair blood vessel malformations (Cleveland Clinic, 2023)(Mayo Clinic, 2023).

Once someone has had a stroke, they may experience complications, such as:

• Paralysis - particularly on one side
• Difficulty talking or swallowing - stroke can affect mouth and throat muscles
• Memory Loss
• Emotional Problems - may have difficulty in controlling emotions and/or develop depression
• Pain - pain and/or numbness may occur in parts of body associated with locations in the brain that were affected by the locations in the brain that were affected by the stroke
• Changes in behavior and self-care ability (Mayo Clinic, 2023)

There are things people can do to try to prevent strokes, including:

• Controlling hypertension
• Lowering cholesterol and saturated fat intake
• Quitting smoking and other tobacco use
• Managing Diabetes
• Maintaining a healthy weight
• Eating fruits and vegetables
• Regular exercise
• Limit alcohol intake
• Treat Obstructive Sleep Apnea
• Avoid illegal drugs

Attached is the Cleveland Clinic's FAST reminder card.

For more information on stroke, visit one of the three references below.

ASA. (2023) About Stroke.  American Stroke Association.  Retrieved form https://www.stroke.org/en/about-stroke

Cleveland Clinic. (2023)  Stroke.  Cleveland Clinc.  Retrieved from https://my.clevelandclinic.org/health/diseases/5601-stroke#symptoms-and-causes

Mayo Clinic (2023) Stroke.  Mayo Clinic.  Retrieved from https://www.mayoclinic.org/diseases-conditions/stroke/symptoms-causes/syc-20350113