STROKE

39

A stroke referred to as a “brain attack,” happens when blood flow to a part of the brain is suddenly interrupted, leading to the death of brain cells due to lack of oxygen and glucose. Recognizing these signs early on is key to avoiding permanent brain damage or even death.

Types of stroke

Strokes are serious medical emergencies that occur when their is an interruption or blockages of blood flow to the brain There are five main types:

1. Ischemic Stroke: This type of brain attack can occur if the blood vessel supplying blood to the brain blocks as a result of blood clotting. This is the most common type of stroke.
   • Symptoms: These vary depending on which parts of the brain are affected and can include sudden weakness or numbness on one side of the body, confusion, speech difficulties, dizziness, and vision problems.
   • Causes: Atherosclerosis, atrial fibrillation, heart attacks, heart valve issues, neck artery injury, and blood clotting problems are common causes.
   • Types: Thrombotic strokes (clot forms in an artery supplying blood to the brain) and embolic strokes (clot forms elsewhere and travels to the brain).
2. Transient Ischemic Attack (TIA): Also known as a “mini-stroke,” this is a temporary blockage in blood flow to the brain, often acting as a warning sign for an impending ischemic stroke.
   • Symptoms: Similar to an ischemic stroke but temporary, lasting only a few minutes to 24 hours.
   • Causes and Risk Factors: Same as for ischemic stroke.
3. Hemorrhagic Stroke: This occurs when bleeding in the brain damages nearby cells, and there are two types based on where the bleeding occurs: subarachnoid hemorrhage (between the brain and skull) and intracerebral hemorrhage (inside the brain).
   • Symptoms: Intense headache, confusion, nausea, sensitivity to light, vision problems, and passing out.
   • Causes and Risk Factors: Various factors such as high blood pressure, high cholesterol, diabetes, obesity, previous strokes, smoking, unhealthy lifestyle, injury, bleeding disorders, cocaine use, abnormal blood vessels, and aneurysms.
4. Brain Stem Stroke: This type affects the brain stem, potentially causing severe consequences due to its critical functions.
   • Symptoms: Vertigo, nausea, double vision, slurred speech, passing out, and in severe cases, “locked-in” syndrome where only eye movement is possible.
   • Causes and Risk Factors: Blood clots, hemorrhages, and injuries to arteries due to sudden head or neck movements, along with risk factors like smoking, high blood pressure, diabetes, atrial fibrillation, and heart disease.

Each type of stroke carries its own set of symptoms, causes, and risk factors, underscoring the importance of understanding and addressing individual risk factors to prevent or minimize the impact of stroke.

Risk Factors

Several factors contribute to the risk of having this brain attack, some of which can be managed or treated, while others cannot be changed:

1. High Blood Pressure (Hypertension): This is the leading cause of strokes. If your blood pressure consistently reads 130/80 or higher, your doctor will discuss treatment options with you.
2. Tobacco Use: Smoking or chewing tobacco increases your risk of stroke. Nicotine raises blood pressure, while cigarette smoke leads to fatty deposits in the main neck artery and thickens blood, making it more prone to clotting.
3. Heart Disease: Conditions like defective heart valves and atrial fibrillation (irregular heartbeat) contribute to about a quarter of strokes in the elderly. Clogged arteries from fatty deposits are also a risk factor.
4. Diabetes: High blood pressure and overweight are common in people with diabetes, both of which increase the risk of stroke. Diabetes damages blood vessels, further elevating the likelihood of a stroke, especially when blood sugar levels are high.
5. Weight and Exercise: Being overweight raises the risk of stroke, but regular physical activity can lower it. Activities like brisk walking for 30 minutes daily or muscle-strengthening exercises help reduce stroke risk.
6. Medications: Certain medications, such as blood thinners used to prevent clotting, can sometimes increase the risk of stroke through bleeding. Hormone therapy for menopause symptoms and low-dose estrogen in birth control pills are also associated with a higher stroke risk.
7. Age: While strokes can occur at any age, the risk increases with age, doubling every decade after age 55.
8. Family History: Strokes can run in families due to shared tendencies toward conditions like high blood pressure or diabetes. Some strokes may be linked to genetic disorders that affect blood flow to the brain.
9. Gender: Although women are slightly less likely to have strokes than men of the same age, they tend to experience strokes later in life, leading to lower recovery rates and higher mortality.
10. Race: African-Americans and nonwhite Hispanic Americans are at a higher risk of stroke compared to other racial groups in the U.S. Additionally, sickle cell disease, more common in these groups and in people of Mediterranean, Middle Eastern, or Asian descent, can narrow arteries and disrupt blood flow, increasing the risk of stroke.

