Medical Emergency – Stroke

(May is stroke awareness month)

Strokes, also called CVA (cardiovascular accident) affect more than 795,000 people in the United States. About 610,000 of these are first or new strokes. A stroke occurs when a clot or plaque forms and blocks blood supply to a part of the brain, or when a blood vessel in the brain bursts. The lack of oxygen to the brain can cause brain damage or death. Brain damage or death can occur within minutes.

Stroke is the number three cause of death in women; 20% of women will have a stroke in their lifetime. Stroke is the number five cause of death in men; 14-17% of men will have a stroke in their lifetime.

For both sexes stroke is a leading cause of disability. Strokes can occur at any age, however the incidence of stroke rises dramatically over age of 65.  Over 50 percent of stroke sufferers over the age of 65 have impaired mobility after the stroke.

Types of strokes

There are two types of strokes: one that blocks an artery that supplies blood to the brain (ischemic stroke) or when an artery in the brain leaks blood or ruptures (hemorrhagic stroke).

Ischemic Stroke

(About 87% of all strokes are ischemic strokes)

An ischemic stroke is when a blood clot blocks the artery leading to a portion of the brain, or atherosclerosis, which is a buildup in of fats, cholesterol and other substances in and on the artery walls called plaque hardens and narrows the arteries, which limits blood flow to tissues and organs, in this instance, blood flow to the brain.

Hemorrhagic Stroke

A hemorrhagic stroke happens when an artery in the brain leaks blood or ruptures (breaks open). The leaked blood puts too much pressure on brain cells, which damages them.

TIA (Trans ischemic attack)

TIAs are sometimes known as “warning strokes” which is a warning sign of a future stroke. It is a medical emergency, just like a stroke. More than a third of people who have a TIA and don’t get treatment have a stroke within one year. The symptoms are the same as those of an early stroke. (slurred speech, weakness visual disturbances)

Know the signs and what to do if stroke is suspected

Other signs of a stroke

(Excerpt from American Stroke Association)

• NUMBNESS or weakness of face, arm, or leg, especially on one side of the body
• CONFUSION, trouble speaking or understanding speech
• TROUBLE SEEING in one or both eyes
• TROUBLE WALKING, dizziness, loss of balance or coordination
• SEVERE HEADACHE with no known cause

What to do and what not to do if stroke suspected:

What TO DO if stroke suspected

• Call 911 immediately
• Note when you first saw symptoms of stroke
• Perform CPR if necessary

What NOT TO DO if stroke suspected

• Do not let that person go to sleep or talk you out of calling 911- A stroke is a medical emergency, many feel that if they wait it out the symptoms will pass. Many times, a stroke can make a person feel sleepy, and may try to talk you out of calling 911- that they just need to take a nap and will feel better. This could mean the difference between life and death, and even how much the person will recover. It is always better to err on the safe side and seek medical attention asap.
• Do not give them medication, food, or drinks- Depending on the type of stroke, medication should never be given unless instructed by medical personnel to do so. A patient can aspirate on food or drinks during a stroke.
• Do not drive yourself or someone else to the emergency room- unless there is no other way and no help is available, stay with the patient and wait for EMS. They are trained and carry life saving equipment with them to handle emergencies.

Stroke Risks

You are at risk of a stroke if you have:

• High blood pressure (this is the number one cause of a stroke)
• Diabetes
• Heart and blood vessel diseases- (carotid artery disease, atrial fibrillation, heart valve disease)
• Are a smoker
• High LDL cholesterol
• Viral infections or conditions that cause inflammation. Rheumatoid arthritis and systemic lupus erythematosus (SLE) showed an excess risk of stroke over the general population.
• Age: A stroke can happen at any age, but the risk is higher for babies under the age of 1 and for adults. In adults, the risk increases with age.
• Race and ethnicity: In the United States, stroke occurs more often in African American, Alaska Native, American Indian, and Hispanic adults than in white adults.
• Family history and genetics
• Anxiety, depression, and high stress levels, social isolation
• Medical conditions- bleeding disorders, kidney disease, sleep apnea, sickle cell disease
• Sedentary lifestyle
• Poor nutrition
• Illicit drug use
• Overweight

Prevention

Talk to a dietician and care provider about ways to prevent stroke. In addition:

• Maintain a healthy weight
• Diet- add colorful vegetables, healthy fats to diet
• Manage stress
• Stop smoking
• Manage blood pressure
• Get enough sleep
• Add daily physical activity if you aren’t already

Diagnosing a stroke

Depending on the symptoms, the doctor can diagnose a stroke using the following:

• Physical symptoms (FAST)
• CT or MRI imaging
• Carotid ultrasound
• Cerebral angiogram
• Echocardiogram

Treatment- ischemic and hemorrhagic stroke

(Excerpt from National Heart, Blood and Lung Institute)

Treating an ischemic stroke

Treatment for an ischemic stroke or transient ischemic (TIA) may include medicines and medical procedures.

