A stroke occurs when a blood
vessel in the brain is
blocked or bursts. Without blood and the oxygen it carries, part of the brain
starts to die. The part of the body controlled by the damaged area of the brain
can't work properly.
Brain damage can begin within minutes, so it
is important to know the symptoms of stroke and act fast. Quick treatment can
help limit damage to the brain and increase the chance of a full
recovery.
What are the symptoms?
Symptoms of a stroke happen
quickly. A stroke may cause:
Sudden numbness, paralysis, or weakness in your face, arm, or
leg, especially on only one side of your body.
New problems with
walking or balance.
Sudden vision changes.
Drooling or
slurred speech.
New problems speaking or understanding simple
statements, or feeling confused.
A sudden, severe headache that is
different from past headaches.
If you have any of these symptoms, call 911 or other emergency services right away.
See your doctor if you have
symptoms that seem like a stroke, even if they go away quickly. You may have
had a
transient ischemic attack (TIA), sometimes called a
mini-stroke. A TIA is a warning that a stroke may happen soon. Getting early
treatment for a TIA can help prevent a stroke.
What causes a stroke?
There are two types of
stroke:
An
ischemic stroke develops when a blood clot blocks a
blood vessel in the brain. The clot may form in the blood vessel or travel from
somewhere else in the blood system. About 8 out of 10 strokes are ischemic (say
'iss-KEE-mick') strokes. They are the most common type of stroke in older
adults.
A
hemorrhagic stroke develops when an artery in the
brain leaks or bursts. This causes bleeding inside the brain or near the
surface of the brain. Hemorrhagic (say 'heh-muh-RAH-jick') strokes are less
common but more deadly than ischemic strokes.
How is a stroke diagnosed?
Seeing a doctor right
away is very important. If a stroke is diagnosed quickly-within the first 3
hours of when symptoms start-doctors may be able to use medicines that can lead
to a better recovery.
The first thing the doctor needs to find out
is what kind of stroke it is: ischemic or hemorrhagic. This is important
because the medicine given to treat a stroke caused by a blood clot could be
deadly if used for a stroke caused by bleeding in the brain.
To
find out what kind of stroke it is, the doctor will do a type of X-ray called a
CT scan of the brain, which can show if there is
bleeding. The doctor may order other tests to find the location of the clot or
bleeding, check for the amount of brain damage, and check for other conditions
that can cause symptoms similar to a stroke.
How is it treated?
For an ischemic stroke, treatment focuses on restoring blood flow to
the brain. If less than 3 hours have passed since your symptoms began, doctors
may use a medicine that dissolves blood clots. Research shows that this
medicine can improve recovery from a stroke, especially if given within 90
minutes of the first symptoms.1 Other medicines may be
given to prevent blood clots and control symptoms.
A
hemorrhagic stroke can be hard to treat. Doctors may do
surgery or other treatments to stop bleeding or reduce pressure on the brain.
Medicines may be used to control blood pressure, brain swelling, and other
problems.
After your condition is stable, treatment shifts to
preventing other problems and future strokes. You may need to take a number of
medicines to control conditions that put you at risk for stroke, such as high
blood pressure, high cholesterol, and diabetes. Some people need to have a
surgery to remove
plaque buildup from the blood vessels that supply the
brain (carotid arteries).
The best way to get
better after a stroke is to start
stroke rehab. The goal of stroke rehab is to help you
regain skills you lost or to make the most of your remaining abilities. Stroke
rehab can also help you take steps to prevent future strokes. You have the
greatest chance of regaining abilities during the first few months after a
stroke. So it is important to start rehab soon after a stroke and do a little
every day.
Can you prevent a stroke?
After you have had a
stroke, you are at risk for having another one. You can make some important
lifestyle changes that can reduce your risk of stroke and improve your overall
health.
Don't smoke. Smoking can more than double
your risk of stroke. Avoid secondhand smoke too.
Eat a
heart-healthy diet that includes plenty of fish, fruits, vegetables, beans,
high-fiber grains and breads, and olive oil. Eat less salt too.
Try to do
moderate activity at least 2½ hours a week. It's fine
to be active in blocks of 10 minutes or more throughout your day and week. Your
doctor can suggest a safe level of exercise for you.
Stay at a
healthy weight.
Control your cholesterol and blood
pressure.
If you have diabetes, keep your blood sugar as close to
normal as possible.
Limit alcohol. Having more than 1
drink a day (if you are female) or more than 2 drinks a day (if you are male)
increases the risk of stroke.
Take a daily aspirin or other
medicines if your doctor advises it.
Avoid getting sick from the
flu. Get a flu shot every year.
Work closely with your doctor. Go to all your
appointments, and take your medicines just the way your doctor says to.
An
ischemic stroke is caused by a blood clot that blocks blood flow to the brain. A
blood clot can develop in a narrowed artery that supplies the brain or can
travel from the heart (or elsewhere in the body) to an artery that supplies the
brain.
Blood clots are usually the result of other problems in
the body that affect the normal flow of blood, such as:
Certain heart valve problems, including having an
artificial heart valve, a repaired heart valve, heart
valve disease such as
mitral valve prolapse, or narrowing (stenosis) of a
heart valve.
Low blood pressure (hypotension) may also cause an
ischemic stroke, although less commonly. Low blood pressure results in reduced
blood flow to the brain and may develop as a result of narrowed or diseased
arteries, a heart attack, a large loss of blood, or a severe infection.
