A stroke is an injury to the brain caused by either the interruption of oxygen supply to brain cells or bleeding into the brain that kills cells by smothering them. Blood clots that block arteries bring about the first type of stroke (ischemic stroke). Bleeding directly onto brain cells, caused by the bursting of brain aneurysms or arteriovenous malformations, leads to the second type (hemorrhagic stroke).

The effects of a stroke can include paralysis, confusion, speech difficulties and many other serious deficits, depending on where in the brain the damage occurs and its severity.

If you have a stroke, you need to seek treatment immediately – a delay in getting care can cost you brain cells. Clot-busting drugs have dramatic results, but only if given within effective time frames – three hours of symptoms’ onset for intravenous clot-busting drugs or four and-one-half hours for intra-arterial infusion.

Stroke Overview:

• Transient Ischemic Attacks
• “Brain Attacks” and Signs of a Stroke
• “F-A-S-T”
• Types of Strokes
• Risk Factors for Stroke
• Diagnosis & Treatment
• Rehabilitation
• For More Information

Transient Ischemic Attacks

Transient ischemic attacks (TIAs), sometimes called mini strokes, are short-lived events that temporarily produce the symptoms of a stroke. Cause by temporary clots, TIAs are strong predictors of stroke. A person who’s had one or more TIAs is almost 10 times more likely to have a stroke than someone of the same age and sex who hasn’t. If you’ve had a heart attack you’re at a higher risk of having a stroke as well.

Recognizing and treating TIAs can reduce your risk of a stroke. A TIA should be considered a medical emergency and followed up immediately with a healthcare provider.

“Brain Attacks,” Signs of a Stroke

Just as an injury to the heart is called a heart attack, many healthcare professionals consider a stroke a “Brain Attack” and urge the same vigilance towards its signs.

Signs of a stroke include the sudden onset of:

• Numbness or weakness of the face, arm or leg, especially on one side of the body.
• Confusion, difficulties talking or understanding speech.
• Trouble walking, dizziness or loss of balance or coordination.
• Severe headache with no known cause.

“F-A-S-T”

If you see a person you think might be having a stroke, remember the acronym F-A-S-T for the key signs of a stroke. They stand for Face, Arms, Speech and Time:

• Face: Ask the person to smile. If one side of the face appears crooked or drooping, he or she may be having a stroke.
• Arms: Ask the person to life both arms into the air. If he or she has difficulty with one arm, this also might be a sign he or she is having a stroke.
• Speech: Ask the person to speak. If his or her words are slurred or they are unable to speak, he or she might be having a stroke.
• Time: If any of the above symptoms are present, call 9-1-1 immediately in order to make sure he or she reaches the hospital FAST.

Types of Strokes

Of the two types of strokes – ischemic and hemorrhagic – 87 percent are ischemic, 13 percent hemorrhagic. All told, nearly 800,000 Americans experience a new or recurrent stroke each year, with 137,000 deaths due to strokes. Women account for some 60 percent of deaths from stroke, versus 40 percent for men.

The obstructions that cause ischemic strokes result from blood clots related to fatty deposits lining blood vessel walls – atherosclerosis. Cerebral thrombosis refers to clots formed at the stroke site in vessels within the brain. Cerebral embolism refers to clots that form in another part of the body, break free and travel through the bloodstream into the brain’s network of blood vessels until they reach a section too small for it to continue.

Risk Factors for Stroke

Some of the risk factors for stroke are things we can’t do anything about, but some are things in our lives that we can change through medical care and lifestyle changes.

What Risk Factors CANNOT be Changed?

• Age – The chance of having a stroke doubles for each decade of life after age 55. Although stroke is common among the elderly, a lot of people under 65 also have strokes.
• Heredity and Race – You are at a greater risk if a parent, grandparent, sister or brother has had a stroke. African Americans have a much higher risk of death from a stroke than Caucasians do because blacks have a higher risk of high blood pressure, diabetes and obesity.
• Gender – Stroke is more common in men than in women. In the majority of age groups, more men than women will have a stroke in a given year. However, more than half of the total stroke deaths occur in women. At all ages, more women than men die of stroke. Certain medications such as birth control pills as well as pregnancy pose special stroke risks for women.
• Prior Stroke, TIA or Heart Attack – The risk of stroke for someone who has already had a stroke, TIA or heart event is many times that of a person who has not.

What Risk Factors CAN be Changed?

