STROKE

What is Stroke
A stroke occurs when the blood supply to part of
the brain is suddenly interrupted or when a blood
vessel in the brain bursts, spilling blood into the
spaces surrounding brain cells. Brain cells die
when they no longer receive oxygen and
nutrients from the blood or there is sudden
bleeding into or around the brain. The symptoms
of a stroke include sudden numbness or
weakness, especially on one side of the body;
sudden confusion or trouble speaking or
understanding speech; sudden trouble seeing in
one or both eyes; sudden trouble with walking,
dizziness, or loss of balance or coordination; or
sudden severe headache with no known cause.
 Types of Stroke
1. Ischemic Stroke
Most strokes (85%) are ischemic
strokes. If you have an ischemic stroke,
the artery that supplies oxygen-rich
blood to the brain becomes blocked.
Blood clots often cause the blockages
that lead to ischemic strokes.
2. Hemorrhagic Stroke
A hemorrhagic stroke occurs when an
artery in the brain leaks blood or
ruptures (breaks open). The leaked
blood puts too much pressure on brain
cells, which damages them.
There are two types of hemorrhagic strokes:
• Intracerebral hemorrhage is the most common type of
hemorrhagic stroke. It occurs when an artery in the brain
bursts, flooding the surrounding tissue with blood.
• Subarachnoid hemorrhage is a less common type of
hemorrhagic stroke. It refers to bleeding in the area between
the brain and the thin tissues that cover it.

3. Transient Ischemic Attack (TIA)

A transient ischemic attack (TIA) is sometimes called a "mini-
stroke." It is different from the major types of stroke because
blood flow to the brain is blocked for only a short time—usually
no more than 5 minutes.
 Symptoms

• Sudden numbness or weakness of the face, arm or leg

(especially on one side of the body)
• Sudden confusion, trouble speaking or understanding
speech
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or
coordination
• Sudden severe headache with no known cause
 Risk Factors

1. Conditions
- High Blood Pressure
- High Cholesterol
- Heart Disease
- Diabetes
- Sickle Cell Disease
• High Blood Pressure
High Blood Pressure is a major risk factor for stroke. It occurs when
the pressure of the blood in your arteries and other blood vessels is
too high.

• High Cholesterol
Cholesterol is a waxy, fat-like substance made by the liver or found in
certain foods. If we take in more cholesterol than the body can use,
the extra cholesterol can build up in the arteries, including those of
the brain. This can lead to narrowing of the arteries, stroke, and other
problems.
• Heart Disease
Common heart disorders can increase your risk for stroke. For
example, coronary artery disease increases your risk for stroke
because plaque builds up in the arteries and blocks the flow of
oxygen-rich blood to the brain. Other heart conditions, such as heart
valve defects, irregular heartbeat (including atrial fibrillation), and
enlarged heart chambers, can cause blood clots that may break
loose and cause a stroke.

• Diabetes
Diabetes mellitus also increases the risk for stroke. Your body needs
glucose (sugar) for energy. Insulin is a hormone made in the
pancreas that helps move glucose from the food you eat to your
body's cells. If you have diabetes, your body doesn’t make enough
insulin, can’t use its own insulin as well as it should, or both.
• Sickle Cell Disease
Sickle cell disease is a blood disorder associated
with ischemic stroke that mainly affects black and Hispanic
children. The disease causes some red blood cells to form
an abnormal sickle shape. A stroke can happen if sickle
cells get stuck in a blood vessel and block the flow of
blood to the brain.
2. Behaviors
- Unhealthy Diet
- Physical Inactivity
- Obesity
- Too Much Alcohol
- Tobacco Use
• Unhealthy Diet
Diets high in saturated fats, trans fat, and cholesterol have been
linked to stroke and related conditions, such as heart disease. Also,
too much salt (sodium) in the diet can raise blood pressure levels.

• Physical Inactivity
Not getting enough physical activity can increase the chances of
having other risk factors for stroke, including obesity, high blood
pressure, high cholesterol, and diabetes. Regular physical activity
can lower your risk for stroke.

• Obesity
Obesity is excess body fat. Obesity is linked to higher "bad"
cholesterol and triglyceride levels and to lower "good" cholesterol
levels. In addition to heart disease, obesity can also lead to high
blood pressure and diabetes.
• Too Much Alcohol
Drinking too much alcohol can raise blood pressure levels and
the risk for stroke. It also increases levels of triglycerides, a form
of fat in your blood, which can harden your arteries.
Women should have no more than 1 drink a day.
Men should have no more than 2 drinks a day.

