Stroke (patient information)

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 * Associate Editor(s)-In-Chief: Jinhui Wu, M.D.

Overview
A stroke is an interruption of the blood supply to any part of the brain. A stroke is sometimes called a "brain attack."

What are the symptoms of stroke?
Symptoms of stroke depends on the location and the area the brain damage. Small strokes may not cause any symptoms. According to The U.S. National Institute of Neurological Disorders and Stroke (NINDS), there are five major signs of stroke as the following.


 * 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

Other diseases with similar symptoms are:
 * Brain tumors
 * Brain abscess
 * Migraine headache
 * Head trauma
 * Meningitis
 * Encephalitis
 * Subarachnoid hemorrhage
 * An overdose of certain medications
 * An imbalance of electrolyte or glucose in the body, such as hyponatremia, hypoglycemia

What causes Stroke?
Stroke is the emergence condition of brain. There are two types of stroke: ischemic stroke and hemorrhagic stroke. Ischemic stroke occurs when the arteries to your brain are narrowed or blocked, causing severely reduced blood flow. While hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. About 80 percent of strokes are ischemic strokes. Clinial studies show that the common risk factors of stroke are hypertension, diabetes, obesity and smoking. According to The U.S. National Institute of Neurological Disorders and Stroke (NINDS), five major signs of stroke are five “sudden”: 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. Nervous system physical examination and head images may help diagnose. Treatment of ischemic stroke includes anti-platelet drugs, anticoagulants, and carotid endarterectomy. For patients with hemorrhagic stroke, surgery may be recommeded to treat these disorders or prevent another one. Rehabilitation is needed for patients to recover the functions lost. The prognosis of stroke depends on the location and area the brain damage, the time from onset to emergence department, the complications and the treatment effect of the rehabilitation. Measurements such as keep a healthy lifestyle, control hypertension and diabetes may decrease your risk of stroke.

Who is at highest risk?

 * Hypertension
 * Heart disease,such as coronary artery disease, rheumatic heart disease
 * Diabetes
 * High cholesterol
 * Smoking
 * Increasing age

When to seek urgent medical care?
A stroke is a medical emergency. Anyone suspected of having a stroke should be taken to a medical facility immediately for evaluation and treatment.

Diagnosis

 * Physical examination, especially examination on nervous system.
 * Computerized tomography (CT): In order to determine the cause of a suspected stroke, a CT scan of the brain is often performed. It can detect bleeding or masses within the brain, which is a much different situation than stroke. Also, CT scan can help differentiate stroke from other brain diseases, such as brain tumor, brain abscess.
 * MRI scan: Magnetic resonance imaging (MRI) uses magnetic waves rather than x-rays to image the brain. It can supply more detailed than those from CT, but this is not a first line test in stroke because an MRI may take more than an hour to complete.
 * MRA (magnetic resonance angiogram): MRA is a procedure to use a specifically view the blood vessels non-invasively (without using tubes or injections) with MRI. Doctors can get more information from this test.
 * Angiogram: An angiogram is an invasive procedure that is sometimes used to view the blood vessels. During this procedure, a long catheter tube is inserted into an artery (usually in the groin area) and dye is injected while x-rays are simultaneously taken. Now angiogram is replaced by computerized tomography with angiography.
 * Computerized tomography with angiography: With the guide of CT, the doctor uses the dye that is injected into a vein in the arm, to image the blood vessels in the brain. This procedure can give information regarding aneurysms or arteriovenous malformations. As well, other abnormalities of brain blood flow may be evaluated.

Treatment options
Treatment of stroke depends on the type.

Treatment of ischemic stroke

The goal of the treatment of ischemic stroke is to restore blood flow to your brain as soon as possible. Quick treatment not only improves your chances of survival, but may also reduce the amount of complications resulting from the stroke.
 * Medications: Medications, such as aspirin, warfarin or heparin, may be proven immediate treatment after a stroke to reduce the likelihood of having another stroke. Tissue plasminogen activator (TPA) is a potent clot-busting drug that helps some people who have had stroke recover more fully. These drugs are forbiddened to people who are having a hemorrhagic stroke.
 * Surgery: Surgical procedure including carotid endarterectomy, angioplasty and stents, can be used to open up an artery that's moderately to severely narrowed by plaques.
 * Carotid endarterectomy: In this procedure, a surgeon opens the blocked artery and removes plaques that block the carotid arteries that run up both sides of your neck to your brain. The procedure may reduce your risk of ischemic stroke.
 * Angioplasty and stents: In this procedure, the doctor put a balloon-tipped catheter into the obstructed area of your artery. When the balloon is inflated, compressing the plaques against your artery walls. Then the stent is usually left in the artery to prevent recurrent narrowing.

Treatment of hemorrhagic stroke Most hemorrhagic stroke is associated with aneurysm and arteriovenous malformation (AVM). Surgery may be recommeded to treat these disorders or prevent another one. The most common procedures include aneurysm clipping, aneurysm embolization and arteriovenous malformation removal.
 * Aneurysm clipping
 * Coiling (aneurysm embolization)
 * Surgical arteriovenous malformation (AVM) removal

Recovery and rehabilitation

The physiatrist will help you recover the skills you may have lost, such as walking, communicating, or keeping balance or coordination. The rehabilitation is very important because the effect of rehabilitation determines the life quality of you and your family in the furture.

Where to find medical care for stroke?
Directions to Hospitals Treating stroke

Prevention of Stroke

 * Keep a good lifestyle: Avoidance of smoking, have a healthy diet, do regular exercise to control your weight.
 * Treatment your hypertension, diabetes and atherosclerosis
 * Preventive medications
 * Anti-platelet drugs, such as aspirin, clopidogrel or ticlopidine
 * Anticoagulants, such as heparin and warfarin

What to expect (Outlook/Prognosis)?
The prognosis of stroke depends on:
 * The location and the area of the brain damage: If a large area of hemorrhagic stroke is near brain axis, the patient has a high life-threatening risk.
 * The time from onset to emergence department: The faster to sent the patient to the hospital after onset, the better outcome will get.
 * Whether the patient is accompanied with the complications or not
 * The treatment effect of the rehabilitation: This determines the life quality of the patient and his/her family in the furture.

Possible complications

 * Breathing food into the airway (aspiration)
 * Decreased life span
 * Difficulty communicating
 * Fractures
 * Malnutrition
 * Muscle spasticity
 * Permanent loss of brain functions
 * Permanent loss of movement or sensation in one or more parts of the body
 * Problems due to loss of mobility, including joint contractures and pressure sores
 * Reduced ability to function or care for self
 * Reduced social interactions
 * Side effects of medications