Stroke

What is Stroke?

Cerebrovascular accident, frequently called stroke, is described by the National Stroke Association as a "brain attack."

It can be caused when a blood vessel ruptures (hemorrhagic stroke), clots migrate to the brain (embolic stroke), or from clot formation in a blood vessel (thrombotic stroke). The blood supply is interrupted (ischemia) and the brain cells of the area die. The person loses control of the functions and abilities controlled by the affected area.

Stroke is the number one disability in adults and the leading cause of death for Americans. Approximately 555,000 people experience new or recurring strokes each year. Men, blacks, and individuals with a family history of stroke are at greater risk. There is an increased risk of stroke with crack/cocaine usage, certain diseases of the blood and clotting disorders, and alcohol abuse.

How is it diagnosed?

History: Onset of symptoms is sudden and can progress to full disability in less than five minutes. If the symptoms persist for more than an hour, a stroke is the likely diagnosis.

Symptoms may include, but are not limited to, any of the following: weakness or paralysis of the face, arm, and leg affecting one side of the body (hemiplegia), sudden, intense headache, blurred vision in one or both eyes, difficulty speaking (dysarthria), dizziness, spinning feeling (vertigo), loss of balance or coordination (ataxia), nausea and vomiting, and sudden fever. Hemorrhagic strokes cause severe and sudden symptoms with loss of consciousness and possible seizures.

The individual may have one of the risk factors for stroke including high blood pressure (hypertension), diabetes, heart disease, elevated cholesterol, obesity, smoking, atrial fibrillation, and carotid artery stenosis. Transient ischemic attacks (TIAs) are stroke symptoms that usually last from two to five minutes, but no more than an hour. Individuals with a history of TIAs or a previous stroke are at a high risk for recurring strokes.

Physical exam: Most commonly, strokes involve the areas of the brain that control voluntary muscle control. The objective findings are weakness or paralysis involving one side of the body. The individual is, for the most part, alert and oriented. Strokes involving the brain stem have more profound effects such as complete loss of consciousness and control of the basic functions of the body (pulse, blood pressure, and temperature regulation). They carry a grave prognosis. Strokes affecting other areas of the brain include a myriad of signs and manifest with problems in thinking (cognition), recognition, behavior, personality, and affect.

Tests: There is no specific test for the diagnosis of stroke. Evaluations of blood flow in the brain, using CT scans and MRI might locate areas of ischemia, hemorrhage, or damage in the brain and brainstem.

How is Stroke treated?

Steroids are used to decrease brain pressure. A new therapy includes drugs to dissolve the clots in the brain if done within four hours of onset (tPA or streptolysin). Prompt treatment of the immediate problems such as severe hypertension, arrhythmias, airway secretions, and respiratory distress prevents complications.

Analgesics, anticonvulsants, skeletal muscle relaxants, and diuretics are used to treat the effects of the stroke and its complications. Further treatment is directed at prevention of future strokes and minimizing the physical effects. Medications can include antihypertensives, platelet inhibitors, and anticoagulants.

Physical therapy and occupational therapy are started early. A speech therapy service treats communication and eating problems. Medical social work services treat emotional and psychological effects and complications. Surgery to correct narrowing of the carotid arteries may be recommended.

Medications

Information	Brand	Generic	Label	Rating
	Lipitor	Atorvastatin
	Plavix	Clopidogrel

Altace (Ramipril), Mevacor (Lovastatin), Pravachol (Pravastatin), Zocor (Simvastatin), Coumadin (Warfarin), Prozac (Fluoxetine)

What might complicate it?

Complications can result directly from the effects of stroke or indirectly as a side effect of treatments. Stroke survivors are prone to injuries, accidents, and problems with memory, judgment, confusion, disorientation, visual impairment, mobility, coordination, and balance.

Predicted outcome

The prognosis depends on prompt recognition and immediate medical treatment. Delay of treatment will result in more damage and may limit effective and appropriate rehabilitation. The outcome is enhanced, if risk factors and complications are treated. One-third will have another stroke in five years. This risk increases with age.

Alternatives

Other possibilities include migraine headaches, transient ischemic attacks, brain tumors, seizures, subdural hematoma, and vestibular disorders.

Rehabilitation

Physical therapy, occupational therapy, speech therapy, respiratory therapy and recreational therapy, three times a week inpatient; three times a week outpatient; and one to five times a week at home, for a period of three to six months.

Appropriate specialists

Psychiatrist, psychologist, and other mental health professionals.

Last updated 20 May 2015