Signs and Symptoms

Symptoms of stroke appear suddenly. If you notice any of these signs and symptoms, seek emergency medical help immediately for yourself or for someone you are with.

• Numbness or weakness of the face, arm, or leg, especially on one side of the body
• Confusion, trouble talking, or difficulty understanding speech
• Trouble seeing in one or both eyes
• Trouble walking, dizziness, or loss of balance or coordination; sudden severe headache with no known cause

What Causes It?

Ischemic stroke results from the following causes.

• A clot (embolus) forms in a part of the body other than the brain, travels through blood vessels, and becomes wedged in a brain artery.
• A blood clot (thrombus) forms in a brain artery and stays attached to the artery wall until it grows large enough to block blood flow

Hemorrhagic stroke results from the following causes.

• A bleeding aneurysm—a weak or thin spot on an artery wall that over time has stretched or
• ballooned out under pressure from blood flow. The wall ruptures and blood spills into the
• space surrounding brain cells.
• Artery walls lose their elasticity and become brittle and thin, prone to cracking
• Arteriovenous malformation (AVM)—a tangle of defective blood vessels and capillaries within the brain that have thin walls that can rupture

Who's Most At Risk?

Individuals with the following characteristics or health conditions are at a higher-than-average risk for developing a stroke.

• More men suffer strokes than women
• African or Japanese Americans are at higher risk
• TIAs, history of stroke
• Age (risk increases with age)
• Hypertension
• Heart disease
• Traumatic injury
• Substance abuse (cocaine, alcohol)
• High total serum cholesterol (for older patients)
• Diabetes
• Increased blood viscosity (thickness)
• Use of oral contraceptives, especially in smokers
• Smoking

What to Expect at Your Provider's Office

If you or someone you know experiences symptoms associated with stroke, call 911 emergency immediately. There are now effective therapies for stroke that must be administered at a hospital within the first three hours after stroke symptoms appear. At the hospital, a health care provider will make a diagnosis and guide you in determining which treatment or combination of therapies will work best for you. He or she will do a complete neurological exam and run a battery of tests, such as blood tests, an electrocardiogram, and a test to measure the severity of the stroke. Imaging techniques such as CT scans, magnetic resonance imaging (MRI), and magnetic resonance angiography (MRA) may be used to reveal the cause of the stroke and pinpoint blockages or reveal malformations.

Treatment Options

Prevention Daily use of aspirin may reduce recurrence of stroke. Proper treatment of conditions that lead to stroke, such as atrial fibrillation or diabetes, can also reduce the risk of having one.

Treatment Plan

The primary goal in treating stroke patients is to prevent any neurological impairment from becoming irreversible. The therapeutic window is extremely short, making it crucial for an individual to seek treatment immediately upon noticing signs or symptoms.

Drug Therapies

A wide range of therapeutic measures may be administered to stroke patients, depending on the type and location of stroke and the extent of damage suffered. Many of these involve restoring proper blood flow to the brain.

Your provider may also prescribe medications, such as the following.

• Antithrombotics, to prevent the formation of blood clots that can become lodged in a cerebral artery and cause strokes; these include antiplatelet drugs and anticoagulants.
• Thrombolytic agents, to halt the stroke by dissolving the blood clot that is blocking blood flow to the brain.
• Neuroprotectants, to protect the brain from secondary injury caused by stroke

Surgical and Other Procedures

Surgery can be used to prevent stroke, to treat acute stroke, or to repair vascular damage or malformations in and around the brain. There are two major types of surgery for stroke prevention and treatment.

• Carotid endarterectomy involves removing fatty deposits (plaque) from the inside of one of the carotid arteries, which are located in the neck and are the main suppliers of blood to the brain.
• EC/IC bypass surgery restores blood flow to a blood-deprived area of brain tissue by rerouting a healthy artery in the scalp to the area of brain tissue affected by a blocked artery.

