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Stroke

Diseases & Conditions A-Z

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BRAIN & NERVOUS SYSTEM

Stroke

Stroke is a cardiovascular disease. It affects the blood vessels that supply blood to the brain. When blood flow to the brain is impaired, oxygen and important nutrients cannot be delivered. The result is abnormal brain function. Blood flow to the brain can be disrupted by either a blockage or rupture of an artery to the brain. There are many causes for a stroke. This is a medical emergency. Prompt treatment could mean the difference between life and death. Early treatment can also minimize damage to your brain and potential disability.

Stroke is the third leading cause of death and the leading cause of adult disability; only cardiovascular disease and cancer cause more deaths annually.

Signs and symptoms

It's important to know the signs and symptoms of a stroke so that you or someone you know can get prompt treatment. The most common signs and symptoms include:

  • Sudden numbness, weakness, or paralysis of the face, arm or leg usually on one side of the body

  • Loss of speech, or trouble talking or understanding speech (aphasia)

  • Sudden blurred, double or decreased vision

  • Dizziness, loss of balance or loss of coordination

  • A sudden, severe "bolt out of the blue" headache or an unusual headache, which may be accompanied by a stiff neck, facial pain, pain between the eyes, vomiting or altered consciousness

  • Confusion, or problems with memory, spatial orientation or perception

For most people, a stroke gives no warning. But one possible sign of an impending stroke is a transient ischemic attack (TIA). A TIA is a temporary interruption of blood flow to a part of your brain. The signs and symptoms of TIA are the same as for a stroke, but they appear for a shorter period several minutes to 24 hours and then disappear, without leaving apparent permanent effects. You may have more than one TIA, and the recurrent signs and symptoms may be similar or different. A TIA indicates a serious underlying risk that a full-blown stroke may follow. People who have had a TIA are nine times as likely to have a stroke as are those who haven't had a TIA.

Causes

A stroke is sometimes called a brain attack. It's caused by a problem with the amount of blood in the brain. One type of stroke ischemic stroke is caused by too little blood in the brain. The other main type of stroke hemorrhagic stroke is caused by too much blood within the brain cavity.

Ischemic stroke
About 80 percent of strokes are ischemic strokes. They occur when blood clots or other particles block arteries to your brain and cause severely reduced blood flow (ischemia). This deprives your brain cells of oxygen and nutrients, and cells may begin to die within minutes. The most common ischemic strokes are:

  • Thrombotic stroke. This type of stroke occurs when a blood clot (thrombus) forms in one of the arteries that supply blood to your brain. A clot usually forms in areas damaged by atherosclerosis a disease in which the arteries are clogged by an accumulation of cholesterol-containing fatty deposits (plaques). This process can occur within one of the two carotid arteries of your neck that carry blood to your brain, as well as in other arteries. An ischemic stroke may also be caused by plaques that completely clog or markedly narrow an artery. This narrowing is called stenosis.

  • Embolic stroke. This type of stroke occurs when a blood clot or other particle forms in a blood vessel away from the brain, but is swept through your bloodstream to lodge in narrower brain arteries. This type of blood clot is called an embolus. It's commonly caused by atrial fibrillation, an abnormal heart rhythm caused by irregular beating in the heart's two upper chambers.

Hemorrhagic stroke
Hemorrhage is the medical word for bleeding. Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. Hemorrhages can result from a number of conditions that affect your blood vessels, including uncontrolled high blood pressure (hypertension) and weak spots in your blood vessel walls (aneurysms). A less common cause of hemorrhage is the rupture of an arteriovenous malformation (AVM) a malformed tangle of thin-walled blood vessels, present at birth. There are two types of hemorrhagic stroke:

  • Intracerebral hemorrhage. In this type of stroke, a blood vessel in the brain bursts and spills into the surrounding brain tissue and damages cells. Brain cells beyond the leak are deprived of blood and are also damaged. High blood pressure is the most common cause of this type of hemorrhagic stroke. High blood pressure can cause small arteries inside your brain to become brittle and susceptible to cracking and rupture.

  • Subarachnoid hemorrhage. In this type of stroke, bleeding starts in a large artery on or near the membrane surrounding the brain and spills into the space between the surface of your brain and your skull. A subarachnoid hemorrhage is often signaled by a sudden, severe "thunderclap" headache. This type of stroke is commonly caused by the rupture of an aneurysm, which can develop with age or result from a genetic predisposition. After a subarachnoid hemorrhage, vessels may go into vasospasm, a condition where arteries near the hemorrhage constrict erratically, causing brain cell damage by further restricting or blocking blood flow to portions of the brain.

