Stroke
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What is a Stroke?
     Types of Strokes
          Ischemic Stroke
          Hemorrhagic Stroke
     Symptoms of a Stroke
          Critical Gender Differences
     After Calling 9-1-1
     Risk Factors for Stroke
          Hidden Risk Factors for Women

What is a Stroke?

Stroke is a medical emergency and the 3rd leading cause of death in the U.S.  It occurs when a blood vessel in the brain bursts or, more commonly, when a blockage develops.  Without treatment, cells in the brain quickly begin to die. The result can be serious disability or death. If a loved one is having stroke symptoms, seek emergency medical attention without delay. Getting to a hospital quickly is vital for a good outcome with a stroke.

A stroke usually happens suddenly but may occur over hours. For example, you may have mild weakness at first. Over time, you may not be able to move the arm and leg on one side of your body.


Types of Stroke

There are two kinds of strokes: Ischemic and Hemorrhagic.

Ischemic Stroke

Symptoms of an ischemic stroke (caused by a blood clot) vary from one person to another, but symptoms usually occur in the side of the body opposite from the side of the brain where the clot occurred.  For example, a stroke in the right side of the brain affects the left side of the body.

Symptoms of a stroke may be so minor that they are ignored or go unnoticed. Some people have symptoms that go away after a short time. This could be caused by a transient ischemic attack, or TIAA TIA is a warning sign that a stroke may soon follow.


Hemorrhagic Stroke

The symptoms of a hemorrhagic stroke (caused by bleeding in the brain) are usually the same as those from a blood clot.  But you also may have other symptoms, such as:

  • Severe headache, sometimes in a specific area.
  • Nausea and vomiting.
  • Neck stiffness.
  • Dizziness, seizures, or changes in mental state, such as irritability, confusion, and possibly unconsciousness.

Hemorrhagic strokes usually occur during the daytime and during physical activity. Symptoms of a hemorrhagic stroke usually begin very suddenly (within seconds) and get worse over several hours.


Symptoms of a Stroke

Stroke is a medical emergency. Know these warning signs. Every second counts:

  •  Sudden numbness, tingling, weakness or paralysis of the face, arm or leg, especially on one side of the body.
  •  Sudden vision changes.
  •  Sudden trouble speaking or slurred speech.
  •  Sudden confusion or trouble understanding simple statements.
  •  Sudden trouble walking, dizziness, loss of balance or coordination.
  •  Sudden, severe headache that is different from past headaches, with no known cause.

There are two methods of quickly determining whether someone has had a stroke: F.A.S.T. and S.T.R.

Use the letters in F.A.S.T. to spot stroke signs and know when to call 9-1-1.
  •  Face Drooping. Does one side of the face droop or is it numb?
  •  Arm Weakness. Is one arm weak or numb?
  •  Speech, is it slurred?
  •  Time to Call 9-1-1.

Now doctors say a bystander can recognize a stroke by asking three simple questions using the S.T.R. method.

  •  S — Ask the individual to Smile.
  •  T — Ask the person to Talk — to speak a simple sentence coherently. (e.g., It is sunny out today.)
  •  R — Ask him or her to Raise both arms.

New Sign of a Stroke:  Stick out your tongue. If the tongue is crooked or goes to one side, that is also an indication of a stroke.

If the person has trouble with any one of these tasks, call 9-1-1 immediately and describe the symptoms to the dispatcher.

Neurologists will tell you that if they can get to a stroke victim within 3 hours, they can totally reverse the effects of a stroke...totally. The trick is getting a stroke recognized, diagnosed, and then getting the patient medically cared for within 3 hours, which is tough.


Critical Differences Between Women and Men

In many cases, using either of these methods is sufficient to get help quickly, but sometimes they aren't. Women may experience different symptoms than men, which may cause delays in getting treatment, leading to higher chances of brain damage, long-term disability, and the higher death rates among women when it comes to strokes.
 

Symptoms most often occurring in Women   Symptoms most often occurring in Men

Women may report symptoms not often associated with strokes.
  • Nausea or vomiting
  • Hallucination
  • Pain
  • General weakness
  • Shortness of breath or trouble breathing
  • Fainting or losing consciousness
  • Seizure
  • Hiccups
  • Confusion, disorientation, or lack of responsiveness
  • Sudden behavioral changes, especially increased agitation

Because these symptoms are unique to women, it may be difficult to immediately connect them to stroke, which may delay treatment.

