This overview is a sample of the type of information available to you at Griffin Hospital's Community Health Resource Center. It is not intended to replace your physician's instructions in the management of your health problems, but to better inform you about a particular illness and alert you to the availability of other materials. If you have a question about any piece of information presented in theses fact sheets, please call your physician, or stop by the Community Health Resource Center at your convenience.

  STROKE

A stroke (also called a cerebrovascular accident or CVA) occurs when the blood supply to an area of the brain is cut off or greatly reduced. When brain cells do not get the blood and oxygen they need, they die. Since the brain is a message center for the body, the effects of a stroke will depend on which part of the brain has been affected and how severely. Sometimes a stroke is referred to as a "brain attack".If the stroke occurs in the part of the brain that controls speech, then that person will have trouble talking. If the damage occurs in a part of the brain that controls movement, that person may have trouble moving an arm or leg. Strokes can also affect memory, vision, swallowing, bowel and bladder functions, emotions, and personality.

After the stroke, brain cells can begin to recover and cells which have not been damaged can begin to learn how to do the work of those which have. This re-learning process is called rehabilitation and should begin as soon as the stroke is stabilized or no longer active. The rehabilitation process can continue for several weeks or longer, even up to a year. With rehabilitation, many people who have had strokes recover completely. Even though some people do not recover completely, rehabilitation can lessen the amount of disability which remains.

WHAT CAUSES A STROKE?

Anything that prevents blood from flowing through the blood vessels which supply the brain can cause a stroke. The most common cause is a blockage. Most blockages are caused by a cerebral thrombosis or a cerebral embolism.A cerebral thrombosis is the blockage of a blood vessel that is already narrowed by arteriosclerosis (fatty deposits on the inner walls of blood vessels). The combination of narrowed blood vessels (stenosis) and the formation of blood clots (thrombus) makes it more likely for an obstruction to occur. This type of stroke is most likely to occur in people with arteriosclerosis and high blood pressure.A cerebral embolism is when a clot that is formed somewhere else in the body breaks off (an embolus), and travels through larger blood vessels until it becomes lodged in a smaller blood vessel in the brain. This is most likely to occur in people with certain types of heart rhythm abnormalities and/or people whose heart muscles have already been damaged by heart attacks or other heart problems.

Another less common type of stroke occurs when a blood vessel which supplies some part of the brain breaks. This leakage prevents blood from reaching the areas of the brain served by this blood vessel. This is called a cerebral hemorrhage. People with uncontrolled high blood pressure and atherosclerosis are more prone to these types of strokes.

WHO IS AT RISK FOR A STROKE?

Strokes can occur at any age, but they are more likely to occur in people over 65, especially those with arteriosclerosis, uncontrolled high blood pressure, or other heart problems. Heavy smokers, diabetics, people who have high cholesterol, and women who are on the birth control pill and also smoke are also at greater risk. Obesity may be a factor. Some people have repeated strokes, some may be mild and some may be severe.

WHAT ARE THE SYMPTOMS?

Strokes usually occur without warning but it is important to recognize the common symptoms of a stroke so that you can get help right away. Early stroke symptoms include: a sudden change in vision, often in one eye; sudden loss of speech or confusion; a sudden, severe headache; or a sudden weakness, numbness, paralysis, or loss of coordination in the face, arm or leg, especially on one side of the body. The symptoms often continue or get worse , and can cause loss of consciousness. Sometimes, the symptoms occur only for a few moments and then go away. These are called mini-strokes or transient ischemic attacks (TIA's), and can be a warning signal that a stroke is about to occur. Sometimes these symptoms resolve on their own without permanent damage. It is important to seek medical care if any of these symptoms occur. With proper treatment, it may be possible to decrease the effects of a stroke and to prevent a major stroke in the future.

DIAGNOSIS

If you are having the symptoms of a stroke, your doctor will probably admit you to the hospital. The doctor will be very interested in how the symptoms began and how long they have lasted. In a physical exam, your eyes will be examined to see if both pupils react equally to light and you will be asked to move your arms and legs to see which parts of your body have been affected. You may also have an electrocardiogram (EKG), a chest x-ray, blood tests, or a lumbar puncture (a spinal tap to check for bleeding). To determine the cause and location of the stroke, your doctor may order x-rays of your head including a three-dimensional x-ray called a CT scan, or a magnetic resonance imaging scan (MRI).

