Brain Stroke, Causes, Symptoms, Treatment, And Prevention!
Brain Stroke Overview:
Stroke ranks as the fourth leading killer in the United States. A stroke can be devastating to individuals and their families, robbing them of their independence. It is the most common cause of adult disability.
Each year approximately 795,000 Americans have a stroke, with about 160,000 dying from stroke-related causes. Officials at the National Institute of Neurological Disorders and Stroke (NINDS) are committed to reducing that burden through biomedical research.
What is a Stroke?
A stroke, or “brain attack,” occurs when blood circulation to the brain fails. Brain cells can die from decreased blood flow and the resulting lack of oxygen.
There are two broad categories of stroke:
- Those caused by a blockage of blood flow,
- and those caused by bleeding into the brain.
A blockage of a blood vessel in the brain or neck called an ischemic stroke, is the most frequent cause of stroke and is responsible for about 80 percent of strokes.
These blockages stem from three conditions:
- the formation of a clot within a blood vessel of the brain or neck called thrombosis;
- the movement of a clot from another part of the body such as the heart to the brain called embolism;
- or a severe narrowing of an artery in or leading to the brain, called stenosis. Bleeding into the brain or the spaces surrounding the brain causes the second type of stroke, called a hemorrhagic stroke.
Two key steps you can take will lower your risk of death or disability from stroke: control stroke’s risk factors and know stroke’s warning signs. Scientific research conducted by the NINDS has identified warning signs and a large number of risk factors.
Warning Signs Of Stroke:
Warning signs are clues your body sends that your brain is not receiving enough oxygen. If you observe one or more of these signs of a stroke or “brain attack,” don’t wait, call a doctor!
Sudden:
- Numbness or weakness of the face, arm, or leg, especially on one side of the body.
- Confusion or trouble talking or understanding speech.
- Trouble seeing in one or both eyes.
- Trouble walking, dizziness, or loss of balance or coordination.
- Severe headache with no known cause.
Other danger signs that may occur include double vision, drowsiness, and nausea or vomiting. Sometimes the warning signs may last only a few moments and then disappear. These brief episodes, known as transient ischemic attacks or TIAs, are sometimes called “mini-strokes.”
Although brief, they identify an underlying serious condition that isn’t going away without medical help. Unfortunately, since they clear up, many people ignore them. Don’t. Paying attention to them can save your life.
The FAST test can help you remember what to do if you think someone may be having a stroke:
- F—Face: Ask the person to smile. Does one side of the face droop?
- A-Arms: Ask the person to raise both arms. Does one arm drift downward?
- S—Speech: Ask the person to repeat a simple phrase. Is their speech slurred or strange?
- T—Time: If you observe any of these signs, call 9-1-1 right away. Early treatment is essential.
If you think you or someone else is having a TIA or stroke, don’t drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room. During a stroke, every minute counts.
Type of Stroke:
1. Ischemic Stroke (Clots):
Ischemic stroke occurs when a vessel supplying blood to the brain is obstructed. It accounts for about 87 % of all strokes.
2. What is Hemorrhagic Stroke?
Hemorrhagic strokes make up about 13 % of stroke cases. They’re caused by a weakened vessel that ruptures and bleeds into the surrounding brain. The blood accumulates and compresses the surrounding brain tissue. The two types of hemorrhagic strokes are intracerebral (within the brain) hemorrhage or subarachnoid hemorrhage.
A hemorrhagic stroke occurs when a weakened blood vessel ruptures. Two types of weakened blood vessels usually cause hemorrhagic stroke: aneurysms and arteriovenous malformations (AVMs).
3. TIA (Transient Ischemic Attack):
Called a mini-stroke, it’s caused by a serious temporary clot. This is a warning sign of stroke and should be taken seriously. TIA is a temporary blockage of blood flow to the brain. Since it doesn’t cause permanent damage, it’s often ignored. But this is a big mistake. TIAs may signal a full-blown stroke ahead.
4. Cryptogenic Stroke:
In most cases, a stroke is caused by a blood clot that blocks the flow of blood to the brain. In some instances, despite testing, the cause of a stroke can’t be determined. This is called a cryptogenic stroke. In most cases, a stroke is caused by a blood clot that blocks blood flow to the brain. But in some instances, despite testing, the cause can’t be determined. Strokes without a known cause are called cryptogenic.
Possible Hidden Causes of Stroke:
- Irregular heartbeat (atrial fibrillation) – AFib patients are at 5 times greater risk for stroke.