Some surgeries (such as endarterectomy) or other procedures (such as
angioplasty) that are used to treat narrowed carotid arteries may cause a blood
clot to break loose, resulting in a stroke.
Causes of hemorrhagic stroke
A
hemorrhagic stroke is caused by bleeding inside the
brain (called intracerebral hemorrhage) or bleeding in the space around the
brain (called subarachnoid hemorrhage). Bleeding inside the brain may be a
result of long-standing high blood pressure. Bleeding in the space around the
brain may be caused by a ruptured
aneurysm or uncontrolled high blood pressure.
Other causes of hemorrhagic stroke are less common but
include:
Head or neck injuries that
result in damage to blood vessels in the head or neck.
Radiation
treatment for cancer in the neck or brain.
Cerebral amyloid
angiopathy (a degenerative blood vessel disorder).
Symptoms
If you have symptoms of a stroke,
seek emergency medical care. General symptoms of a
stroke include:
Sudden numbness, paralysis, or weakness in your face, arm, or
leg, especially on only one side of your body.
New problems with
walking or balance.
Sudden vision changes.
Drooling or
slurred speech.
New problems speaking or understanding simple
statements, or feeling confused.
A sudden, severe headache that is
different from past headaches.
Symptoms vary depending on whether the stroke is caused by
a clot or bleeding. The location of the blood clot or bleeding and the extent
of brain damage can also affect symptoms.
Symptoms of an ischemic stroke (caused
by a clot blocking a blood vessel) usually occur in the side of the body
opposite from the side of the brain where the clot occurred. For example, a
stroke in the right side of the brain affects the left side of the
body.
Symptoms of a hemorrhagic stroke (caused by bleeding
in the brain) can be similar to those of an ischemic stroke but may be
distinguished by symptoms relating to higher pressure in the brain, including
severe headache, nausea and vomiting, neck stiffness, dizziness, seizures,
irritability, confusion, and possibly unconsciousness.
Symptoms of a stroke may progress over minutes, hours, or
days, often in a stepwise fashion. For example, mild weakness may progress to
an inability to move the arm and leg on one side of the body.
If a stroke is caused by a large blood clot
(ischemic stroke) or bleeding (hemorrhagic stroke), symptoms occur suddenly,
within seconds.
When an artery that is narrowed by
atherosclerosis becomes blocked, stroke symptoms
usually develop gradually over minutes to hours, or (in rare cases)
days.
If several smaller strokes occur over time, the person may
have a more gradual change in walking, balance, thinking, or behavior (multi-infarct dementia).
It is not always easy for people to recognize symptoms of a
small stroke. They may mistakenly think the symptoms can be attributed to
aging, or the symptoms may be confused with those of other conditions that
cause similar symptoms.
What Happens
When you have an
ischemic stroke, the oxygen-rich blood supply to part of your brain is reduced.
With a
hemorrhagic stroke, there is bleeding in the
brain.
After about 4 minutes without blood and oxygen,
brain cells become damaged and may die.
The body tries to restore
blood and oxygen to the cells by enlarging other blood vessels (arteries) near
the area.
If blood supply is not restored, permanent brain damage
usually occurs.
When brain cells are damaged or die, the body parts
controlled by those cells cannot function. The loss of function may be mild or
severe and temporary or permanent. This depends on where and how much of the
brain is damaged and how fast the blood supply can be returned to the affected
cells.
If you have
symptoms of a stroke, seek emergency medical care.
Life-threatening complications may occur after a
stroke. Early treatment may decrease the amount of
permanent damage to brain cells, decreasing the amount of disability.
Stroke is the most common nervous system-related cause of physical
disability. Of people who survive a stroke, half will
still have some disability 6 months after the stroke.
Recovery
depends on the location and amount of brain damage caused by the stroke, the
ability of other healthy areas of the brain to take over functioning for the
damaged areas, and
rehabilitation. In general, the less damage there is
to the brain tissue, the less disability results and the greater the chances of
a successful recovery.
You have the greatest chance of regaining
your abilities during the first few months after a stroke. Regaining some
abilities, such as speech, comes slowly, if at all. About half of all people
who have a stroke will have some long-term problems with talking,
understanding, and decision-making. They also may have changes in behavior that
affect their relationships with family and friends.
Long-term
complications of a stroke, such as
depression and
pneumonia, may develop right away or months to years
after a stroke. Some long-term complications may be prevented with proper home
treatment and medical follow-up. For more information, see the Home Treatment
section of this topic.
What to expect after a stroke
In addition to the
more obvious physical problems you have after a stroke, you (or a caregiver)
may also notice:
Diet with few
fruits and vegetables. Research suggests that people
who eat more fruits, vegetables, fish, and whole grains (for example, brown
rice) may have a lower risk of stroke than people who eat lots of red meat,
processed foods such as lunch meat, and refined grains (for example, white
flour).2
Diet with too much salt. A
healthy diet includes less than 2,300 mg of sodium a day (about one
teaspoon).
Use of some medicines, such as birth control
pills-especially by women who smoke or have a history of blood-clotting
problems. In postmenopausal women,
hormone replacement therapy has been shown to slightly
increase the risk of stroke.3
Heavy use of
alcohol. People who drink alcohol excessively, especially people who
binge drink, are more likely to have a stroke. Binge drinking is defined as
drinking more than 5 drinks in a short period of time.
Illegal drug use (such as a stimulant, like cocaine).
Risk factors you cannot change
include:
Age. The risk of stroke increases with age.
