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A stroke, or “brain attack,” occurs when blood circulation to the brain fails. Brain cells can die from decreased blood flow and the resulting lack of oxygen. There are two broad categories: those caused by a blockage of blood flow and those caused by bleeding.
If you’re like most of us, you plan for your future. When you take a job, you examine its benefit plan. When you buy a home, you consider its location and condition so that your investment is safe. Today, more and more people are protecting their most important asset–their health. Are you?
Stroke ranks as the third leading killer in the United States. It can be devastating to individuals and their families, robbing them of their independence. It is the most common cause of adult disability. Each year more than 700,000 Americans have a stroke, with about 160,000 dying from stroke-related causes.
A stroke, or “brain attack,” occurs when blood circulation to the brain fails. Brain cells can die from decreased blood flow and the resulting lack of oxygen. There are two broad categories: those caused by a blockage of blood flow and those caused by bleeding.
A blockage of a blood vessel in the brain or neck is called an ischemic stroke. While not usually fatal, it is the most frequent cause and is responsible for about 80 percent of strokes. These blockages stem from three conditions:
Bleeding into the brain or the spaces surrounding the brain causes the second type, called hemorrhagic stroke.
Two key steps you can take will lower your risk of death or disability: know stroke’s warning signs and control its risk factors. Scientific research has identified warning signs and a large number of risk factors.
Warning signs are clues your body sends that your brain is not receiving enough oxygen. If you observe one or more of these signs of a stroke or “brain attack,” don’t wait, call a doctor or 911 right away!
Other danger signs that may occur include double vision, drowsiness, and nausea or vomiting. Sometimes the warning signs may last only a few moments and then disappear. These brief episodes, known as transient ischemic attacks or TIAs, are sometimes called “mini-strokes.”
Although brief, they identify an underlying serious condition that isn’t going away without medical help. Unfortunately, since they clear up, many people ignore them. Don’t. Heeding them can save your life.
A risk factor is a condition or behavior that occurs more frequently in those who have, or are at greater risk of getting, a disease than in those who don’t. Having a risk factor for stroke doesn’t mean you’ll have it someday. On the other hand, not having a risk factor doesn’t mean you’ll avoid it. But your risk of stroke grows as the number and severity of risk factors increases.
Stroke occurs in all age groups, in both sexes, and in all races in every country. It can even occur before birth, when the fetus is still in the womb. In African-Americans, stroke is more common and more deadly–even in young and middle-aged adults–than for any ethnic or other racial group in the United States. Scientists have found more and more severe risk factors in some minority groups and continue to look for patterns of stroke in these groups.
Some of the most important treatable risk factors are:
Some of the most important risk factors for stroke can be determined during a physical exam at your doctor’s office. If you are over 55 years old, a worksheet in a pamphlet available from the NINDS can help you estimate your risk and show the benefit of risk-factor control. Ask your doctor about this.
Many risk factors for can be managed, some very successfully. Although risk is never zero at any age, by starting early and controlling your risk factors you can lower your risk of death or disability from stroke. With good control, the risk in most age groups can be kept below that for accidental injury or death.
Americans have shown that stroke is preventable and treatable. In recent years, a better understanding of the causes of stroke has helped Americans make lifestyle changes that have cut the stroke death rate nearly in half.
Scientists predict that, with continued attention to reducing the risks of stroke and by using currently available therapies and developing new ones, Americans should be able to prevent 80 percent of all strokes.
Physicians have a wide range of therapies to choose from when determining a patient’s best therapeutic plan. The type of therapy a patient should receive depends upon the stage of disease. Generally there are three treatment stages for stroke: prevention, therapy immediately after, and post rehabilitation. Therapies to prevent a first or recurrent stroke are based on treating an individual’s underlying risk factors, such as hypertension, atrial fibrillation, and diabetes, or preventing the widespread formation of blood clots that can cause ischemic stroke in everyone, whether or not risk factors are present. Acute stroke therapies try to stop while it is happening by quickly dissolving a blood clot causing the stroke or by stopping the bleeding of a hemorrhagic stroke. The purpose of post rehabilitation is to overcome disabilities that result from its damage. Therapies for stroke include medications, surgery, or rehabilitation.
Medication or drug therapy is the most common treatment for stroke. The most popular classes of drugs used to prevent or treat stroke are antithrombotics (antiplatelet agents and anticoagulants), thrombolytics, and neuroprotective agents.
Surgery can be used to prevent stroke, to treat acute stroke, or to repair vascular damage or malformations in and around the brain. There are two prominent types of surgery for stroke prevention and treatment: carotid endarterectomy and extracranial/intracranial (EC/IC) bypass.
is a surgical procedure in which a doctor removes fatty deposits (plaque) from the inside of one of the carotid arteries, which are located in the neck and are the main suppliers of blood to the brain. As mentioned earlier, the disease atherosclerosis is characterized by the buildup of plaque on the inside of large arteries, and the blockage of an artery by this fatty material is called stenosis.
