In the United States, there are over 795,000 strokes each year. That is the reason why people continue to search for stroke causes and prevention, as well as treatment of stroke.
Stroke is the number five leading cause of death in the US and it causes more serious long-term disability than any other disease. About three-quarters of all strokes occur in those that are above 65.
Stroke is more deadly among African Americans – even in those that are young and middle-aged adult – than for any other racial group or ethnic group in the US. Learning about stroke is important. It will help you act in time to save yourself, relative, friend or co-worker.
Also, making changes in your lifestyle can help you prevent stroke.
Strokes are brain attacks, which occur when the blood supply to the brain is blocked. A stroke requires immediate medical attention when it happens.
What is a stroke?
A stroke occurs when the blood supply to the brain is either reduced or interrupted. When this occurs, the brain doesn’t get enough nutrients or oxygen supply, and the brain cells begin to die.
About 40% of people in the U.S. who died from stroke are male, while about 60% of deaths caused by strokes occur in females. According to the AHA (American Heart Association), compared with Caucasian people, African-Americas have almost twice the risk of a first-time stroke, as well as a much higher risk of death caused by stroke.
Fast facts on stroke
- When a stroke occurs, the brain doesn’t receive enough nutrients or oxygen, causing its cells to die.
- A stroke needs to be diagnosed immediately it occurs and treated quickly to minimize brain damage.
- Treatment of stroke depends on the type.
- Treating underlying conditions that could be the risk factor and maintaining a healthy lifestyle are the most effective ways to prevent strokes.
Types of stroke
A stroke can occur in two main ways: when something causes bleeding in the brain or when something blocks the blood flow to the brain. Here are the main two types of stroke:
1. Ischemic strokes
Ischemic stroke accounts for 87% of all strokes. They occur when there is a blood clot that blocks the flow of blood to a part of the brain. This can happen in two ways:
- A buildup of plaque can narrow the blood vessel of the neck or brain and cause a clot to form. Plaque is a combination of cholesterol, fat and other substances that accumulate in the inner lining of the artery walls. This condition is known as hardening of the arteries or atherosclerosis.
- A clot can break off from a blood vessel in any part of the body and travel to the brain where it gets stuck in one of the tiny blood vessels in the brain. This is known as embolism.
2. Hemorrhagic strokes
Hemorrhagic strokes occur when a weakened blood vessel in the brain ruptures and bleeds into the brain tissue around. This puts more pressure on blood cells around the tissue, cutting off their blood supply and damaging the brain.
An aneurysm which is a weak spot in the blood vessel wall that balloons outward can also lead to hemorrhagic strokes.
Chronic high blood pressure can also weaken spots in the artery wall and make the spots more prone to rupture.
Research showed that about 13% of all strokes are hemorrhagic strokes.
What is a mini-stroke?
A transient ischemic attack or TIA can be secondary to the temporary blockage, which is caused by a blood clot. TIA is known as “warning stroke” or “mini-stroke,” because it is a warning sign of a future stroke.
According to the Centers for Disease Control and Prevention, over a third of people who have a TIA often have a major stroke within one year if they fail to treat the condition.
Leading causes of stroke
The cause of a stroke depends on the type of stroke. The 3 main types of stroke include hemorrhagic stroke, ischemic stroke and transient ischemic attack (TIA).
A hemorrhagic stroke is caused by a leaking or burst blood vessel. Blood seeps into or around the tissues of the brain, causing more pressure and damaging brain cells.
The two possible causes of hemorrhagic stroke are aneurysm and arteriovenous malformation. An aneurysm is a weakened, bulging section of the blood vessel caused by high blood pressure and can cause a blood vessel to burst.
Arteriovenous malformation is an abnormal connection between the arteries and veins, which can lead to bleeding in the brain.
An ischemic stroke is caused by the blockage in an artery that leads to the brain. The blockage may be caused by atherosclerosis or a blood clot. With this condition, a fatty substance called plaque builds up on the blood vessels’ walls.
When a piece of plaque breaks off and lodge in an artery, it blocks the blood flow and causes an ischemic stroke.
A TIA is caused by a temporary blockage in an artery that leads to the brain. This blockage, typically a blood clot, prevents blood from flowing to some parts of the brain. A TIA typically lasts for between a few minutes and a few hours, and then the blockage moves and flow of blood resumed.