- Heart structure problem (such as Patent Foramen Ovale).
- Hardening of the arteries (Large Artery Atherosclerosis).
- Blood clotting disorder (Thrombophilia).
Causes:
There are two main types of stroke that have different causes. Ischemic strokes are caused by a blockage of a blood vessel. Hemorrhagic strokes are caused by sudden bleeding in the brain. Sometimes the doctor may not be able to figure out the cause of your stroke.
I. Ischemic stroke:
Ischemic strokes are usually caused by a piece of or a blood clot that blocks blood flow to the brain.
A. Plaque buildup:
When a fatty substance called plaque builds up on the inner walls of the arteries, it can lead to a disease called atherosclerosis. Plaque hardens and narrows the arteries, which limits blood flow to tissues and organs.
Plaque can build up in any artery in the body, including arteries in the brain and neck. Carotid artery disease is when plaque builds up in the carotid arteries in the neck that supply blood to the brain. It is a common cause of ischemic stroke.
Blood clots in the brain or elsewhere in the body:
Plaque in an artery can break open. Blood stick to the site of the plaque injury and clump together to form blood clots. These clots can partly or fully block an artery.
A blood clot that forms in one part of the body can also break loose and travel to the brain. This type of ischemic stroke is called an embolic stroke. Certain heart and blood conditions, such as atrial fibrillation and sickle cell disease, can cause blood clots that lead to stroke.
B. Inflammation:
Chronic (long-term) contributes to ischemic stroke. Researchers are still trying to understand this fully. We know that inflammation can damage the blood vessels and contribute to atherosclerosis, however. In addition, ischemic stroke can lead to inflammation that further damages brain cells.
II. Transient ischemic attack:
A transient ischemic attack (TIA) is caused by a blockage in the brain just like an ischemic stroke. But the blockage breaks up before there is any damage to your brain. It typically lasts less than an hour but can come and go. Eventually, it can progress to a full stroke. A TIA is also called a mini-stroke.
Sudden bleeding can cause a hemorrhagic stroke. This can happen when an artery in or on top of the brain breaks open. The leaked blood causes the brain to swell, putting pressure on it that can damage brain cells.
Some conditions make blood vessels in the brain more likely to bleed.
- An aneurysm is a balloon-like bulge in an artery that can stretch and burst.
- Arteriovenous malformations (AVMs) are tangles of poorly formed arteries and veins that can break open in the brain.
- High blood pressure puts pressure on the inside walls of the arteries. This pressure makes them more likely to break open, especially when they are weakened because of an aneurysm or AVM.
Complications:
A stroke can cause lasting brain damage, long-term disability, or even death. When you have a stroke, your doctor may rate how severe it is. A more severe stroke means more brain tissue was damaged. When there has been significant damage, your doctor may call it a massive stroke. This can mean more severe complications.
After having a stroke, you may develop complications such as:
- Dangerous blood clots. Being unable to move around for a long time can raise your risk of developing blood clots in the deep veins of the legs. In some cases, blood clots can break loose and travel to the lungs. Your stroke care team may try to prevent these complications with medicine or a device that puts pressure on your calves to keep your blood flowing.
- Difficulty speaking. If a stroke affects the muscles you use to speak, you may have trouble communicating as easily as before.
- Loss of bladder or bowel control. Some strokes affect the muscles used to urinate and have bowel movements. You may need a urinary catheter (a tube placed into the bladder) until you can urinate on your own. The use of these catheters can lead to urinary tract infections. You may also lose control of your bowels or be constipated.
- Loss of bone density or strength. This usually happens on one side of the body. Physical activity as part of rehabilitation can help prevent this loss. Your care team may also evaluate you for osteoporosis.
Also,
- Loss of vision, hearing, or touch. Your ability to feel pain or temperature may be affected after a stroke, or you may have trouble seeing or hearing as well as before. Some of these changes could affect your ability to cook, read, change your clothes, or do other tasks.
- Muscle weakness or inability to move. A stroke can make your muscles become weak and stiff or cause them to spasm. This can be painful or make it hard to stand or walk around on your own. You may also have problems with balance or controlling your muscles. This puts you at risk of falling.
- Problems swallowing and pneumonia. If a stroke affects the muscles used for swallowing, you may have a hard time eating or drinking. You may also be at risk of inhaling food or drink into your lungs. If this happens, you may develop pneumonia.
- Problems with language, thinking, or memory. Stroke may affect your ability to focus on a task or make decisions quickly. It also raises the risk of dementia.