Other types of tests may also be done, depending on your doctor and your medical condition. If an embolism is thought to be the cause, your doctor may request that you have x-rays of your neck arteries, called a carotid arteriogram or a special heart test, called an echocardiogram to look for clots. It is very important for your doctor to determine the cause and type of stroke you have had to provide the best treatment.

TREATMENT

The most important factor in the successful treatment of a stroke is immediate medical attention. The best recovery occurs when medical attention is provided right away. In a severe stroke, you may be unconscious and need help with breathing. A catheter (tube) may be placed in the bladder to drain urine, or in the stomach to provide food, along with intravenous lines (IVs) to provide fluids and medications.

Initially, treatment will be focused on getting blood back to the areas of the brain that have been affected by the stroke. It will also be important to reduce any pressure in the brain and prevent further damage. The type of stroke you have and how soon you were able to get to the hospital will determine the type of treatment that is best for you.

Your treatment plan may include anticoagulation (anti-clotting). Heparinization (thinning the blood by using medications) is commonly done to prevent more clots from forming and to help blood flow as smoothly and easily as possible. Medications which dissolve blood clots (thrombolytic agents) are often used in strokes caused by blood clots. Other medications that may be used include corticosteroids (reduce inflammation), hyperosmolar agents (decrease swelling in the brain), calcium channel blocking drugs (prevent constriction of blood vessels), and neuroprotective agents (protect brain cells). Each medication has both benefits and risks which will be carefully considered by your doctors to determine which is most appropriate for you based on the type and cause of the stroke, your medical condition, and how soon you were able to get to the hospital. In some types of strokes, surgery is recommended to remove a known blockage, repair a damaged blood vessel, or relieve abnormal pressure on the brain cells.

REHABILITATION

One of the most important parts of stroke recovery is rehabilitation. Beginning rehabilitation as soon as you are medically stable and ready leads to the best recovery of function. You also will prevent complications of being immobile, such as contractures (tightening of muscles and joints), skin breakdown, and weakness. For most patients, rehabilitation is a team effort between you and your family, your doctor and nurses, and physical, occupational, and speech therapists. It works best with your full participation and the participation of your family if this is possible. Formal rehabilitation in a facility can last a few weeks to months depending on how you respond. Many people continue to improve and get stronger for up to a year or longer as they continue their rehabilitation exercises on their own after they leave the facility.

A physical therapist will be involved if you have lost the ability to move any of your body parts. The therapist will work with you on standing, walking, balancing, and strengthening of your muscles. The therapist will show you how to adjust to any changes in your body functions and assist you in getting the equipment you need. An occupational therapist may work with you to help you relearn how to do normal daily activities such as bathing, dressing, eating, and household chores. A speech therapist may work with you if your speech or swallowing is affected by your stroke. Nurses specially trained in rehabilitation will work with you to control your bowel and bladder functions if needed, and teach you or your family how to care for any special needs you may have. Your doctor will direct your rehabilitation treatment plan, coordinate and adjust your medications, and decide when you are able to go home safely. Some people continue with their rehabilitation at home or in an outpatient program. Others go to another facility to build up strength before returning home.

WHAT CAN YOU DO

If you have had a stroke, you will want to prevent additional strokes from occurring in the future. Certain factors can help decrease your risk of having a stroke, including keeping your blood pressure controlled if you have high blood pressure, and keeping your blood sugar controlled if you are diabetic. It may also help to stop smoking, lose weight if you are overweight, and decrease the amount of fat in your diet. Your doctor may recommend you take aspirin daily as a preventive measure. You should continue to get regular check ups and also continue with your rehabilitation exercises to maintain the function that you still have.

COPING

You may find it frustrating to have to re-learn or not be able to do daily tasks and activities the same way that you used to do them. Social workers and counselors are available to talk to you and your family during your hospital stay, in your rehabilitation program, and in home care and community programs. Support groups made up of others who have gone through similar situations can also be a source of support to you and your family.

Please note that this information is intended to give you a general overview of the topic. It is not intended to replace advice or instruction of a health professional. We recommend that you consult your physician, nurse, or qualified health professional regarding the information in this publication. © 1994 Planetree, Inc. Reproduction of this material in any form is limited to license agreement.

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