Race. African Americans, Native Americans, and Alaskan Natives
have a higher risk than those of other races. Compared with whites, African
Americans have about 2 times the risk of a first
ischemic stroke. And African-American men and women are more likely to die from
stroke.4
Gender. Stroke is more common in
men than women until age 75, when more women than men have strokes. Because
women live longer than men, more women than men die of stroke.4
Call 911 or other emergency services immediately if:
Signs of a
stroke develop suddenly. These
may include:
Sudden numbness, paralysis, or weakness in your face, arm, or
leg, especially on only one side of your body.
New problems with
walking or balance.
Sudden vision changes.
Drooling or
slurred speech.
New problems speaking or understanding simple
statements, or feeling confused.
A sudden, severe headache that is
different from past headaches.
You have signs of a
transient ischemic attack (TIA). Symptoms are similar
to those of a stroke, except:
The loss of vision is usually described as
a sensation that a shade is being pulled down over one eye.
TIA symptoms typically disappear after 10 to 20 minutes but
may last longer. There is no way to tell whether the symptoms are caused by a
stroke or by TIA, so emergency medical care is needed for both
conditions.
Call your doctor immediately if you
have:
Had recent symptoms of a TIA or stroke, even if
the symptoms have disappeared.
Had a TIA or stroke and are taking
aspirin or other medicines that prevent blood clotting and you notice any
signs of bleeding.
Had a stroke and have a
choking episode from food going down your windpipe.
Had a stroke
and have signs of a blood clot in a
deep blood vessel, which include redness, warmth, and
pain in a specific area of your arm or leg.
Call your doctor for an appointment if you:
Think you have had a TIA in the past and have
not talked with your doctor about it.
Have had a stroke and have a
pressure sore. Pressure sores, which usually develop
along the elbows, ankles, heels, knees, buttocks, and tailbone and on the back
along the spine, are caused by staying in one position too long. The first sign
of a pressure sore is a reddened area that does not go away with rubbing or
massaging.
Have had a stroke and notice that your affected arm or
leg is becoming increasingly stiff or you are not able to straighten it
(spasticity).
Have had a stroke and notice signs of a urinary tract
infection. Signs may include fever, pain with urination, blood in urine, and
low back (flank) pain. For more information, see the topic
Urinary Tract Infections in Teens and Adults.
Have had a stroke and you are having trouble keeping
your balance.
Watchful Waiting
Watchful waiting is not appropriate if you have
signs of a stroke. Emergency medical care is needed to prevent or treat any
complications that may be life-threatening. Prompt treatment may prevent
extensive damage to the brain, decreasing permanent
disabilities from the stroke.
If the
stroke is caused by a blood clot, early care by a doctor in the emergency room
or hospital is critical. If you seek help within 3 hours, you can sometimes
receive a medicine (tissue plasminogen activator, or t-PA) that dissolves
clots, but this medicine should be given within the first 3 hours after
symptoms begin. Not everyone can safely receive this medicine.
Who To See
Doctors who can diagnose and treat stroke
include:
Some hospitals have a stroke team made up of many
different health professionals, such as a physical therapist, an occupational
therapist, a speech therapist, a rehabilitation doctor (physiatrist), a nurse,
and a social worker.
Time is critical when diagnosing a
stroke. A quick diagnosis within the first 3 hours may
enable your doctor to use medicines that can lead to a better recovery.
The first priority will be to determine whether you are having an
ischemic or hemorrhagic stroke. This distinction is critical because the medicine
given for an ischemic stroke (caused by a blood clot) could be life-threatening
if the stroke is hemorrhagic (caused by bleeding). Your doctor will also want
to rule out other conditions that have symptoms similar to a stroke and to
check for complications.
The first test after a stroke is
typically a
computed tomography (CT) scan of the brain, which is a
series of X-rays of your brain that can show whether there is bleeding. This
test will help your doctor diagnose whether the stroke is ischemic or
hemorrhagic.
Magnetic resonance imaging (MRI) may also be done to
find out the amount of damage to the brain and help predict recovery.
Other initial tests recommended for ischemic stroke include:
Blood tests, such as
a
complete blood count (CBC),
blood sugar,
electrolytes, liver and kidney function, and
prothrombin time (a test that measures how long it
takes your blood to clot). These tests are done to help your doctor make
choices about your treatment and to check for conditions that may cause
symptoms similar to a stroke.
Guidelines recommend that risk factors for heart disease also be
assessed after a stroke to prevent disability or death from a future heart
problem. This is because many people who have had a stroke also have
coronary artery disease.
Treatment Overview
Prompt treatment of
stroke and medical problems related to stroke, such as
high blood sugar and pressure on the brain, may minimize brain damage and
improve the chances of survival. Starting a
rehabilitation program as soon as possible after a
stroke increases your chances of recovering some of the abilities you
lost.
Initial treatment for stroke
Initial treatment for
a stroke varies depending on whether it's caused by a blood clot (ischemic) or
by bleeding in the brain (hemorrhagic). Before starting treatment, your doctor
will use a
computed tomography (CT) scan of your head and
possibly
magnetic resonance imaging (MRI) to diagnose the type
of stroke you've had. Further tests may be done to find the location of the
clot or bleeding and to assess the amount of brain damage. While treatment
options are being determined, your blood pressure and breathing ability will be
closely monitored, and you may receive oxygen.
