Stroke

Clinical Guidelines

Stroke Association

Resources

If you think you are having a stroke call 911 immediately

F.A.S.T. is an easy way to remember the sudden signs of stroke. When you can spot the signs, you’ll know that you need to call 9-1-1 for help right away. F.A.S.T. is:

Letter F Face Drooping – Does one side of the face droop or is it numb? Ask the person to smile. Is the person’s smile uneven?
Letter A Arm Weakness – Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
Letter S Speech Difficulty – Is speech slurred? Is the person unable to speak or hard to understand? Ask the person to repeat a simple sentence, like “The sky is blue.” Is the sentence repeated correctly?
Letter T Time to call 9-1-1 – If someone shows any of these symptoms, even if the symptoms go away, call 9-1-1 and get the person to the hospital immediately. Check the time so you’ll know when the first symptoms appeared.


What is Stroke?

Stroke is a disease that affects the arteries going to and within the brain. Stroke is the fourth leading cause of death and a leading cause of disability in the United States.

Stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts. When that happens, part of the brain cannot get the blood and oxygen it needs, so it and brain cells die.

What are the types of stroke?

  • Ischemic stroke– can be caused either by a clot obstructing the flow of blood to the brain
  • Hemorrhagic stroke– this occurs when a blood vessel rupturing and preventing blood flow to the brain.
  • ATIA (transient ischemic attack), or “mini stroke”- is caused by a temporary clot.

Warning signs:

  • Face drooping
  • Arm weakness
  • Speech difficulty
  • Sudden numbness of the leg
  • Sudden confusion or trouble understanding
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, standing, and/or dizziness
  • Sudden severe headache with no known cause

Risk Factors:

  • Age— the chance of having a stroke approximately doubles for each decade of life after age 55. While stroke is common among the elderly, a lot of people under 65 also have strokes.
  • Heredity (family history)— stroke risk is greater if a parent, grandparent, sister or brother has had a stroke. Some strokes may be symptoms of genetic disorders like CADASIL (Cerebral Autosomal Dominant Arteriopathy with Sub-cortical Infarcts and Leukoencephalopathy), which is caused by a gene mutation that leads to damage of blood vessel walls in the brain, blocking blood flow. Most individuals with CADASIL have a family history of the disorder — each child of a CADASIL parent has a 50% chance of inheriting the disease.
  • Race— African-Americans have a much higher risk of death from a stroke than Caucasians do. This is partly because blacks have higher risks of high blood pressure, diabetes and obesity.
  • Sex— Stroke is more common in men than in women. In most age groups, more men than women will have a stroke in a given year. However, more than half of total stroke deaths occur in women. At all ages, more women than men die of stroke. Use of birth control pills and pregnancy pose special stroke risks for women.
  • Prior stroke, TIA or heart attack—Transient ischemic attacks (TIAs) are “warning strokes” that produce stroke-like symptoms but no lasting damage. 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. Recognizing and treating TIAs can reduce your risk of a major stroke. TIA should be considered a medical emergency and followed up immediately with a healthcare professional. A heart attack can also increase the risk for a stroke.

Modifiable changes to reduce risk for a Stroke: (Again these can be found at the same website above)

  • High blood pressure— High blood pressure is the leading cause of stroke and the most important controllable risk factor for stroke. Many people believe the effective treatment of high blood pressure is a key reason for the accelerated decline in the death rates for stroke.
  • Cigarette smoking— Cigarette smoking to be an important risk factor for stroke. The nicotine and carbon monoxide in cigarette smoke damage the cardiovascular system in many ways. The use of oral contraceptives combined with cigarette smoking greatly increases stroke risk.
  • Diabetes mellitus— Diabetes is an independent risk factor for stroke. Many people with diabetes also have high blood pressure, high blood cholesterol and are overweight. This increases their risk even more. While diabetes is treatable, the presence of the disease still increases the risk of stroke.
  • Carotid or other artery disease —the carotid arteries in the neck supply blood to the brain. A carotid artery narrowed by fatty deposits from atherosclerosis (plaque buildups in artery walls) may become blocked by a blood clot. Carotid artery disease is also called carotid artery stenosis.
  • Peripheral artery diseaseis the narrowing of blood vessels carrying blood to leg and arm muscles. It’s caused by fatty buildups of plaque in artery walls. People with peripheral artery disease have a higher risk of carotid artery disease, which raises their risk of stroke.
  • Other heart disease— People with coronary heart disease or heart failure have a higher risk of stroke. Dilated cardiomyopathy (an enlarged heart), heart valve disease and some types of congenital heart defects also raise the risk of stroke.
  • High blood cholesterol —People with high blood cholesterol have an increased risk for stroke. Also, it appears that low HDL (“good”) cholesterol is a risk factor for stroke in men, but more data are needed to verify its effect in women.
  • Poor diet —Diets high in saturated fat, trans fat and cholesterol can raise blood cholesterol levels. Diets high in sodium (salt) can contribute to increased blood pressure. Diets with excess calories can contribute to obesity. Also, a diet containing five or more servings of fruits and vegetables per day may reduce the risk of stroke.
  • Physical inactivity and obesity— Being inactive, obese or both can increase your risk of high blood pressure, high blood cholesterol, diabetes, heart disease and stroke. 30 minutes of physical activity is recommended daily.

 

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