• Tobacco Use
Tobacco use increases the risk for stroke. Cigarette smoking can
damage the heart and blood vessels, which increases your risk
for stroke. Also, nicotine raises blood pressure, and carbon
monoxide reduces the amount of oxygen that your blood can
carry. Exposure to other people’s secondhand smoke can
increase the risk for stroke even for nonsmokers.
3. Family History and Other
Characteristics
- Genetics and Family History
- Other Characteristics

Age Sex Race or ethnicity

• Age.
Age is the single most important risk factor for stroke. The older you
are, the more likely you are to have a stroke. The chance of having a
stroke about doubles every 10 years after age 55. Although stroke is
common among the elderly, many people younger than 65 years also
have strokes.

• Sex.
Stroke is more common in men than in women for most age groups. But
women of all ages are more likely to die from stroke than are men.
Pregnancy and use of birth control pills pose special stroke risks for
women.

• Race or ethnicity.
Blacks, Hispanics, American Indians, and Alaska Natives have a greater
chance of having a stroke than do non-Hispanic whites or Asians. The
risk of having a first stroke is nearly twice as high for blacks than for
whites. Blacks are also more likely to die from stroke than are whites.
 Preventing Stroke

1. Healthy Living
- Healthy Diet
- Healthy Weight
- Physical Activity
- No Smoking
- Limited Alcohol
2. Other Medical Conditions
- Check Cholesterol
- Control Blood Pressure
- Manage Diabetes
- Manage Heart Disease
- Take Your Medicine
- Talk with Your Health Care Team
 Stroke Treatment
1. Stroke Prevention
Medical treatments may be used to control high blood
pressure and/or manage atrial fibrillation among high-risk patients.
Those medicines include:
• Anticoagulants/Antiplatelets
Antiplatelet agents such as aspirin and anticoagulants, such as
warfarin, interfere with the blood's ability to clot and can play an
important role in preventing stroke.
• Antihypertensives
Antihypertensives are medications that treat high blood pressure.
Depending on the type of medication, they can lower blood
pressure by opening the blood vessels, decreasing blood volume
or decreasing the rate and/or force of heart contraction.
Additionally, when arteries show plaque
buildup or blockage, medical procedures
may be needed. Such as:
• Carotid Endarterectomy
Carotid endarterectomy, also called
carotid artery surgery, is a procedure
in which blood vessel blockage (fatty
plaque) is surgically removed from the
carotid artery.
• Angioplasty/Stents
Doctors sometimes use balloon
angioplasty and implantable steel
screens called stents to treat
cardiovascular disease and help open
up the blocked blood vessel.
2. Ischemic Stroke Treatment
- tPA, the Gold Standard
The only FDA approved treatment for ischemic
strokes is tissue plasminogen activator (tPA, also known
as IV rtPA, given through an IV in the arm). tPA works by
dissolving the clot and improving blood flow to the part of
the brain being deprived of blood flow. If administered
within 3 hours(and up to 4.5 hours in certain eligible
patients), tPA may improve the chances of recovering
from a stroke. A significant number of stroke victims don’t
get to the hospital in time for tPA treatment; this is why it’s
so important to identify a stroke immediately.
 - Endovascular Procedures
Another treatment option is an endovascular procedure* called
mechanical thrombectomy, strongly recommended, in which trained
doctors try removing a large blood clot by sending a wired-caged
device called a stent retriever, to the site of the blocked blood vessel in
the brain. To remove the brain clot, doctors thread a catheter through
an artery in the groin up to the blocked artery in the brain. The stent
opens and grabs the clot, allowing doctors to remove the stent with the
trapped clot. Special suction tubes may also be used. The procedure
should be done within six hours of acute stroke symptoms, and only
after a patient receives tPA.
3. Hemorrhagic Stroke Treatment
- Endovascular Procedures
Endovascular procedures may be used to treat certain
hemorrhagic strokes similar to the way the procedure is used for
treating an ischemic stroke. These procedures are less invasive
than surgical treatments, and involve the use of a catheter
introduced through a major artery in the leg or arm, then guided to
the aneurysm or AVM; it then deposits a mechanical agent, such as
a coil, to prevent rupture.
- Surgical Treatment
For strokes caused by a bleed within the brain (hemorrhagic
stroke), or by an abnormal tangle of blood vessels (AVM), surgical
treatment may be done to stop the bleeding. If the bleed is caused by
a ruptured aneurysm (swelling of the vessel that breaks), a metal clip
may be placed surgically at the base of the aneurysm to secure it.
- Clinical Trials
Medical treatments continue to evolve and improve, thanks in
part to clinical trials (research). These are scientific studies that
determine if a possible new medical advance can help people and
whether it has harmful side effects.
 Source

• https://medlineplus.gov/stroke.html
• http://www.cdc.gov/stroke/
• http://www.ninds.nih.gov/disorders/stroke/stroke.htm