 
Men and women can have some of the same signs and symptoms of stroke (see above). However, some stroke symptoms occur more often in men.
  • Drooping on one side of the face or an uneven smile
  • Slurred speech or difficulty speaking
  • Trouble understanding speech
  • Arm weakness or muscle weakness on one side of the body

While some symptoms may differ between men and women, it’s equally important for both to be able to spot a stroke early and get help.

 

Call 9-1-1 immediately if you experience symptoms because time lost is a brain lost. If unsure whether it might be a stroke, still call 9-1-1. Once paramedics arrive, they can assess your symptoms and begin treatment, if needed. And... don't be fooled if the person can converse with you or the Paramedics to some degree. Even if blood pressure readings are normal and the person doesn't appear to be having a stroke, they may be having one.

Much of this information is from healthline: Everything You Need to Know About Stroke.
Another pertinent article: 
Hidden Risk Factors for Women.

After Calling 9-1-1

Remember, the person who answers the phone when you call 9-1-1 is trained to walk you through the process. Be calm and listen to the questions that they ask. Answer as clearly as you can and stay on the line. Never hang up until you are told to do so by the 9-1-1 dispatcher.


If Alone and Having
a Stroke.

  1. Call 9-1-1 ASAP! Stroke is a medical emergency, you need to get medical care as soon as possible, even if there are people around you.

  2. Let the EMTs do their job and get you to the hospital.

  3. If you are having an ischemic stroke (blockage in a brain artery), there is a medication that can be administered to get rid of it, but it needs to be administered within 3 hours of the onset of symptoms to really be effective. The longer brain cells are deprived of oxygen, the more of them die, so every second counts.


Things to Do If Someone Else Is Having a Stroke.
  1. Call 9-1-1 immediately, even if the symptoms disappear.
  2. Tell the dispatcher the symptoms & the time you first noticed them.
  3. Perform CPR, if necessary.
  4. Do Not let that person go to sleep or talk you out of calling 9-1-1.
  5. Do Not give them medication, food, or drinks.
  6. Do Not drive yourself or someone else to the emergency room.


Receiving timely stroke treatment is an important step to recovery. Learn why:


Risk Factors for Stroke

Certain diseases or conditions increase your risk of stroke. These include:

  • High blood pressure (hypertension) is the second most important stroke risk factor after age. It is a risk factor you can change.
     
  • Diabetes doubles your risk of stroke because of the circulation problems associated with the disease.
     
  • High cholesterol can lead to hardening of your arteries (atherosclerosis). 
     
    Hardening of the arteries can cause coronary artery disease and heart attack, which can damage the heart muscle and increase your risk for stroke. You might not have symptoms until your artery is nearly closed or until you have a heart attack or stroke. Signs can also depend on which artery is narrowed or blocked.

    Symptoms related to your coronary arteries include:

    • Arrhythmia, an unusual heartbeat.
    • Pain or pressure in your upper body, including your chest, arms, neck, or jaw. This is known as angina.
    • Shortness of breath.

Certain behaviors can increase your risk of stroke. These include:

  • Smoking, including secondhand smoke
  • Physical inactivity
  • Being overweight
  • Diet with few fruits and vegetables 
    Research suggests that people who eat more fruits, vegetables, fish, and whole grains (for example, brown rice) may have a lower risk of stroke than people who eat lots of red meat, processed foods like lunch meat, and refined grains like white flour.
     
  • Diet with too much salt — A healthy diet includes less than 2,300 mg of sodium a day (about one teaspoon).
     
  • Use of some medicines, such as birth control pills — especially by women who smoke or have a history of blood-clotting problems.  In postmenopausal women, hormone replacement therapy has been shown to slightly increase the risk of stroke.
     
  • Heavy use of alcohol. People who drink alcohol excessively, especially people who binge drink, are more likely to have a stroke.  Binge drinking is defined as drinking more than 5 drinks in a short period of time.
     
  • Illegal drug use (such as a stimulant, like cocaine).

Risk factors you cannot change include:

  • Age. The risk of stroke increases with age.
  • Race. African Americans, Native Americans, and Alaskan Natives have a higher risk than those of other races. Compared with whites, African Americans have about 2 times the risk of a first ischemic stroke.  And African-American men and women are more likely to die from stroke.
  • Gender. Stroke is more common in men than women until age 75, when more women than men have strokes. Because women live longer than men, more women than men die of stroke.
  • Family history. The risk for stroke is greater if a parent, brother, or sister has had a stroke or transient ischemic attack (TIA). For more information, see the topic Transient Ischemic Attack (TIA).
  • History of stroke or TIA.