Brain stroke symptoms
The loss of blood flow to the brain destroys tissue within the brain. Brain stroke symptoms show up in parts of the body controlled by the damaged part of the brain.
The sooner the person having a stroke gets diagnosed and care, the better the outcome will possibly be. Because of this, it is important to know the signs of stroke in order to act quickly. Symptoms of a stroke can include:
- Slurring speech
- Trouble understanding speech or trouble speaking
- Numbness or weakness in the arm, leg and face, especially on one side of the body
- Vision issues, such as trouble seeing in one or both eyes with vision blurred or blackened, or double vision.
- Loss of balance or coordination
- Sudden, severe headache with no known cause
- Trouble walking
- Loss of consciousness
- Trouble breathing
FAST is an acronym that can help you remember the signs and symptoms of a stroke.
- Face drooping – Ask the affected person to smile. If the smile is uneven, go to the hospital as fast as possible
- Arm weakness – Ask the affected person to raise both arms. If one of the arms is drifting downward, rush o the hospital.
- Speech difficulty – Is the speech hard to understand or slurred? Ask the person to repeat a simple sentence such as “The ball is rolling.” If the sentence is not repeated correctly, rush to the hospital.
- Time to call emergency – If someone shows any of the above signs and symptoms of stroke, even if the symptoms go away, check the time to know when the symptoms first began.
It is best to be safe than sorry when it comes to a stroke, so don’t hesitate to call the emergency number if you think you the symptoms of a stroke.
Symptoms of stroke in women
The fourth-leading health issue that causes the death of United States women is a stroke. Women have a higher risk of having a stroke than men. While some brain stroke symptoms are the same in men and women, some are more common in women.
Signs and symptoms of stroke in women include:
- General weakness
- Vomiting or nausea
- Sudden behavioral change, especially increased agitation
- Losing consciousness or fainting
- Trouble breathing or shortness of breath
- Disorientation, confusion or lack of responsiveness
Women are more likely to die from stroke than men, so it is necessary to be able to identify a stroke as soon as possible.
Signs and symptoms of a stroke in men
The fifth-leading health problem that causes death in men is a stroke. According to the National Institutes of Health, men are more likely to have a stroke in younger years than women, but less likely to die from it than women.
Some of the signs and symptoms of a stroke are common in men and women, but the following symptoms of a stroke are more common in men:
- Muscle weakness or arm weakness on one side of the body
- Difficulty speaking, slurred speech and trouble understanding other speech
- Drooping on one side of the face or an uneven smile
Although some symptoms may be different between men and women, it is equally necessary for both to know how to spot a stroke early and get help quickly.
Risk factors for stroke
Many risk factors can make you susceptible to stroke. The National Heart, Lung, and Blood Institute says, the more risk factors you have, the more the possibility of having a stroke. Some of the risk factors for stroke are:
Consuming an unhealthy diet can increase your risk of having a stroke. You should minimize foods that are high in:
- Trans fats
- Saturated fats
2. Alcohol consumption
Taking too much alcohol also increase your risk of stroke. You should consume alcohol in moderation. This means it should not be more than two drinks per day for men and one drink for women.
Taking more than recommended drink per day can increase your blood pressure levels and triglyceride levels, which can lead to atherosclerosis.
Lack of exercise or inactivity can also increase your risk of stroke. Regular exercise offers you lots of health benefits. The CDC recommends that at least, adults need 2.5 hours of aerobic exercise every week.
4. Personal background
Certain personal risk factors for stroke raise your risk for stroke. But you can control them. Here are the personal risk factors:
- Sex: While both men and women can have strokes, CDC says they are more common in women than in men.
- Family history: Your genetic, such as having high blood pressure can put you at a higher risk of having a stroke.
- Race and ethnicity: Hispanics, Asian Americans and Caucasians are less likely to have a stroke than American Indians, Alaska Natives and African-Americans.
- Age: The older you’re, the more likely you’re to have a stroke.
Using tobacco in any form can also raise your risk for stroke because it can damage your heart and blood vessels. This is further increased if you are smoking because nicotine use can raise your blood pressure.