Symptoms

Recognizing the signs and symptoms of this brain attack is essential for prompt medical intervention. These symptoms can manifest differently in men and women and may include:

• Sudden weakness or numbness on one side of the face, arm, or leg.
• Loss of vision, coordination, sensation, or speech, may worsen over time.
• Sudden dimming of vision, especially in one eye.
• Loss of balance, often accompanied by symptoms like vomiting, nausea, fever, hiccups, or difficulty swallowing.
• Sudden, severe headache without any other apparent cause, followed by loss of consciousness.
• Brief fainting spells.
• Dizziness or sudden falls without an obvious reason.

To aid in recognizing a stroke, healthcare professionals use the FAST acronym:

• Face: Ask the person to smile and observe if one side of their face droops.
• Arms: Request the person to raise both arms and watch for weakness or sagging in one arm.
• Speech: Have the person say a simple phrase and listen for slurred or unusual speech.
• Time: Every minute counts, so call 911 immediately if any of these signs are present.

It’s crucial not to delay seeking emergency care if you or someone around you displays symptoms of this brain attack. Quick treatment is vital for survival and recovery.

If symptoms pass quickly, it could indicate a transient ischemic attack (TIA), a brief blockage of blood flow to the brain often preceding a stroke. Ignoring this warning sign is not advisable.

Getting to the hospital promptly is essential, as some treatments must commence within a few hours of symptom onset. Early intervention significantly improves the chances of preventing death or disability resulting from this brain attack.

Being prepared for emergencies can greatly impact outcomes. Consider the following:

• Familiarize yourself and your loved ones with the warning signs of a stroke.
• If you have any medical conditions, wear identification listing them, along with allergies and medications.
• Educate children on the FAST test, how to contact emergency services, provide your address, and describe the situation accurately.

Prevention of stroke

It is possible to prevent a significant portion of strokes, with up to 50% being preventable. By addressing and managing certain risk factors, individuals can reduce their likelihood of experiencing a stroke.

Controllable risk factors for stroke include:

1. High blood pressure: Keeping blood pressure within a healthy range is crucial for stroke prevention.
2. Atrial fibrillation: Managing irregular heartbeat reduces the risk of blood clots that can lead to stroke.
3. Uncontrolled diabetes: Proper management of blood sugar levels helps prevent complications that contribute to stroke risk.
4. High cholesterol: Lowering cholesterol levels through diet, exercise, and medication reduces the buildup of plaque in arteries.
5. Smoking: Quitting smoking significantly lowers the risk of stroke.
6. Excessive alcohol intake: Moderating alcohol consumption reduces stroke risk.
7. Obesity: Maintaining a healthy weight through diet and exercise lowers the risk of stroke.
8. Carotid or coronary artery disease: Treating these conditions helps prevent blockages that can lead to stroke.

While some risk factors cannot be controlled, such as age, gender, race, and family history of stroke, individuals can still take steps to manage their overall risk through regular medical check-ups and early intervention.

Transient ischemic attacks (TIAs), also known as “mini-strokes,” serve as warning signs for impending stroke and should not be ignored. Recognizing and reporting symptoms to a healthcare provider can lead to preventive measures being taken to reduce the risk of a full-blown stroke.

Regular check-ups with a doctor are essential for monitoring and managing risk factors before they become serious. By addressing controllable risk factors and staying vigilant for warning signs, individuals can significantly reduce their likelihood of experiencing a stroke.

Sources

• National Institute of Neurological Disorders and Stroke
• FamilyDoctor.org
• National Heart. Lung, and Blood Institute
• American Stroke Association
• American Academy of Family Physicians
• American Heart Association
• Neurology Today
• Lancet 
• CDC
• American Association of Neurologic Surgeons
• Cleveland Clinic
• Mount Sinai Hospital
• National Stroke Association
• The Internet Stroke Cente
• UpToDate: “Patient information
• Cedars Sinai
• American College of Cardiology
• American Society of Hematology