Stroke: What to Know, Signs and SymptomsheadingContent

Posted on July 28, 2016

brain image that looks like circuit boardDid you know that up to 80 percent of strokes are preventable? A stroke is the lack of blood supply and oxygen to the brain cells. Once a stroke happens, the brain neurons affected by the stroke, are dead.

There are two types of strokes. What are they and what are the warning signs?

An ischemic stroke is when a blood clot blocks the blood vessels and part of the brain starts dying or losing blood and oxygen. Hemorrhagic stroke is another type of stroke. A hemorrhagic stroke occurs when a blood vessel ruptures and there is bleeding into the brain.

The symptoms can be varied depending on location of the blockage. Classic symptoms can include weakness on one side, loss of coordination, facial weakness or numbness and slurred speech. Visual aberration, where the patient can only see to one side of the visual field, could also be a symptom of a stroke.

Strokes in the back of the brain have symptoms, which can result in double-vision and dizziness. People sometimes think they were just dizzy and seek medical attention. Sometimes, a stroke in the back part of the brain can be very small, but even a small stroke in that area could be devastating if not detected early enough.

How are hemorrhage and ischemic strokes treated?

If there is a large amount of bleeding in the brain caused by a hemorrhagic stroke a neurologist will call a neurosurgeon to provide treatment. If the hemorrhage stroke is small and there is no damage to the underlying brain, a neurologist will closely monitor the stroke. A patient suffering from a small hemorrhagic stroke may recover completely.

With an ischemic stroke, brain cells die. As a neurologist, there are different diagnostic studies we can do. When a visible blood clot is seen in the brain on an MRI or CT scan, a neurologist may call in a neurointerventionalist (interventional neurologist) to treat the stroke. The interventional neurologist may intervene by injecting tPA (tissue plasminogen activator), which is a blood clot buster, or they can mechanically extract the clot.

When the interventional neurologist sees the patient, the neurologist follows the patient’s progress. Typically, if the patient presents with an ischemic stroke within the first three to four-and-a-half hours, intravenous tPA treatment can be given to treat. If there is a blood clot, the interventional neurologist can remove the clot, as well.

Stroke guidelines are changing, and so it’s important for the patients to get to a hospital as soon as possible. It’s very important for a family member to be present when a patient is admitted to the hospital. Many times, stroke patients lose speech and it’s hard to communicate with them, and a family member can give the neurologist a history of when symptoms started.

What should I avoid if I think I’m having a stroke?

If you are having symptoms of a stroke, you should call 911, because there are treatments which can be done right away, like tPA. If tPA is administered in a reasonable time frame, it can really help out in terms of outcome. You may take an aspirin.

Lying down and taking a nap is the worst thing you can do. If you fall asleep for a while, it may be too late to do anything about the stroke when you wake. If you think you’re having a stroke you should call 911; don’t try and drive.

What is TIA?

Once in a while, we see a transient ischemic attack (TIA), which is a temporary artery blockage in the brain. The stroke symptoms are seen but are resolved within less than 24 hours. When we do an MRI or CT scan, we don’t see any signs of a stroke. A TIA falls in the same category, but leaves no permanent deficit physically.

It’s important to treat a TIA the same way as a stroke. A neurologist will still do the complete diagnostic work-up, including Carotid Doppler and an echocardiogram (EKG). The neurologist will place the patient on aspirin or other anti-platelet therapy, because even after TIA, the risk for a subsequent stroke is high. The chance of having another stroke in the first three days after having the first one is high and this risk lasts up to three months.

At that time, a neurologist makes sure the patient is doing the right things, like seeing their primary care doctor regularly, taking their medications and maintaining a healthy diet and exercise regimen. Patient’s should also avoid smoking and alcohol, and take an aspirin if they were not taking one before. If the patient had a stroke while on aspirin, a neurologist will see if switching to another medication would be more beneficial.

Can therapy help out after someone has already had a stroke?

Neuronal tissue typically does not regenerate whether it’s the brain, spinal cord or the nerves. Physical therapy enables the surrounding neurons to take over the function of the brain cells that died. With a smaller stroke, the response to therapy is better. Therapy also works better in younger individuals because the surrounding neurons are more active.

In general, how do people know they’re at risk for a stroke?

The major risk factors for a stroke are:

  • Hypertension
  • Diabetes
  • High cholesterol
  • Smoking
  • Alcohol
  • Obesity

The more risk factors you have, the higher your risk for a stroke. How well diabetes and hypertension are controlled by individuals can help lower the risk of a stroke. If you’re diabetic, you want to avoid alcohol because it raises the sugar level. For a diabetic, a glass of wine might not be a good idea. You should talk to your primary care physician to see if you should have a smaller quantity or completely avoid wine altogether.

If there is a family history of stroke or heart attack at a young age, than you are at a higher risk. Typically, most stroke patients have facial droop, slurred speech and a slight arm drift; any of these signs should be a reason for you, a family member or friend, to call 911. Other signs like dizziness and double vision are still significant stroke symptoms.