Treatment

The main treatment for an ischemic stroke is a medicine called tissue plasminogen activator (tPA). It breaks up the blood clots that block blood flow to your brain. This medication is injected into your vein. If tPA isn’t an option an anticoagulant or blood thinning medication, such as aspirin or clopidogrel may be given.

Do not take aspirin unless directed by your care provider.

Medical procedures

A procedure to open up blocked arteries and restore blood flow to the brain may be needed. This can be done several ways.

Depending on the location, age and overall health the surgeon may perform a thrombectomy. The clot is removed from the blood vessel using a catheter inserted intd the groin and threaded to the blocked artery in the neck or vein. From there, the surgeon will use angioplasty and stenting or a device called a stent retriever to open up the blocked artery.

Angioplasty and stenting procedures use a thin tube to deliver a balloon or small mesh tube into the artery. Inflating the balloon or expanding the mesh tube clears space for blood to flow more easily to the brain.

The stent retriever is a wire mesh inside the catheter that traps the clot. The stent retriever and the blood clot are then pulled out through the tube.

If carotid artery disease caused the stroke, the doctor may perform a carotid endarterectomy, a surgery to remove plaque from the carotid artery in the neck.

Treating a hemorrhagic stroke

(Excerpt from National Heart, Blood and Lung Institute)

Hemorrhagic stroke can happen suddenly and grow worse quickly. Just as with an ischemic stroke, getting treatment as quickly as possible is essential for a full recovery. The type of treatment depends on what part of the brain is bleeding and how severe it is.

Treatment

Sometimes blood pressure medicine is given to lower the pressure and strain on blood vessels in the brain. Anticoagulant medicines are discontinued and sometimes vitamin k is administered to help coagulate the blood.

Medical procedures

Procedures may include:

Aneurysm clipping to block off the aneurysm from the blood vessels in the brain. This surgery helps stop bleeding from an aneurysm. During the procedure, a surgeon places a tiny clamp at the base of the aneurysm.

Coil embolization to block blood flow to or seal an aneurysm. The surgeon will insert a tube called a catheter into an artery in the groin. The doctor will thread the tube to the aneurysm in the brain. A tiny coil will be pushed through the tube and into the aneurysm. The coil will cause a blood clot to form, which will block blood flow through the aneurysm and prevent it from bursting again.

Rehabilitation

Rehabilitation following a stroke can take days, months or even years. The road to recover depends on many factors, such as type of stroke, if diagnosed and treated promptly, overall health, age and sex and race.

After a stroke, you may need rehabilitation to help you recover. Rehabilitation may include working with speech, physical, and occupational therapists. Your care team may also recommend medicines to manage pain, muscle spasms, or other problems as you recover. In addition, recovery can be frustrating and emotionally challenging. Be sure to talk with your care team about your feelings. The sooner you receive care, the better the outcome.

Language, speech and memory:

Language, speech and memory are often affected by a stroke. Many times, you may have words you want to speak but are unable to. Or you may be able to speak but not be able to put words together that make sense. Speech and language specialists can help you adjust and learn how to effectively communicate again.

Muscle and nerve :

A stroke may affect only one side of the body or part of one side. It can cause muscle weakness or paralysis, which can put you at risk for falling. Physical and occupational therapists can help you strengthen and stretch your muscles. They can also help you relearn how to do daily activities, such as dressing, eating, and bathing.

Bladder and bowel:

A stroke can affect the muscles and nerves that control the bladder and bowels. You may not be able to get to the bathroom in time. Medicines and a bladder or bowel specialist can help with these problems.

Swallowing and eating:

 You may have trouble swallowing after a stroke. Signs of this problem are coughing or choking during eating or coughing up food after eating. Working with a speech therapist can help overcome some of these difficulties. In some instances, a modified diet may be prescribed.

Mobility affected:

Canes, braces, grab bars, special eating utensils, wheelchairs, and other devices can make it easier to keep doing your regular activities after a stroke. Working with a physical and occupational therapist can help you achieve the optimum level of recovery you had before the stroke.

Learning how to adjust to life after a stroke can be challenging. Patient support groups provide a valuable resource that can offer not just support but can connect you with services to help you with recovery and adjusting to changes you may experience.

Talk with your doctor about local support groups for both you and any family members or caregivers that will be helping you. In addition, let your care provider know if you are experiencing depression or are having frequent mood changes (both are common). Your care provider may recommend a course of antidepressants, counselling, or other therapies to help you cope with your new way of life.