Treatments for Stroke

Treatment is determined by the type of stroke you have, whether you're having an ischemic stroke or a stroke that involves bleeding into the brain (hemorrhagic).

Ischemic Stroke

To treat an ischemic stroke, doctors must quickly restore blood flow to your brain. This may be done with:

  • Emergency IV medication. Therapy with drugs that can break up a clot has to be given within 4.5 hours from when symptoms first started if given intravenously. The sooner these drugs are given, the better. Quick treatment not only improves your chances of survival but also may reduce complications.

    An IV injection of recombinant tissue plasminogen activator (tPA) — also called alteplase (Activase) — is the gold standard treatment for ischemic stroke. An injection of tPA is usually given through a vein in the arm with the first three hours. Sometimes, tPA can be given up to 4.5 hours after stroke symptoms started. It restores blood flow by dissolving the blood clot causing your stroke. By quickly removing the cause of the stroke, it may help people recover more fully from a stroke. Your doctor will consider certain risks, such as potential bleeding in the brain, to determine if tPA is appropriate for you.
     

  • Emergency endovascular procedures. Doctors sometimes treat ischemic strokes directly inside the blocked blood vessel. Endovascular therapy has been shown to significantly improve outcomes and reduce long-term disability after ischemic stroke. These procedures must be performed as soon as possible:
     
    • Medications delivered directly to the brain. Doctors insert a long, thin tube (catheter) through an artery in your groin and thread it to your brain to deliver tPA directly where the stroke is happening. The time window for this treatment is somewhat longer than for injected tPA, but is still limited.
       
    • Removing the clot with a stent retriever. Doctors can use a device attached to a catheter to directly remove the clot from the blocked blood vessel in your brain. This procedure is particularly beneficial for people with large clots that can't be completely dissolved with tPA. This procedure is often performed in combination with injected tPA.

The time window when these procedures can be considered has been expanding due to newer imaging technology. Doctors may order perfusion imaging tests (done with CT or MRI) to help determine how likely it is that someone can benefit from endovascular therapy.

  • Other procedures. To decrease your risk of having another stroke or transient ischemic attack (TIA), your doctor may recommend a procedure to open up an artery that's narrowed by plaque. Options vary depending on your situation, but include:

    • Carotid endarterectomy. Carotid arteries are the blood vessels that run along each side of your neck, supplying your brain (carotid arteries) with blood. This surgery removes the plaque blocking a carotid artery, and may reduce your risk of ischemic stroke. A carotid endarterectomy also involves risks, especially for people with heart disease or other medical conditions.
       
    • Angioplasty and stents. In an angioplasty, a surgeon threads a catheter to your carotid arteries through an artery in your groin. A balloon is then inflated to expand the narrowed artery. Then a stent can be inserted to support the opened artery.

Hemorrhagic stroke

Emergency treatment of hemorrhagic stroke focuses on controlling the bleeding and reducing pressure in your brain caused by the excess fluid. Treatment options include:

  • Emergency measures. If you take blood-thinning medications to prevent blood clots, you may be given drugs or transfusions of blood products to counteract the blood thinners' effects. You may also be given drugs to lower the pressure in your brain (intracranial pressure), lower your blood pressure, prevent spasms of your blood vessels and prevent seizures.
     
  • Surgery. If the area of bleeding is large, your doctor may perform surgery to remove the blood and relieve pressure on your brain or repair blood vessel problems. Your doctor may recommend one of these procedures after a stroke or if an aneurysm, arteriovenous malformation (AVM) or other type of blood vessel problem caused your hemorrhagic stroke:
     
    • Surgical clipping, placing a tiny clamp at the base of the aneurysm to stop blood flow to it, to keep it from bursting, or keeping it from bleeding again.
       
    • Coiling (endovascular embolization), using a catheter inserted into an artery in your groin and guided to your brain and placing tiny detachable coils into the aneurysm to fill it, blocking blood flow into the aneurysm and causing blood to clot.
       
    • Surgical arteriovenous malformation (AVM) removal if located in an accessible area of the brain to remove a smaller AVM, eliminating the risk of rupture and lowering the risk of a hemorrhagic stroke. However, it's not always possible if it's located deep within the brain, is large, or its removal would cause too much impact on brain function.
       
    • Stereotactic radiosurgery to repair blood vessel malformations, using multiple beams of highly-focused radiation. It is an advanced, minimally invasive treatment.

Most of this information is from the Mayo Clinic's article on strokes.


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