Stroke is the third leading cause of death in the United States after heart disease and cancer. It is a major cause of disability among adults and a major factor in late-life dementia. The incidence of stroke is on the rise.
What Is a Stroke?
A stroke (sometimes called a "brain attack") happens when blood circulation to the brain fails. A few minutes without oxygen and important nutrients from the blood can damage or kill affected brain cells. Sometimes cell damage can be repaired and some lost skills regained. However, the death of brain cells is permanent.
Most strokes are caused by a blood clot or narrowing of a blood vessel (artery) leading to the brain. Other strokes are caused by a hemorrhage (bleeding) from an artery. There are three major types of stroke:
- Thrombotic strokes are caused by fatty deposits (plaques) that have built up in the arteries carrying blood to the brain. This slows blood flow and can cause clots to form on the plaques that narrow or block the flow of oxygen and nutrients to the brain.
- An embolic stroke is caused by a blood clot formed in another part of the body that breaks loose, travels through the bloodstream, and blocks an artery carrying oxygen and nutrients to the brain. When traveling through the body the blood clot is called an embolus.
- A hemorrhagic stroke is caused when an artery supplying blood bleeds into the brain. The broken blood vessel prevents needed oxygen and nutrients from reaching brain cells. One type of hemorrhagic stroke is caused when an artery that has weakened over time bulges (called an aneurysm) and suddenly bursts.
Diagnosis and Treatment
A stroke requires immediate medical care. If you think you are having a stroke, call 911. Research shows that treatment during the first few hours after stroke symptoms appear can be important for the best possible recovery. An emergency doctor or a neurologist (a doctor who diagnoses and treats disorders of the brain and nervous system) will provide emergency treatment. Then a family doctor, internist, or geriatrician can step in and provide continuing care.
Doctors make an early diagnosis by studying symptoms, reviewing the patient's medical history, and performing tests such as a computerized tomography (CT) scan-a 3-dimensional x-ray of the brain.
What You Can do to Prevent a Stroke
A stroke is a single, damaging attack, but the conditions or risk factors that lead to a stroke, such as high blood pressure, smoking, heart disease, and diabetes develop over many years. The National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health, has developed a worksheet to help you estimate your stroke risk. For a copy of Brain Basics: Preventing Stroke, contact the NINDS information office listed below.
You can reduce your stroke risk by taking the following steps:
- Control your blood pressure. Have your blood pressure checked often, and, if it is high, follow your doctor's advice on how to lower it. Treating high blood pressure reduces the risk for both stroke and heart disease.
- Stop smoking. Cigarette smoking is linked to increased risk for stroke. Research shows that the risk of stroke for people who have quit smoking for 2-5 years is lower than people who still smoke.
- Exercise regularly. Researchers think that exercise may make the heart stronger and improve circulation. It also helps control weight. Being overweight increases the chance of high blood pressure, atherosclerosis, heart disease, and adult-onset (type 2) diabetes. Physical activities like brisk walking, cycling, swimming, and yard work lower the risk of both stroke and heart disease. Talk with your doctor before starting a vigorous exercise program.
- Eat a healthy diet. Choose, prepare, and eat foods low in fats, saturated fatty acids, and cholesterol. Eat a variety of fruits and vegetables.
- Control your diabetes. If untreated, diabetes can damage the blood vessels throughout the body and lead to atherosclerosis.
What to Do if You Have a Stroke
Call 911 immediately. The warning signs for stroke are:
- Sudden numbness or weakness of face, arm or leg, especially on one side of the body
- Sudden confusion, trouble speaking or understanding
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking, dizziness, loss of balance or coordination
- Sudden severe headache with no known cause
Sometimes the warning signs last for only a few minutes and then disappear. This could be a mini-stroke, called a transient ischemic attack (TIA). Although they don't last long, TIAs are a symptom of a medical problem. Don't ignore a TIA - see your doctor right away.
Rehabilitation for Stroke Rehabilitation should begin as soon as possible after the patient is stable. It often continues after the patient has gone home. Stroke rehabilitation includes many kinds of therapies: physical therapy to strengthen muscles and improve balance and coordination; speech and language therapy; occupational therapy to improve eye-hand coordination and skills needed for tasks such as bathing and cooking. A team of health care experts (physicians, physical and occupational therapists, nurses, social workers, and speech and language specialists) coordinates activities for the patient and family.
Rehabilitation progress varies from person to person. For some, recovery is completed within weeks following a stroke; for others, it may take many months or years. Sometimes the damage from a stroke is so serious that the patient does not respond to rehabilitation and makes little or no progress toward recovery.
Where to Get More Information
National Institute of Neurological Disorders and Stroke
P.O. Box 5801
Bethesda, MD 20824
National High Blood Pressure Education Program
c/o NHLBI Information Center
P.O. Box 30105
Bethesda, Maryland 20824-0105
The National Stroke Association
9707 East Easter Lane
Englewood, Colorado 80712-3747
American Stroke Association
A Division of the American Heart Association
7272 Greenville Avenue
Dallas, TX 75231
For a list of free publications from the National Institute on Aging (NIA), contact:
NIA Information Center
P.O. Box 8057
Gaithersburg, MD 20898-8057