Initial treatment
focuses on restoring blood flow for an ischemic stroke or controlling bleeding
for a hemorrhagic stroke. As with a
heart attack, permanent damage from a stroke often
occurs within the first few hours. The quicker you receive treatment, the less
damage will occur.
Ischemic stroke
Emergency treatment for an ischemic stroke depends on the location and
cause of the clot. Measures will be taken to stabilize your vital signs,
including giving you medicines.
If your stroke is diagnosed within 3 hours of
the start of symptoms, you may be given a clot-dissolving medicine called
tissue plasminogen activator (t-PA), which can
increase your chances of survival and recovery. But t-PA is not safe for
everyone. If you have had a hemorrhagic stroke, use of t-PA would be
life-threatening. Your eligibility for t-PA will be quickly assessed in the
emergency room.
You may also receive
aspirin or
aspirin combined with another antiplatelet medicine.
But aspirin is not recommended within 24 hours of treatment with t-PA. Other
medicines may be given to control blood sugar levels, fever, and seizures. In
general, high blood pressure won't be treated immediately unless
systolic pressure is over 220 millimeters of mercury
(mm Hg) and
diastolic is more than 120 mm Hg (220/120, which is
also called 220 over 120).
Hemorrhagic stroke
Initial treatment for hemorrhagic stroke is difficult. Efforts are made
to control bleeding, reduce pressure in the brain, and stabilize vital signs,
especially blood pressure.
There are few medicines available to treat
hemorrhagic stroke. In some cases, medicines may be given to control blood
pressure, brain swelling, blood sugar levels, fever, and seizures. You will be
closely monitored for signs of increased pressure on the brain, such as
restlessness, confusion, difficulty following commands, and headache. Other
measures will be taken to keep you from straining from excessive coughing,
vomiting, or lifting, or straining to pass stool or change
position.
Surgery generally is not used to control mild to moderate
bleeding resulting from a hemorrhagic stroke. But if a large amount of bleeding
has occurred and the person is rapidly getting worse, surgery may be needed to
remove the blood that has built up inside the brain and to lower pressure
inside the head.
If the bleeding is due to a ruptured
brain aneurysm, surgery to repair the aneurysm may be
done. Repair may include:
Using a metal clip to clamp off the
aneurysm to prevent renewed bleeding.
Whether these surgeries can be done depends on the location
of the aneurysm and your condition following the stroke.
Ongoing treatment
After emergency treatment for
stroke, and when your condition has stabilized, treatment focuses on
rehabilitation and preventing another stroke. It will be important to control
your risk factors for stroke, such as
high blood pressure,
atrial fibrillation,
high cholesterol, or
diabetes.
Your doctor will probably want
you to take
aspirin or other
antiplatelet medicines. If you had an
ischemic stroke (caused by a blood clot), you may need to take
anticoagulants to prevent another stroke. You may also
need to take medicines, such as
statins, to lower high cholesterol or medicines to
control your blood pressure. Medicines to lower high blood pressure
include:
A procedure called
carotid artery stenting is another option for some
people who are at high risk of stroke. This procedure is much like coronary
angioplasty, which is commonly used to open blocked arteries in the heart.
During this procedure, a doctor inserts a metal tube called a
stent inside your carotid artery to increase blood
flow in areas blocked by plaque. The doctor may use a stent that is coated with
medicine to help prevent future blockage.
Early aggressive
rehabilitation may allow you to regain some normal functioning. Your
rehabilitation will be based on the physical abilities that were lost, your
general health before the stroke, and your ability to participate.
Rehabilitation begins with helping you resume activities of daily living, such
as eating, bathing, and dressing. For more information, see the topic
Stroke Rehabilitation.
Changes in
lifestyle may also be an important part of your ongoing treatment to reduce
your risk of having another stroke. It will be important for you to exercise to
the extent possible, eat a balanced diet, and quit smoking, if you smoke. Your
doctor may suggest that you follow the
Dietary Approaches to Stop Hypertension (DASH) diet if
you have high blood pressure. If you have high cholesterol, you may need to
follow the
Therapeutic Lifestyle Changes (TLC) diet. These eating
plans stress a diet that is low in fat (especially saturated fat) and contains
more whole grains, fruits, vegetables, and low-fat dairy products.
If you get
worse, it may be necessary for your loved one to move you to a care facility
that can meet your needs, especially if your caregiver has his or her own
health problems that make it difficult to properly care for you. It is common
for caregivers to neglect their own health when they are caring for a loved one
who has had a stroke. If your caregiver's health declines, the risk of injury
to you and your caregiver may increase. For more information, see:
If your condition gets worse, you
may want to think about
palliative care. Palliative care is a type of care for
people who have illnesses that do not go away and often get worse over time. It
is different from care to cure your illness, called curative treatment.
Palliative care focuses on improving your quality of life-not just in your
body, but also in your mind and spirit. Some people combine palliative care
with curative care.
Palliative care may help you manage symptoms
or side effects from treatment. It could also help you cope with your feelings
about living with a long-term illness, make future plans around your medical
care, or help your family better understand your illness and how to support
you.
If you are interested in palliative care, talk to your
doctor. He or she may be able to manage your care or refer you to a doctor who
specializes in this type of care.
Although stroke rehabilitation
is increasingly successful at prolonging life, a stroke can be a disabling or
fatal condition. People who have had a stroke may consider discussing health
care and other legal issues that may arise near the end of life. Many people
find it helpful and comforting to state their health care choices in writing
with an
advance directive while they are still able to make
and communicate these decisions.