- Seizures. This is more common in the weeks after a stroke and is less likely as time goes on. If you have seizures, your stroke team may give you medicine.
- Swelling in the brain. After a stroke, fluid may build up between the brain and the skull or in the cavities of the brain, causing swelling. Doctors may drain fluid from the brain or cut away part of the skull to relieve the pressure on your brain.
Risk Factors for a Stroke?
A risk factor is a condition or behavior that occurs more frequently in those who have or are at greater risk of getting, a disease than in those who don’t. Having a risk factor for stroke doesn’t mean you’ll have a stroke. On the other hand, not having a risk factor doesn’t mean you’ll avoid a stroke. But your risk of stroke grows as the number and severity of risk factors increases.
Some factors for stroke can’t be modified by medical treatment or lifestyle changes.
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Age:
- A stroke occurs in all age groups. Studies show the risk of stroke doubles for each decade between the ages of 55 and 85. But strokes also can occur in childhood or adolescence. Although stroke is often considered a disease of aging, the risk of stroke in childhood is actually highest during the perinatal period, which encompasses the last few months of fetal life and the first few weeks after birth.
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Gender:
- Men have a higher risk for stroke in young and middle age, but rates even out at older ages, and more women die from stroke. Men generally do not live as long as women, so men are usually younger when they have their strokes and therefore have a higher rate of survival.
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Race:
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- People from certain ethnic groups have a higher risk of stroke. For African Americans, stroke is more common and more deadly—even in young and middle-aged adults—than for any ethnic or another racial group in the United States.
- Studies show that the age-adjusted incidence of stroke is about twice as high in African Americans and Hispanic Americans as in Caucasians, and while stroke incidence has declined for whites since the 1990s, there has not been a decline for Hispanics or black Americans.
- An important risk factor for African-Americans is sickle cell disease, which can cause a narrowing of arteries and disrupt blood flow. The incidence of the various stroke subtypes also varies considerably in different ethnic groups.
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Family history of stroke:
- Stroke seems to run in some families. Several factors may contribute to familial stroke. Members of a family might have a genetic tendency for stroke risk factors, such as an inherited predisposition for high blood pressure (hypertension) or diabetes. The influence of a common lifestyle among family members also could contribute to familial stroke.
Other risk factors for stroke-some of which you can control-include:
- Anxiety, depression, and high-stress levels. Working long hours and not having much contact with friends, family, or others outside the home are also linked with a higher risk of stroke.
- Living or working in areas with air pollution.
- Other medical conditions, such as certain bleeding disorders, sleep apnea, kidney disease, migraine headaches, and sickle cell disease.
- Blood-thinners or other medicines can lead to bleeding.
- Other unhealthy lifestyle habits, including eating unhealthy foods, not getting regular physical activity, drinking alcohol, getting too much sleep (more than 9 hours), and using illegal drugs such as cocaine.
- Overweight and obese or carrying extra weight around your waist and stomach.
Treatment Options:
ischemic stroke Treatment:
Treatment for an ischemic stroke or transient ischemic (TIA) may include medicines and medical procedures.
Medicines:
- The main treatment for an ischemic stroke is a medicine called tissue plasminogen activator (tPA).
- It breaks up the blood clots that block blood flow to your brain. A doctor will inject tPA into a vein in your arm.
- This type of medicine must be given within 3 hours after your symptoms start.
- In some cases, it is given up to 4.5 hours.
- The sooner treatment begins, the better your chances of recovery.
If you cannot have tPA, your doctor may give an anticoagulant or blood-thinning medicine, such as aspirin or clopidogrel. This helps stop blood clots from forming or getting larger. The main side effect of these medicines is bleeding.
Medical procedures:
You may need a procedure to open up blocked arteries and restore blood flow to the brain. This can be done in several ways.
A thrombectomy removes the clot from the blood vessel. A surgeon will put a long, flexible tube called a catheter into your groin (upper thigh) and thread it to the blocked artery in your neck or brain. They will then use angioplasty and stenting or a device called a stent retriever to open up the blocked artery.
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Angioplasty and stenting procedures:
- use a thin tube to deliver a balloon or small mesh tube into the artery. Inflating the balloon or expanding the mesh tube clears space for blood to flow more easily to the brain.
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The stent retriever is:
- a wire mesh inside the catheter that traps the clot. The stent retriever and the blood clot are then pulled out through the tube.
If carotid artery disease caused your stroke, your doctor may suggest carotid endarterectomy, a surgery to remove plaque from the carotid artery in your neck. Visit our Carotid Artery Disease Health Topic to learn more about how these procedures work.