Risk factors

Many factors can increase your risk of a stroke. A number of these factors can also increase your chances of having a heart attack. They include:

  • Family history. Your risk of stroke is slightly greater if one of your parents or a brother or sister has had a stroke or TIA.

  • Age. Your risk of stroke increases as you get older.

  • Sex. Stroke affects men and women about equally. But women are more likely to die of stroke than are men.

  • Race. Blacks are at greater risk of stroke than are people of other races. This is partly due to a higher prevalence of high blood pressure and diabetes.

  • High blood pressure (hypertension). High blood pressure is a risk factor for both ischemic and hemorrhagic strokes. It can weaken and damage blood vessels in and around your brain, leaving them vulnerable to atherosclerosis and hemorrhage.

  • Undesirable levels of blood cholesterol. High levels of low-density lipoprotein (LDL) cholesterol, the "bad" cholesterol, may increase your risk of atherosclerosis. In excess, LDLs and other materials build up on the lining of artery walls, where they may harden into plaques. High levels of triglycerides, another blood fat, also may increase your atherosclerosis risk. In contrast, high levels of high-density lipoprotein (HDL) cholesterol, the "good" cholesterol, reduce your risk of atherosclerosis by escorting cholesterol out of your body through the liver.

  • Cigarette smoking. Smokers have a much higher risk of stroke than do nonsmokers. Smoking contributes to plaques in your arteries. Nicotine makes your heart work harder by increasing your heart rate and blood pressure. The carbon monoxide in cigarette smoke replaces oxygen in your blood, decreasing the amount of oxygen delivered to the walls of your arteries and your tissues, including the tissues in your brain.

  • Diabetes. Diabetes is a major risk factor for stroke. When you have diabetes, your body not only can't handle sugar appropriately but also can't process fats efficiently, and you're at greater risk of high blood pressure. These diabetes-related effects increase your risk of developing atherosclerosis. Diabetes also interferes with your body's ability to break down blood clots, increasing your risk of ischemic stroke.

  • Obesity. Being overweight increases your chance of developing high blood pressure, heart disease, atherosclerosis and diabetes all of which increase stroke risk.

  • Cardiovascular disease. Several cardiovascular diseases can increase your risk of a stroke, including congestive heart failure, a previous heart attack, an infection of a heart valve (endocarditis), a particular type of abnormal heart rhythm (atrial fibrillation), aortic or mitral valve disease, valve replacement, or a hole in the upper chambers of the heart known as patent foramen ovale. Atrial fibrillation is the most common condition associated with strokes caused by embolic clots. In addition, atherosclerosis in blood vessels near your heart may indicate that you have atherosclerosis in other blood vessels including those in and around your brain.

  • Previous stroke or TIA. If you've already had a stroke, your risk of having another one increases. In addition, people who have had a TIA are nine times as likely to have a stroke as are those who haven't had a TIA.

  • Elevated homocysteine level. This amino acid, a building block of proteins, occurs naturally in your blood. But people with elevated levels of homocysteine have a higher risk of heart and blood vessel damage.

  • Use of birth control pills. The risk of stroke is higher among women who take birth control pills, especially among smokers and women older than 35. However, today's low-dose pills carry a much lower risk than their earlier counterparts.

Other factors that can increase your risk of stroke include heavy or binge drinking, the use of illicit drugs such as cocaine, and uncontrolled stress.

When to seek medical advice

If you notice any signs of a stroke or TIA, get medical help right away. A TIA may seem like a passing event. But it can be an important warning sign and a chance to take steps that may prevent a stroke.

If someone appears to be having a stroke, watch the person carefully while waiting for an ambulance. You may need to take additional actions in the following situations:

  • If breathing ceases, begin resuscitation.

  • If vomiting occurs, turn the person's head to the side. This can prevent choking.

  • Don't let the person eat or drink anything.

Every minute counts when it comes to treating a stroke. The longer a stroke goes untreated, the greater the damage and potential disability. The success of most treatments depends on how soon a person is seen by a doctor in a hospital emergency room after signs and symptoms begin.

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