6. Health history
Certain medical conditions can raise your risk of having a stroke. Some of them are:
- High cholesterol
- High blood pressure
- Being overweight or obese
- Sickle cell disease
- Enlarged heart chambers and irregular heartbeats
- Heart valve defects
- TIA or a previous stroke
- Heart disorders like coronary artery disease
If you want to know your risk factors for stroke, visit your doctor.
Diagnosis of stroke
When you visit a doctor, your doctor will ask you or a member of your family about your symptoms and what you were doing when the symptoms arose. Your doctor will use your medical history to find out your risk factors and also:
- Listen to your heart
- Check your blood pressure
- Ask about the medications you take
A physical examination will also be conducted on you, during which you will be evaluated for:
- Vision issues
- Signs of confusion
- Numbness in your legs, arms or face
The doctor will then carry out certain tests. These tests will help in the diagnosis of a stroke. The tests will help doctors determine:
- If you have a stroke
- What may have caused it
- Whether you have bleeding in the brain
- What part of the brain is affected
These tests will also help doctors determine if your symptoms are caused by something different.
Tests to diagnose strokes
Doctors may put you through many tests to further help them determine if you have a stroke or another condition. The tests include:
1. Blood tests
Several blood tests will be carried out to determine:
- How fast your blood clots
- Your platelet levels
- If you have an infection
- Your blood sugar levels
The doctor may also order an EKG (electrocardiogram). This test records electrical activities in your heart, measuring the heart’s rhythm and how fast it beats. It can help determine if you have any heart condition that may have led to a stroke, such as prior heart attack or atrial fibrillation.
Undergoing an echocardiogram test can help find sources of clots in the heart. The clots may have traveled to the brain and caused a stroke.
4. MRI and CT scan
You may have to undergo both or either of MRI (magnetic resonance imaging) scan and a CT (computerized tomography) scan.
The magnetic resonance imaging scan will help the doctors see if any brain cells or brain tissue have been damaged. A computerized tomography will provide a clear and detailed picture of the brain showing any bleeding or damage in the brain. The scan may show other brain conditions that may be causing stroke symptoms too.
5. Carotid ultrasound
A carotid ultrasound (aka carotid duplex scan) shows plaque (fatty deposits) in the carotid arteries, which supply the blood to the brain, face and neck. It will also show whether the carotid arteries have been blocked or narrowed.
6. Cerebral angiogram
The doctor may also order cerebral angiogram to determine if you have had a stroke. This test provides a detailed look at the arteries in the brain and neck. It can show clots or blockages that may have caused your symptoms.
Treatment of stroke
To recover from a stroke, there is a need for medical evaluation and prompt treatment. According to the American Heart Association, “Time lost is brain lost.” Call emergency as soon as you realize that you may be having a stroke, or you spot symptoms of stroke in a loved one.
Treatment of stroke depends on each type of stroke.
1. Hemorrhagic stroke
Treatments for hemorrhagic stroke are:
If you have a hemorrhagic stroke, the treatment goal for you is to make your blood clot. So you may be given medication that counteracts any blood thinners you take.
The doctor may also prescribe drugs that can help reduce blood pressure, prevent seizures, prevent blood vessel constriction and lower the pressure in the brain for you.
The doctor may discover an aneurysm that has not started bleeding or has stopped during imaging tests. To prevent more bleeding, a surgeon may place a small clamp at the base of the aneurysm to cut off blood supply and prevent a possible new bleeding or broken blood vessel.
During this procedure, a doctor will guide a long tube to the weakened blood vessel or area of hemorrhage. A coil-like device will then be installed in the area where the artery wall is weak to block blood flow to the area, reducing bleeding.
If the doctor discovers that an aneurysm has burst, they may carry out surgery to clip the aneurysm and prevent further bleeding. Also, a craniotomy may be carried out to relieve the pressure on your brain after a large stroke.
2. Ischemic stroke and TIA treatment
The cause of these types of stroke can either be a blood clot or other blockages in the brain. So they are mainly treated in the following ways:
Antiplatelet and anticoagulants
The first defense line against stroke damage is often over-the-counter aspirin. Within 24-48 hours after the stroke symptoms start, anticoagulant and antiplatelet drugs should be taken.
A procedure to inflate the narrowed artery and support the artery walls with a stent if your doctor finds where artery walls have weakened.