Hemorrhagic stroke Treatment:
Hemorrhagic stroke can happen suddenly and grow worse quickly. Just as with an ischemic stroke, getting treatment as quickly as possible is essential for a full recovery. The type of treatment you receive depends on what part of your brain is bleeding and how severe it is.
Medicines:
You may be given blood pressure medicine to lower the pressure and strain on blood vessels in the brain. You will also be taken off any anticoagulant or blood-thinning medicines that may have led to bleeding. Depending on the type of medicine you were taking, you may be given vitamin K to help stop bleeding.
Medical procedures:
Procedures may include:
- Aneurysm clipping block off the aneurysm from the blood vessels in the brain. This surgery helps stop bleeding from an aneurysm. It can also help prevent the aneurysm from bursting again. During the procedure, a surgeon places a tiny clamp at the base of the aneurysm.
- Coil embolization to block blood flow to or seal an aneurysm. The surgeon will insert a tube called a catheter into an artery in the groin. He or she will thread the tube to the aneurysm in your brain. A tiny coil will be pushed through the tube and into the aneurysm. The coil will cause a blood clot to form, which will block blood flow through the aneurysm and prevent it from bursting again.
- Blood transfusion
- Draining excess fluid that collects in the brain. Fluid can build up after a stroke, pushing the brain against the skull and causing damage. Draining the fluid can relieve that pressure.
- Surgery or radiation to remove or shrink an arteriovenous malformation (AVM). An AVM is a tangle of arteries and veins that can break open in the brain.
- Surgery to remove pooled blood. Typically, the stroke team will use surgery only if you show signs of getting worse.
- Surgery to temporarily remove part of the skull if you have a lot of swelling. This allows room for the brain to swell without putting pressure on the brain.
Other care you may receive in the hospital:
In addition to treating the blockage or bleeding causing the stroke, your healthcare team may suggest additional treatments or tests.
- Breathing support. If your stroke makes it difficult to breathe or your oxygen levels are low, you may receive ventilator support.
- Compression therapy. A sleeve can be placed on your leg and filled with air to reduce the risk of venous thromboembolism.
- Feeding tube. If it is difficult for you to swallow on your own, your team may set up a feeding tube to provide you with nutrients.
- Fluids. If you have low blood pressure or low blood volume, you may get fluids to restore proper levels.
- Medicine to reduce fever. Your team will monitor your body temperature and may give you acetaminophen or another medicine to reduce fever and prevent additional brain damage.
- Rehabilitation plan. Before you leave the hospital, your medical team will test how well you can speak, swallow, and walk. You and your medical team can work together to set up a rehabilitation plan.
- Skincare. To prevent skin irritation or sores from forming, your team will help make sure that you have enough cushioning, your skin stays dry, and that you change positions often if you cannot move well on your own.
Stroke is a life-threatening condition that can cause severe disability. or care may help some patients have a better quality of life with fewer symptoms.
Canes, braces, grab bars, special eating utensils, wheelchairs, and other devices can make it easier to keep doing your regular activities after a stroke.
Take care of your mental health:
After a stroke, you may have changes in your behavior or judgment. For example, your mood may change quickly. Because of these and other changes, you may feel scared, anxious, and depressed. Recovering from a stroke can be slow and frustrating. Some people develop symptoms of post-traumatic stress disorder (PTSD).
Talk about how you feel with your healthcare team. Your doctor may recommend:
- Joining a patient support group which may help you adjust to life after a stroke. You can see how other people manage similar symptoms and their conditions. Talk with your doctor about local support groups or check with an area medical center.
- Medicines, such as antidepressants, or other treatments that can improve your quality of life.
- Support from family and friends, which can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you.
Learn the warning signs of serious complications and have a plan
The most common side effect of taking blood thinners to reduce your stroke risk is bleeding. This happens if the medicine thins your blood too much. This side effect can be life-threatening. Bleeding can occur inside your body cavities or from the surface of your skin.
Know the warning signs of bleeding so you can get help right away. They include:
- Blood in your urine, bright red blood in your stools, or black tarry stools
- Bright red vomit or vomit that looks like coffee grounds
- Increased menstrual flow
- Pain in your abdomen or severe pain in your head
- Unexplained bleeding from the gums and nose
- Unexplained bruising or tiny red or purple dots on the skin
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Disclaimer: “Nothing in this article makes any claim to offer cures or treatment of any disease or illness. If you are sick please consult with your doctor.”
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