Advance directives can include
the ability to refuse treatment in specific situations. The three main types of
advance directives are:
Do not resuscitate orders
(DNRs).
Living wills.
Durable power of attorney for
health care (DPA).
Do not resuscitate orders (DNRs)typically request that no extraordinary measures be used to save your
life. Extraordinary measures include cardiopulmonary resuscitation (CPR), use
of an electrical shock to stop a fatal abnormal heart rhythm (defibrillation),
intubation (placement of a breathing tube down your throat), or the use of
lifesaving drugs. People with DNR orders will only be given drugs that make
them more comfortable in their last moments. You may request that you be
identified as a DNR if you wish to avoid expensive, uncomfortable, or invasive
medical care that probably will not improve your long-term prognosis and may
increase your discomfort.
Living wills are
written documents that contain specific instructions about the type of
treatment you wish to receive at the end of your life. Unlike a DNR order,
which applies to a specific moment when you require resuscitation, living wills
apply to more general situations.
You are unable to make decisions
about the type of care you wish to receive.
Whenever two doctors agree that one of these conditions
has been met, your doctor will deliver care based on the directions in your
living will. Usually, living wills instruct doctors not to prescribe any
treatment that would unnecessarily lengthen the process of dying.
A durable power of attorney (DPA) for health care
document appoints a specific person (surrogate) to make decisions about your
care if you are incapacitated. (A DPA can also be called the appointment of a
health care agent or health care surrogate.) Unlike DNRs or living wills, DPAs
allow an independent observer of your choice to assess your current health
condition and to speak to your doctor before any decision about your care is
made. DNRs and living wills do not allow for this type of dialogue, because
your treatment is based on choices you made without knowing the exact nature of
your condition.
People who are unconscious
immediately after a stroke have the least chance of a full recovery. Some
people may have a poor recovery because of the location and extent of brain
damage. But many people do successfully recover.
It is not
possible to predict precisely how much physical ability you will regain. The
more ability you retain immediately after a stroke, the more independent you
are likely to be when you are discharged from the hospital. After a
stroke:
People usually show the greatest progress in
being able to walk during the first 6 weeks. Most recovery occurs within the
first 3 months, but you may continue to improve slowly over the next few
years.
Speech, balance, and skills needed for day-to-day living
return more slowly and may continue to improve for up to a
year.
About half of the people who suffer a stroke have problems
with coordination, communication, judgment, or behavior that affect their work
and personal relationships.
After a person has had a stroke, family members can learn
ways to provide
rehabilitation support and encouragement to their
loved one.
Prevention
You can help prevent a stroke if you
control risk factors and treat other medical conditions that can lead to a
stroke.
And if you have already had a stroke or a
transient ischemic attack (TIA), you can prevent
another stroke in the same way, by controlling risk factors and treating
medical conditions that can lead to stroke.
A transient ischemic
attack (TIA) is a warning sign that a
stroke may soon occur. Prompt medical attention for a
TIA may help prevent a stroke.
Seek emergency medical help immediately if you have symptoms of a TIA, which are
similar to those of a stroke. Symptoms include problems with vision, speech,
behavior, and thought processes. A TIA may cause loss of consciousness,
seizure, dizziness (vertigo), and weakness or numbness on one side of the body.
But symptoms of a TIA are temporary and usually disappear after 10 to 20
minutes, although they may last longer.
Treating other medical
conditions can help prevent a stroke.
Hardened arteries. If
you have been told that you have hardening of the arteries (atherosclerosis), check with your doctor about whether
you should take an aspirin each day and/or a medicine to lower your
cholesterol. Taking an aspirin daily can also reduce the risk of stroke in a
person who has already had an
ischemic stroke, a TIA, or
carotid endarterectomy surgery.
Blocked carotid artery. If your doctor hears a swishing
sound-a
bruit (say "broo-E")-when listening to blood flow
through the large blood vessels in your neck (carotid arteries), ask whether you need further testing (usually carotid
ultrasound). Surgery to reopen a blocked carotid artery may be appropriate. For
more information on this surgery, see:
A procedure called
carotid artery stenting is another option for some
people at high risk for stroke. This procedure is much like coronary
angioplasty, which is commonly used to open blocked arteries in the heart.
During this procedure, a doctor inserts a metal tube called a
stent inside your carotid artery to increase blood
flow in areas blocked by plaque. The doctor may use a stent that is
coated with medicine to help prevent future
blockage.
Limiting alcohol. Low to moderate alcohol consumption may
decrease the risk of ischemic stroke. Moderate drinking is 2
drinks a day for men, and 1 drink a day for women.
Excessive use of alcohol (more than 2 drinks a day)
can raise your risk of stroke.
Staying at a healthy weight. Being
overweight increases your risk of developing high blood pressure, heart
problems, and diabetes, which are risk factors for TIA and stroke.
Becoming more active. Do activities that raise your
heart rate. Try to do
moderate activity at least 2½ hours a week. One way to
do this is to be active 30 minutes a day, at least 5 days a week. It's fine to
be active in blocks of 10 minutes or more throughout your day and week.7 A large study showed that physical activity lowers your risk
of stroke, partly by reducing the two greatest risk factors for stroke: high
blood pressure and heart disease. The more physically active you are, the lower
your risk. Moderately active people had a 20% lower risk of stroke than
inactive people. Highly active people had about a 30% reduction of
risk.8Exercise can also help raise
HDL ("good") cholesterol levels in your body, which
also lowers the risk of stroke.