During mechanical thrombectomy, your doctor inserts a catheter into a large blood vessel inside your head and use the device to pull out the clot from the vessel. This surgery is most successful if it is performed 6-24 hours after the stroke starts.
Taking thrombolytic drugs can help break up blood clots in the brain arteries to stop the stroke and reduce brain damage.
One such drug, Alteplase IV r-tPA or tissue plasminogen activator (tPA), is considered the gold standard in the treatment of ischemic stroke. It works by dissolving blood clots quickly if delivered within the first 3-4.5 hours after the stroke symptoms started. Those who receive a tPA injection a more likely to recover from a stroke and less likely to have any lasting disability caused by a stroke.
It is rare that other treatments don’ work, but if they don’t work, your doctor may do surgery to remove plaques from your arteries and a blood clot. This may be carried out with a catheter, or if the clot is large, the doctor may open an artery to remove the blockage.
Aside from emergency treatment, healthcare providers will also advise you on what to do to prevent future strokes.
You can use many medications for stroke treatment. The medication your doctor prescribes largely depends on the type of stroke you had. Some medications are prescribed to prevent a stroke from happening in the first place, while others are prescribed to prevent a second stroke.
Here are the most common stroke medications:
- Tissue plasminogen activator (tPA): tPA is an emergency medication provided during a stroke to break up the blood clot causing a stroke. It is currently the only available medication that can perform this but has to be given within 3-4.5 hours after symptoms of a stroke start. The doctor injects this drug into a blood vessel so it can begin to work as quickly as possible to reduce the risk of stroke complication.
- Antiplatelet drugs: These drugs make it difficult for the blood platelets to stick together (they prevent blood clot). The most common antiplatelet medications are clopidogrel (Plavix) and aspirin. The two drugs can be used to prevent ischemic strokes and secondary stroke. If you have never had a stroke in the past, you should only use aspirin as a preventive drug if you have a high risk of atherosclerotic cardiovascular disease (e.g. stroke and heart attack) and a low risk of bleeding.
- Anticoagulants: These drugs help reduce the ability of blood to clot. The most common anticoagulant is warfarin (Coumadin, Jantoven). These medications can also prevent existing blood clots from becoming larger, which is the reason a doctor may prescribe them to prevent a stroke, or after a TIA or ischemic stroke has occurred.
- Blood pressure drugs: High blood pressure can cause plaque buildup in the arteries to break off. These plaque buildup pieces can block arteries and cause a stroke. As a result, it is important to control high blood pressure to prevent a stroke.
- Statins: This medication helps lower high blood cholesterol levels and it is one of the most prescribed medications in the U.S. These medications prevent your body from producing an enzyme that can turn cholesterol into plaque, which can cause a stroke and heart attack. Common satins are atorvastatin (Lipitor), simvastatin (Zocor) and rosuvastatin (Crestor).
A stroke can result in temporary or permanent disabilities. Stroke complications depend on the part of the brain affected by a stroke and how long the brain was without blood flow. Stroke complications may include:
- Loss of muscle movement or paralysis: One side of the body can become paralyzed, or lose control of certain muscles like those on one side of one arm or face. Physical therapy may help you return activities to the part affected by paralysis, such as dressing, walking and walking.
- Thinking difficulties or memory loss: Several people who have had strokes usually experience some memory loss. Some of them may find it hard to think, reason, understand concepts and make judgments.
- Difficulty swallowing or talking: A stroke might affect your throat and mouth muscle control, making it hard to eat, swallow (dysphagia) or talk clearly (dysarthria). You may also have difficulty with language (aphasia), including understanding speech or speaking, writing or reading. You may need therapy from a speech-language pathologist.
- Emotional issues: People who have had strokes may find it hard to control their emotions, or they may easily develop depression.
- Change in behavior and self-care ability: Anyone who has had a stroke may become more withdrawn, more impulsive and less social. Such a person may need help with daily chores and grooming.
- Pain: Pain, strange sensations or numbness may occur in the parts of the body affected by stroke. For instance, if the stroke causes you to lose feeling in the right arm, you may develop an uncomfortable tingling sensation in your right arm. You may also be sensitive to change in temperature, especially extreme cold, after a stroke. This condition mainly develops many weeks after a stroke but may improve over time.
Recovering from a stroke
The leading cause of long-term disability in the U.S. is a stroke. However, it has been reported by the National Stroke Association that 10% of stroke survivors make an almost-complete recovery, while 25% recover with just minor impairments.