Complementary and Alternative Therapies The goals of complementary and alternative therapies are to prevent strokes, treat risk factors (hypertension, diabetes, and cardiovascular disease), and prevent recurrences. Nutrition

Nutritional tips include the following.

• Eat a diet high in fiber, potassium, and magnesium
• Decrease saturated fats and sodium
• Avoid alcohol (it increases risk of hemorrhagic stroke)
• Use garlic and onion (help regulate lipids and prevent atherosclerosis, which is fat deposits inside the arteries)

Potentially beneficial nutritional supplements include the following.

• Folate (400 to 800 IU a day)
• Essential fatty acids; a mix of omega-6 (evening primrose) and omega-3 (flaxseed) may be optimal (2 tablespoons oil a day or 1,000 to 1,500 IU two times a day)
• Vitamin E: 400 to 1,600 IU a day
• Coenzyme Q10: 10 to 50 mg a day
• Vitamin C: 250 to 500 mg two times a day
• Bromelain: 250 mg three times a day between meals

Herbs

The use of certain herbal remedies may be helpful.

• Gingko biloba, for depression and/or dementia following a stroke (60 to 80 mg three times a day). It may also be used for arterial occlusive disease. For hemorrhagic stroke patients, check with your health care provider before using.
• Hawthorn (Crataegus species), for heart and vascular conditions
• Mistletoe (Viscum album), to treat and prevent atherosclerosis

Herbs may be used as dried extracts (pills, capsules, or tablets), teas, or tinctures (alcohol extraction, unless otherwise noted). Dose for teas is 1 heaping tsp. herb/cup water steeped for 10 minutes (roots need 20 minutes).

Homeopathy

An experienced homeopath can prescribe a regimen for treating stroke that is designed especially for you. Some of the most common acute remedies are listed below.

• Acontitum napellus for numbness and/or paralysis after a cerebral accident
• Belladonna for stroke that leaves person very sensitive to any motion, with vertigo and trembling
• Kali bromatum for stroke resulting in restlessness, wringing of the hands or other repeated gestures, insomnia, and night terrors
• Nux vomica for cerebral accident with paresis (muscular weakness caused by disease of the nervous system), expressive aphasia (language disorder), convulsions, and great irritability

Acute dose is three to five pellets of 12X to 30C every one to four hours until symptoms are relieved.

Acupuncture

Many studies have been conducted on the effects of acupuncture during stroke rehabilitation. These studies have found that acupuncture reduces hospital stays and improves recovery speed. Acupuncture has been shown to help stroke patients regain motor and cognitive skills and to improve their ability to manage daily functioning. Based on the available data, the National Institutes of Health recommended acupuncture as an alternative or supplemental therapy for stroke rehabilitation. In general, the evidence indicates that acupuncture is most effective when initiated as soon as possible after a stroke occurs, but good results have been found for acupuncture started as late as six months following a stroke.

People who have suffered a stroke often have a deficiency of qi in the liver meridian and a relative excess in the gallbladder meridian. In addition to a primary needling treatment on the liver meridian and the supporting kidney meridians, moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points) may be used to enhance therapy. Treatment may also include performing acupuncture on affected limbs. Certain scalp acupuncture techniques that have been developed by Chinese, Korean, and Japanese practitioners also show promise.

Chiropractic

Chiropractors do not treat stroke, and high velocity manipulation of the upper spine is considered inappropriate in individuals who are taking blood-thinning medications or other medications used to reduce the risk of stroke. It should also be noted that chiropractic spinal manipulation of the neck is associated with an exceedingly small risk of stroke (0.5 strokes reported per 2 million spinal manipulations).

Prognosis/Possible Complications

There are many possible complications associated with stroke.

• Seizures
• Paralysis
• Cognitive (thinking) deficits
• Speech problems
• Emotional difficulties
• Daily living problems
• Pain

About 70 percent of stroke sufferers survive. They often undergo a long period of rehabilitation, involving physical and occupational therapies. About 80 percent of stroke patients can walk and 60 percent achieve self-care, while 25 percent experience moderate to severe impairment.