Lower your risk for stroke by:
Taking aspirin if you have had a heart attack.
For more information, see:
Taking
anticoagulants, as prescribed by your doctor, if you
have atrial fibrillation or have had a heart attack with other
complications.
Eating a nutritious, balanced diet that is low in
cholesterol, saturated fats, and salt. Foods high in saturated fat and
cholesterol can make hardening of the arteries worse. Eat more
fruits and vegetables to increase your intake of
potassium and vitamins B, C, E, and riboflavin. Add whole grains to your diet.
Eating fish one or more times a month may also reduce your risk of stroke.
Limit the amount of salt you eat too. For more information, see:
Avoiding
illegal drugs (such as a stimulant, like cocaine).
Cocaine can increase blood pressure and cause the heart to beat more rapidly,
thereby increasing your risk of stroke.
Avoiding birth control
pills if you have other risk factors. If you smoke or have high cholesterol or
a history of blood clots, taking birth control pills increases your risk of
having a stroke.
Avoiding
hormone replacement therapy. In women who have gone
through
menopause, hormone replacement therapy has been shown
to slightly increase the risk of stroke.3
Avoid getting sick from the
flu. Get a flu shot every year.
Home Treatment
After a
stroke, home treatment will be an important part of
your rehabilitation.
You may need to use assistive devices to help
you:
Eat. Large-handled silverware can be easier to grab
and use if you have a weak hand. If you have trouble swallowing, you may need
to change your diet or your doctor may provide you with a feeding tube to use
at home.
Get dressed. Devices called reachers can help you
put on socks or stockings if you have weakness in one arm or hand.
Walk. Canes and walkers can be used to help prevent
falls.
Tips for a successful recovery
Be as involved as possible in your care. Although you may feel like letting a caregiver take charge, the
more you can participate, the better. Ask for help in dealing with any
disabilities you may have, and try to make people understand your
limitations.
Participate in a
stroke rehabilitation program as soon as possible.
After a stroke, a combination of physical, speech, and occupational therapies
can help you manage the basics of daily living, such as bathing, dressing, and
eating. A team that includes a doctor, a variety of therapists, and nurses will
work with you to overcome disabilities, learn new ways to do tasks, and
strengthen parts of your body impaired by the stroke. For more information, see
the topic
Stroke Rehabilitation.
Tips for dealing with the effects of a stroke
Managing getting dressed. Getting
dressed may be easier if you use stocking/sock spreaders, rings or strings
attached to zipper pulls, and buttonhooks. Talk with an
occupational therapist about assistive devices that
may be available to help you get dressed.
Managing vision problems. After a stroke, some people have problems seeing to one side.
For example, people with right-sided paralysis may have difficulty seeing to
the right.
Managing eating problems. You may not be able to feel
food on one or both sides of your mouth. This increases your risk for choking.
You may need further tests or an evaluation by a speech therapist.
Managing bowel and bladder problems.
Some people who have a stroke suffer loss of bladder control (urinary
incontinence) after the stroke. But this is usually temporary, and it can have
many causes, including infection, constipation, and the effects of
medicines.
Tips for family members and caregivers
Family adjustment will be important to
your loved one's recovery. Strong support from the family can greatly enhance
recovery.
Help
manage speech and language problems with some simple
tips. These problems may involve any or all aspects of language use, such as
speaking, reading, writing, and understanding the spoken word. Speaking slowly
and directly and listening carefully can help.
Rehabilitation support involves participating in your
loved one's rehabilitation as often as you can. Give as much support and
encouragement as possible.
For more information on rehabilitation at home, see
the topic
Stroke Rehabilitation.
Although stroke
rehabilitation is increasingly successful at prolonging life, a stroke can be a
disabling or fatal condition. People who have had a stroke may consider
discussing health care and other legal issues that may arise near the end of
life. Many people find it helpful and comforting to state their health care
choices in writing with a
living will or other
advance directive while they are still able to make
and communicate these decisions. For more information, see the topic
Care at the End of Life.
Medications
It is very important to seek emergency
medical attention for
stroke symptoms. If you are having an
ischemic stroke, which is caused by a blood clot, you may be given medicines that
get rid of the clot. If you are having a
hemorrhagic stroke, which is caused by bleeding in the
brain, you will not be given medicines.
If you are having an
ischemic stroke, you may be able to receive tissue plasminogen activator
(t-PA), a clot-dissolving medicine. This medicine is strongly recommended, but
it is most effective if given within 3 hours of the onset of stroke
symptoms.1 If you receive t-PA within this 3-hour
window, it may improve your recovery. Evidence shows that there may be some
benefit in giving t-PA even beyond 3 hours.9, 10, 11 But t-PA can be life-threatening
because it can cause bleeding in the brain. It is not used to treat hemorrhagic
stroke.
Blood clots cause most strokes, so medicines that prevent
the formation of blood clots are used to prevent additional ischemic strokes.
These medicines are usually given after the initial treatment for stroke. They
are not recommended in the first 24 hours after t-PA has been given. The two
types of medicines used to prevent clotting are:
Antiplatelet medicines, which prevent
the smallest cells in blood (platelets) from sticking together.
Aspirin is the antiplatelet medicine most commonly used to prevent strokes.