Currently, the NINDS is sponsoring the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST), a large clinical trial designed to test the effectiveness of carotid endarterectomy versus a newer surgical procedure for carotid stenosis called stenting. The procedure involves inserting a long, thin catheter tube into an artery in the leg and threading the catheter through the vascular system into the narrow stenosis of the carotid artery in the neck. Once the catheter is in place in the carotid artery, the radiologist expands the stent with a balloon on the tip of the catheter. The CREST trial will test the effectiveness of the new surgical technique versus the established standard technique of carotid endarterectomy surgery.
Stroke is the number one cause of serious adult disability in the United States. Stroke disability is devastating to the stroke patient and family, but therapies are available to help rehabilitate post-stroke patients.
Many stroke patients require psychological or psychiatric help after a stroke. Psychological problems, such as depression, anxiety, frustration, and anger, are common post-stroke disabilities. Talk therapy, along with appropriate medication, can help alleviate some of the mental and emotional problems that result from stroke. Sometimes it is also beneficial for family members of the stroke patient to seek psychological help as well.
Although stroke is a disease of the brain, it can affect the entire body. Some of the disabilities that can result from a stroke include paralysis, cognitive deficits, speech problems, emotional difficulties, daily living problems, and pain.
A common disability that results is paralysis on one side of the body, called hemiplegia. A related disability that is not as debilitating as paralysis is one-sided weakness or hemiparesis. The paralysis or weakness may affect only the face, an arm, or a leg or may affect one entire side of the body and face. A person who suffers a stroke in the left hemisphere of the brain will show right-sided paralysis or paresis. Conversely, a person with a stroke in the right hemisphere of the brain will show deficits on the left side of the body. A stroke patient may have problems with the simplest of daily activities, such as walking, dressing, eating, and using the bathroom.
Motor deficits can result from damage to the motor cortex in the frontal lobes of the brain or from damage to the lower parts of the brain, such as the cerebellum, which controls balance and coordination. Some stroke patients also have trouble eating and swallowing, called dysphagia.
Stroke patients may experience pain, uncomfortable numbness, or strange sensations after a stroke. These sensations may be due to many factors including damage to the sensory regions of the brain, stiff joints, or a disabled limb. An uncommon type of pain resulting is called central stroke pain or central pain syndrome (CPS).
CPS results from damage to an area in the mid-brain called the thalamus. The pain is a mixture of sensations, including heat and cold, burning, tingling, numbness, and sharp stabbing and underlying aching pain. The pain is often worse in the extremities – the hands and feet – and is made worse by movement and temperature changes, especially cold temperatures. Unfortunately, since most pain medications provide little relief from these sensations, very few treatments or therapies exist to combat CPS.
Some risk factors for stroke apply only to women. Primary among these are pregnancy, childbirth, and menopause. These risk factors are tied to hormonal fluctuations and changes that affect a woman in different stages of life.
Research in the past few decades has shown that high-dose oral contraceptives, the kind used in the 1960s and 1970s, can increase the risk of stroke in women. Fortunately, oral contraceptives with high doses of estrogen are no longer used and have been replaced with safer and more effective oral contraceptives with lower doses of estrogen. Some studies have shown the newer low-dose oral contraceptives may not significantly increase the risk of stroke in women.
Subarachnoid hemorrhage, in particular, causes one to five maternal deaths per 10,000 pregnancies.
A study sponsored by the NINDS showed that the risk of stroke during pregnancy is greatest in the post-partum period – the 6 weeks following childbirth. The risk of ischemic stroke after pregnancy is about nine times higher and the risk of hemorrhagic stroke is more than 28 times higher for post-partum women than for women who are not pregnant or post-partum. The cause is unknown.
In the same way that the hormonal changes during pregnancy and childbirth are associated with increased risk of stroke, hormonal changes at the end of the childbearing years can increase the risk of stroke.
The young have several risk factors unique to them. Young people seem to suffer from hemorrhagic strokes more than ischemic strokes. This is a significant difference from older age groups where ischemic strokes make up the majority of stroke cases.
Hemorrhagic strokes represent 20 percent of all strokes in the United States and young people account for many of these. Clinicians often separate the “young” into two categories: those younger than 15 years of age, and those 15 to 44 years of age. People 15 to 44 years of age are generally considered young adults. They have many of the risk factors mentioned above, such as:
Some other causes of stroke in the young are linked to genetic diseases.
Medical complications that can lead to stroke in children include intracranial infection, brain injury, vascular malformations such as moyamoya syndrome, occlusive vascular disease, and genetic disorders such as sickle cell anemia, tuberous sclerosis, and Marfan’s syndrome.
The symptoms of stroke in children are different from those in adults and young adults. A child experiencing a stroke may have:
It is a medical emergency when a child shows any of these symptoms.
In children with stroke, the underlying conditions that led to the stroke should be determined and managed to prevent future strokes. For example, a recent clinical study sponsored by the National Heart, Lung, and Blood Institute found that giving blood transfusions to young children with sickle cell anemia greatly reduces the risk of stroke. The Institute even suggests attempting to prevent stroke in high-risk children by giving them blood transfusions before they experience a stroke.
Most children who experience a stroke will do better than most adults after treatment and rehabilitation. This is due in part to the immature brain’s great plasticity, the ability to adapt to deficits and injury. Children who experience seizures along with stroke do not recover as well as children who do not have seizures. Some children may experience residual hemiplegia, though most will eventually learn how to walk.
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