• High Blood Pressure – This is not only the leading cause of stroke but the most controllable.
• Cigarette Smoking – The nicotine and carbon monoxide in cigarette smoke damage the heart and vascular system in several ways.
• Diabetes Mellitus – Diabetes is a risk factor for stroke all by itself. Along with Diabetes, many people also have high blood pressure, high cholesterol and are overweight. Although Diabetes is treatable its presence increases the risk of stroke.
• Carotid Artery Disease (Carotid Artery Stenosis) – Carotid arteries are located on either side of the neck and supply blood to the brain. When plaque builds in the artery walls (atherosclerosis) the artery may become blocked by a blood clot.
• Peripheral Artery Disease (PAD) – This occurs with narrowing of the blood vessels that supply blood to both the arms and legs. Individuals with PAD have a higher risk of carotid artery disease thereby increasing risk for stroke.
• Atrial Fibrillation – Instead of the heart beating effectively, atrial fibrillation causes a “quiver” which may allow the blood to pool thereby causing a clot. If this clot breaks off entering the bloodstream it may lodge in the artery leading to the brain, causing a stroke.
• Other Heart Disease – A diagnosis of coronary heart disease or heart failure carry a higher risk of stroke than individuals with a normally functioning heart. Dilated cardiomyopathy (enlarged heart) valvular heart disease and some types of congenital (at birth) heart defects also raise the risk of stroke.
• Sickle Cell Disease Anemia – This is a genetic disorder that primarily affects African-American and Hispanic children. These red blood cells due to their shape are less able to carry oxygen to the body’s tissues and organs and may stick to blood vessel walls blocking arteries to the brain and causing a stroke.
• Poor Diet – Diets high in saturated fat, Trans fat and cholesterol can raise cholesterol levels. When too much LDL (bad cholesterol) circulates in the blood, over time plaque can build up in the inner walls of the arteries that feed both the heart and brain increasing risk for heart attack and stroke. High levels of HDL (good cholesterol) seem to protect against heart attack while low levels of HDL may increase the risk of heart disease.

Diet-Related Issues Include:

• Sodium – Diets high in sodium (salt) can contribute to increase blood pressure which increases risk for stroke. Nutritionists advise you not to add salt to your food (in fact, to remove the salt shaker from table), to check food labels for sodium content and to follow your doctors’ and dieticians’ orders for restricting sodium. The dietician can provide you with a list of foods to avoid.
• Physical inactivity and obesity – Being inactive, obese or both can increase your risk of high blood pressure, high cholesterol, diabetes, heart disease and stroke. The American Heart Association and American Stroke Association recommend at least 30 minutes of activity on most or all days. The exercise routine can be as simple as parking your car furthest from the store and taking the stairs instead of the elevator. This does not need to be complicated or costly…get out and take a walk.

Diagnosis & Treatment

Even before a patient enters the PRH Emergency Department with the apparent symptoms of a stroke, a “stroke alert” is issued to mobilize a team of clinicians expert in treating stroke (ideally, the stroke alert will have been sent ahead by the EMS responders in the field). In the ED, the patient will be assessed by ED physician and staff and by members of the Stroke Team – neurologists and others who have been called in. Blood tests and CT scans will be performed quickly, a diagnosis will be made and therapeutic medications administered. The patient’s family will be contacted, if they’re not already present.

The patient will be admitted to the hospital for continuing treatment. Once the patient has stabilized, the need will be for rehabilitation therapy by physical therapists, occupational therapists and speech and language pathologists. A multispecialty team of neurologists, hospitalists, nurses, case managers and therapists will work with the patient and family to develop a plan for discharge and rehabilitation.

Rehabilitation

Depending on the severity of the patient’s condition, he or she may be discharged to an inpatient rehabilitation facility for follow-up care, or to his or her home, to take part in outpatient rehab services in PRH’s Day Rehabilitation Center.

The specialties of rehabilitation include:

• Physical Therapy (PT) is therapy focused on mobility skills (bed, transfers, walking), leg flexibility and strengthening, balance, endurance and using equipment to assist with mobility such as walkers or wheelchairs.
• Occupational Therapy (OT) is therapy focused on activities of daily living (ADLs), including feeding, dressing, toilet use, bathing and other self care; arm and hand use for strength, coordination, and sensation; and visual and perceptual problems.
• Speech and Language Pathology (SLP) is therapy addressing communication, perceptual and cognitive skills as well as any swallowing difficulties.

For More Information:

Brain Injury Association of New Hampshire
Phone: (603) 225-8400 Toll free in NH (800) 773-8400
www.bianh.org

Brain Injury Association of Maine
Phone: (800) 275-1233
biame.convio.net

Krempel’s Foundation
Phone: (603) 570-2026 Ext: 2
www.krempelsfoundation.org

Wentworth Connections
Transportation (603) 431-8677 (Portsmouth Residents)
Day Program (603) 433-0070
www.wentworthconnections.org

Transportation Assistance for Seacoast Citizens (TASC)
Residents of eight Seacoast Communities; Exeter, Greenland, Hampton, Hampton Falls, North Hampton, Rye, Stratham and Seabrook.
Phone: (603)926-0926
www.tasc-rides.org

American Stroke Association
Phone: (800) 553-6321 Warmline (888) 478-7653 (1-888-4STROKE)
www.strokeassociation.org

National Stroke Association
Phone: (800) 787-6537
www.stroke.org

National Institute of Neurologic Disorders and Stroke
www.ninds.nih.gov

The Brain Attack Coalition
www.stroke-site.org