People who cannot take aspirin or who have
transient ischemic attacks (TIAs) or a stroke while
taking aspirin are sometimes given other antiplatelet medicines, such as
clopidogrel (Plavix). Another medicine that can prevent ischemic stroke is
Aggrenox, which is aspirin combined with extended-release dipyridamole. Aspirin
is not recommended within the first 24 hours of giving t-PA. For more
information, see:
Anticoagulants, which prevent the
production of proteins needed for blood to clot normally. Anticoagulants
(particularly warfarin) are the best method of preventing blood clots that form
in the heart because of
atrial fibrillation,
heart attack, heart valve problems, or
heart failure. Anticoagulants are not given as
emergency treatment for stroke. If you take warfarin (such as Coumadin), see:
For people with
coronary artery disease, treatment with
cholesterol-lowering drugs called
statins can slow the development of
atherosclerosis in the
carotid arteries and may also reduce the chance of
having a TIA or stroke. Studies have shown a reduced risk of stroke in people
taking statins.5, 12, 6 (For more information on statins, see the topic
High Cholesterol.)
Medication Choices
Medicine used in the emergency treatment of stroke caused
by a clot (ischemic stroke) includes
tissue plasminogen activator (t-PA), a medicine that
breaks up clots.
After emergency treatment for a stroke, the focus
will turn to preventing future transient ischemic attacks (TIAs) or another
stroke. Your doctor will decide which medicines to use based on the risks and
possible side effects of the medicines. These medicines are not usually given
until at least 24 hours after treatment with t-PA.
Antiplatelet medicines
Antiplatelets
decrease blood clot formation by preventing the smallest blood cells (platelets) from sticking together and forming blood
clots. Antiplatelet medicines include the following:
Aspirin with extended-release dipyridamole
(Aggrenox) is used for the prevention of ischemic stroke.
Aspirin
is an antiplatelet medicine often used for a first TIA or ischemic stroke or if
you have atherosclerosis. Talk with your doctor before you start taking aspirin
to prevent a stroke.
Clopidogrel (Plavix) may be used if you have
had a TIA or ischemic stroke and cannot take aspirin.
Anticoagulant medicines
Anticoagulants
(warfarin and heparin) are often used instead of or in combination with
antiplatelets, such as aspirin or clopidogrel. Anticoagulants are used for
people who are at risk for stroke because of:
Abnormal heart rhythms (atrial
fibrillation).
Heart attack, if a clot is present in the
heart.
Heart failure.
Abnormal or artificial heart
valves.
If you have high blood pressure, your doctor may
want you to take medicines to lower it. Blood pressure medicines
include:
Choosing which medicine to use
to prevent stroke is based on evaluation of your risks and the benefits of
taking that medicine. The American College of Physicians recommends:
Warfarin for people who are at risk for
stroke because of abnormal heart rhythms (atrial fibrillation) or blood clots that form in the heart or another place in
the body. Warfarin is usually given to people age 65 and
older.
Aspirin for people who have had a transient ischemic attack
(TIA). Talk with your doctor before you start taking aspirin to prevent a
stroke.
Other antiplatelet medicines, such as aspirin with
extended-release dipyridamole (Aggrenox) or clopidogrel (Plavix).
Surgery
When surgery is being considered after a
stroke, your age, prior overall health, and current
condition are major factors in the decision. Surgery is not recommended as part
of the initial or emergency treatment for
ischemic stroke.
Surgery for ischemic stroke
Carotid endarterectomy. Carotid
endarterectomy is surgery to remove
plaque buildup in the
carotid arteries in people with moderate to severe
narrowing of the carotid arteries. This surgery can help prevent additional
strokes. For more information, see:
If a stroke has occurred because of a narrowed carotid
artery, a carotid endarterectomy may help lower the risk of a future
stroke.
You are most likely to benefit from surgery if you have
had a TIA or mild stroke in the past 6 months and have 70% or greater narrowing
in one of your carotid arteries. Carotid endarterectomy may be appropriate if
your carotid arteries are moderately or severely blocked (50% to 69% narrowing)
and you have had one or more TIAs or mild strokes.13 Talk to your doctor about whether a carotid
endarterectomy is right for you.
Carotid endarterectomies are
most successful when they are performed by a surgeon who is experienced in the
procedure. Ask your doctor about his or her rate of complications.
Surgery for hemorrhagic stroke
Surgeries for hemorrhagic stroke include:
Surgery to drain or remove blood in or around the brain that was
caused by a bleeding blood vessel (hemorrhagic stroke).
A
procedure (endovascular coil embolization) to
repair a brain
aneurysm that is the cause of a hemorrhagic stroke. A
small coil is inserted into the aneurysm to block it off. Whether this surgery
can be done depends on the location of the aneurysm, its size, and whether you
are healthy enough to withstand the procedure.
Surgery to remove or
block off abnormally formed blood vessels (arteriovenous malformations) that
have caused bleeding in the brain. An arteriovenous malformation is a
congenital disorder, which means it was present at birth. An arteriovenous
malformation causes an abnormal web of blood vessels and veins in the brain,
brain stem, or spinal cord. The vessel walls of an arteriovenous malformation
may become weak and leak or rupture.
People with a
brain aneurysm need evaluation of all their symptoms
to determine whether and when surgery is needed. Endovascular coil embolization
is the preferred treatment for people with a brain aneurysm. It is also used
for those who are at high risk for complications from a surgical repair of the
aneurysm.14 In cases where endovascular coil
embolization is not possible, aneurysm clipping with craniotomy is done.
