A stroke, or cerebrovascular accident (CVA), is an event in which blood flow to an area of the brain is interrupted.
Most strokes are caused by artery disease and/or high blood pressure. Most often, a blood vessel (artery) taking blood to the brain becomes blocked or starts bleeding. This blockage is usually due to a blood clot (thrombus). This type of blockage is an ischemic stroke. A torn or burst blood vessel may also cause bleeding in the brain. This type is called a hemorrhagic stroke.
Plaques or clots in large arteries of the neck may cause warning signs called mini-strokes, or transient ischemic attacks (TIAs), and strokes, when they break away and block a blood vessel in the brain, temporarily stopping blood flow to an area of the brain. Plaque is made of fatty material that sticks to blood vessel walls.
Symptoms tend to occur suddenly and almost always affect only one side of the body. They are usually worst in the first 24 to 72 hours. Common symptoms include weakness or numbness of face, arm, and leg muscles and difficulty speaking or swallowing. Others are confusion, vision changes, dizziness, and loss of balance. TIA symptoms usually disappear in a few hours. Most last less than 10 minutes. Those lasting longer than 24 hours are called strokes.
The type of symptoms from a stroke depend on the area of the brain that is damaged. Serious strokes can cause extensive paralysis and loss of speech. Less serious strokes may not become apparent for several days.
The health care provider will suspect stroke, based on the medical history and physical examination. Computed tomography (CT) or magnetic resonance imaging (MRI) of the brain will be done to further evaluate the area of the brain involved in the stroke and to determine if the stroke is due to a blood clot or a burst blood vessel. A study of the heart’s electrical activity (electrocardiogram, or ECG) will be done to rule out irregular heartbeat (atrial fibrillation), which may cause a stroke by promoting the development of blood clots in the heart that can travel to the brain and cause a stroke.
An ultrasound of the carotid arteries in the neck may be done to look for a blockage of the arteries supplying blood to the brain.
The type of stroke determines the treatment. However, survival may depend on an immediate visit to the hospital emergency department. There, a potent blood thinner may be given to people with ischemic strokes. This drug, tPA, can dissolve a clot, although certain risks (e.g., bleeding in the brain) are related to it. The emergency room health care provider, in consultation with a specialist of the nervous system (neurologist), will determine if this medication is appropriate depending on the type of stroke, elapsed time from beginning of the symptoms, and other criteria. Surgery may be necessary in some types of hemorrhagic strokes.
A stroke may have mild to severely disabling effects. How much ability one can recover may not be known for several months. Many people need rehabilitation, such as speech therapy, physical therapy, and occupational therapy.
Treatment must also target conditions such as high blood pressure, diabetes, tobacco use, lifestyle, and high cholesterol levels. Also, other strokes must be prevented by reducing or eliminating the cause(s) of the initial stroke. Many people can do this by using drugs to prevent blood clots from forming. Often, taking a small amount of aspirin each day will do this. Other people must control high blood pressure and reduce other risk factors for stroke, such as diabetes, high cholesterol levels, smoking, and being overweight.
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Copyright © 2016 by Saunders, an imprint of Elsevier, Inc.
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