Following Up

Following hospitalization, stroke patients must be carefully monitored for potential recurrence.

Source: www.mdconsult.com

Exams and Tests

Diagnosis of a stroke is based on a medical history and physical exam. However, it is not always easy for people to recognize symptoms of a small stroke. The symptoms of stroke may be attributed to the normal aging process or confused with other conditions that cause similar symptoms.

If stroke is suspected, the doctor will want to do one or both of the following tests to determine whether the stroke was caused by a clot (ischemic stroke) or from bleeding (hemorrhagic stroke) inside the brain.

• Cerebral computed tomography (CT) scan
• Magnetic resonance imaging (MRI)

ACT scan or MRI may not be able to accurately identify the exact location and amount of brain damage caused by a clot (ischemic stroke) within the first few hours after a stroke. The doctor may do additional tests, depending on the results of the CT scan or MRI.

If disease or narrowing of one of the large arteries in the neck (carotid arteries) is suspected, the following tests may be done:

• Carotid ultrasonography/doppler scanning
• Magnetic resonance angiography (MRA)
• Carotid arteriography

If a stroke is thought to be caused by a clot that formed in the heart, the following tests may be done:

• Chest X-ray
• Electrocardiography (ECG, or EKG)
• Echocardiography
• Holter monitoring or telemetry

Other laboratory tests may be done to determine if other conditions are present, to check the person's overall health, and to determine if a person's blood clots too easily. Early Detection

There is no screening for stroke at this time, but there is screening for many of the risk factors. See the topics High Blood Pressure (Hypertension), Type 1 Diabetes, Type 2 Diabetes, High Cholesterol, and Coronary Artery Disease and Stable Angina

Home Treatment

If you think that you may be having a stroke, seek emergency medical care immediately. Home treatment is not appropriate. Prompt early treatment may prevent permanent brain damage and the disability that comes with it.

If you have had a stroke, you may need to use some assistive devices to help you at home. Assistive devices can be used to help you:

Eat. Large-handled silverware can be easier to grab and use if you have a weak hand.

Get dressed. Devices called reachers can help put on socks or stockings if you have weakness in one arm or hand.

Walk. Canes and walkers can be used to help prevent falls.

• Tips for a successful recovery
• Take care of yourself.
• Take care of yourself after a stroke
• After a stroke, keep in mind that you are the most important person in your own recovery. You need to have a major say in the decisions about your care. This may be hard for you, and you may sometimes feel like sitting back and letting others take charge.

Make sure others understand that you want to be involved in the decisions about your care.

State your wishes and opinions on matters that affect you. Talk with your health professional about your concerns. Ask questions.

If you need extra time to think or you have trouble talking, try not to let others make decisions for you without hearing what you have to say.

If you have a speech problem, it may be hard to get others to understand your wishes. Ask someone to help you express your ideas and needs.

If you feel that anyone is “talking down” to you, speak up. Also, speak up if you feel someone is talking about you as if you were not present.

Recognize and deal with depression.

Recognize and deal with depression after a stroke

It is normal for a person who has had a stroke to feel sad about the disabilities caused by the stroke. Some people who have a stroke become depressed. Depression is a serious condition that needs treatment

People who are depressed feel negative, hopeless, or "down in the dumps" and have a noticeable loss of interest or pleasure in almost all activities. People who are depressed may also:

• Lose or gain weight.
• Have decreased or increased appetite.
• Have difficulty falling asleep or sleep too much. They usually feel tired all the time.
• Feel worthless or very guilty.
• Be more irritable or angry.
• Be unable to concentrate, remember, or make decisions as well as they did before the stroke.
• Have recurring thoughts of death or suicide. If you have thoughts of death and suicide, seek medical help right away.

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