After a stroke, it is important to start recovery and rehabilitation as soon as possible. In fact, stroke recovery and rehabilitation should start in the hospital. At the hospital, a care team can help stabilize your condition, find the effects of your stroke, identify underlying factors and start therapy to help you regain some of your affected skills.
When recovering from a stroke, you should focus on 4 main areas including:
1. Speech therapy
If you’ve had a stroke, it can cause language and speech impairment for you. You need to work with a speech and language therapist to relearn how to speak. You could even find verbal communication hard after a stroke; they will help you to find ways of communication.
2. Relearning sensory skills
If the stroke affects the part of your brain that relays sensory signals, you may discover your senses are no longer working or “dulled”. That may mean that you no longer feel things well, such as pain, pressure or temperature. A therapist can help you learn to adjust to lack of sensation.
3. Cognitive therapy
Several survivors of strokes have changes to their reasoning and thinking skills after a stroke. This can result in a mood and behavioral change. An occupational therapist will help you recover your old ways of thinking and behavior and also to control your emotional responses.
4. Physical therapy
Strength and muscle tone may be weakened by the stroke, and you may find it difficult to move your body the way you do before. A physical therapist will help you regain strength and balance, and also find ways to adjust your limitations.
Rehabilitation may take place in your home, skilled nursing home or in a rehabilitation clinic.
Prevention of stroke
There are steps you can take to prevent stroke. Living a healthy lifestyle is the most important. Prevention of stroke includes taking the following measures:
- Drink alcohol in moderation, if at all: If you like to drink excessively, you should reduce your alcohol intake because it can raise your blood pressure.
- Quit smoking: if you smoke, you need to quit smoking to lower your risk for stroke.
- Keep your weight down: It is vital to keep your weight at a healthy level. Being overweight or obese increases your stroke risk. Here is how to manage your weight
- Get checkups: If you want to stay on top of your health, get checkups always. This means getting checkups regularly and staying in communication with your doctor. Manage your diabetes if you have, address heart problems if you have, talk to a doctor about modifying your lifestyle, get blood pressure and cholesterol checked, and discuss your medication with a doctor.
- Quit tobacco use: Smoking raises your risk of stroke, so you need to quit smoking.
- Lower the amount of saturated fat and cholesterol in your diet: Consuming less trans fats and saturated fats and reducing your cholesterol intake may help reduce the plaque in your arteries.
- Exercise regularly: Cardio or aerobic exercise reduces your risk of stroke. Exercise can also increase your level of high-density lipoprotein cholesterol, lower your blood pressure and improve the overall health of your heart and blood vessels. It helps you control diabetes, reduce stress and lose weight. Try 30 minutes of activities daily – such as swimming, jogging, bicycling or walking.
- Eat a diet rich in vegetables and fruits: A diet that contains 5 or more daily serving of vegetables or fruits may help reduce your risk of stroke. You may follow a Mediterranean diet that emphasizes vegetables, whole grains, nuts, fruits and olive oil to reduce your risk of stroke.
- Control your high blood pressure: To reduce the risk of stroke, you need to control your high blood pressure. If you have had a stroke, lowering your blood pressure may also help prevent a subsequent stroke or TIA. Limiting your sodium intake, alcohol intake, exercising, maintaining a healthy weight and managing stress can help keep blood pressure in check.
- Avoid illegal drugs: Certain street drugs like methamphetamines and cocaine are established risk factors for a stroke or TIA. Cocaine reduces your blood flow and can also narrow the arteries.
- Treat obstructive sleep apnea (OSA): The doctor may recommend an overnight oxygen assessment to screen obstructive sleep apnea – a sleep disorder in which the level of oxygen drops intermittently during the night.
The bottom line
Think you are too young to have a stroke? Think again! If you suspect you are experiencing stroke symptoms, it is important to seek emergency medical treatment.
You can only take the clot-busting drug after the first hours you experience stroke symptoms, and early treatment is among the most effective methods of reducing the risk for long-term disability and complications.
It is also possible to prevent a stroke. Whether you are trying to prevent the first or second stroke, medications can help reduce the risk of blood clots that can lead to strokes. Visit your doctor for the prevention strategy that works for you.