Other Treatment
Stroke rehabilitation is a
critical part of a successful recovery. Early
rehabilitation, begun as soon as possible after the
stroke, helps to reduce dependence on others. Most
recovery occurs during the first 3 months after a stroke but may continue
slowly over the next few years. For more information, see the topic
Stroke Rehabilitation.
Carotid artery stenting can sometimes be used to open
narrowed arteries to the brain in an effort to prevent stroke. Carotid artery
stenting (also called cerebral percutaneous transluminal angioplasty) is
similar to the procedure used to open narrowed arteries that supply blood to
the heart (cardiac angioplasty). During this procedure, a
vascular surgeon inserts a metal tube called a
stent inside your carotid artery to increase blood
flow in areas blocked by plaque.
Carotid artery stenting may be as
effective as carotid endarterectomy in preventing stroke, heart attack, and
other complications in some people with narrowed carotid arteries.15, 16, 17 Talk to
your doctor if you would like to know if carotid artery stenting is a good
option for you.
Other studies are under way regarding new methods
for treating stroke.
Other Places To Get Help
Organizations
National Institute of Neurological Disorders and
Stroke
P.O. Box 5801
Bethesda, MD 20824
Phone:
1-800-352-9424 (301) 496-5751
TDD:
(301) 468-5981
Web Address:
www.ninds.nih.gov
The National Institute of Neurological Disorders and
Stroke (NINDS), a part of the National Institutes of Health, is the leading
U.S. federal government agency supporting research on brain and nervous system
disorders. It provides the public with educational materials and information
about these disorders.
American Stroke Association, a division of the American
Heart Association
7272 Greenville Avenue
Dallas, TX 75231
Phone:
1-888-4-STROKE (1-888-478-7653)
Web Address:
www.strokeassociation.org
This association provides information and referrals to local
self-help groups for people who have had a stroke and for their families.
Pamphlets and other information can be obtained by calling the Dallas
office.
Family Caregiver Alliance
180 Montgomery Street
Suite 1100
San Francisco, CA 94104
Phone:
1-800-445-8106 (415) 434-3388
E-mail:
info@caregiver.org
Web Address:
www.caregiver.org
This organization supports and assists people who are
providing long-term care at home. It also provides education, research,
services, and advocacy.
National Institutes of Health Senior
Health
9000 Rockville Pike
Bethesda, MD 20892
Phone:
(301) 496-4000
E-mail:
custserv@nlm.nih.gov
Web Address:
www.NIHSeniorHealth.gov
This Web site for older adults offers aging-related
health information. The site was developed by the National Institute on Aging
(NIA) and the National Library of Medicine (NLM), both part of the National
Institutes of Health (NIH). NIHSeniorHealth features up-to-date health
information from NIH. In addition, the American Geriatrics Society provides
independent review of some of the material found on this Web site. The Web
site's senior-friendly features include large print, simple navigation, and
short, easy-to-read segments of information. A visitor to this Web site can
click special buttons to hear the text aloud, make the text larger, or turn on
higher contrast for easier viewing.
National Stroke Association
9707 East Easter Lane, Building B
Centennial, CO 80112
Phone:
1-800-STROKES (1-800-787-6537)
Fax:
(303) 649-1328
E-mail:
info@stroke.org
Web Address:
www.stroke.org
This association provides education, information, referrals, and
research on stroke.
Adams HP Jr, et al. (2007). Guidelines for the early
management of adults with ischemic stroke: A guideline from the American Heart
Association/American Stroke Association Stroke Council, Clinical Cardiology
Council, Cardiovascular Radiology and Intervention Council, and the
Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in
Research Interdisciplinary Working Groups: The American Academy of Neurology
affirms the value of this guideline as an educational tool for neurologists.
Stroke, 38(5): 1655-1711.
Fung TT, et al. (2004). Prospective study of major
dietary patterns and stroke risk in women. Stroke, 35:
2014-2019.
Wassertheil-Smoller S, et al. (2003). Effect of
estrogen plus progestin on stroke in postmenopausal women. The Women's Health
Initiative: A randomized trial. JAMA, 289(20):
2673-2684.
American Heart Association (2008). Heart disease and stroke statistics-2008 update (At-A-Glance version). Available online: http://www.americanheart.org/presenter.jhtml?identifier=3037327.
Stroke Prevention by Aggressive Reduction in
Cholesterol Levels (SPARCL) Investigators (2006). High-dose atorvastatin after
stroke or transient ischemic attack. New England Journal of Medicine, 355(6): 549-559.
O'Regan C, et al. (2007). Statin therapy in stroke
prevention: A meta-analysis involving 121,000 patients. American Journal of Medicine, 121(1): 24-33.
U.S. Department of Health and Human Services (2008).
2008 Physical Activity Guidelines for Americans (ODPHP
Publication No. U0036). Washington, DC: U.S. Government Printing Office.
Available online:
http://www.health.gov/paguidelines/pdf/paguide.pdf.
Lee CD, et al. (2003). Physical activity and stroke
risk: A meta-analysis. Stroke, 34(10):
2475-2481.
The ATLANTIS, ECASS, and NINDS rt-PA Study Group
Collaborative (2004). Association of outcome with early stroke treatment:
Pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials.
Lancet, 363(9411): 768-774.
Hacke W, et al. (2008). Thrombolysis with alteplase 3
to 4.5 hours after acute ischemic stroke. New England Journal of Medicine, 359(13): 1317-1329.
Wahlgren N, et al. (2008). Thrombolysis with alteplase
3-4.5 h after acute ischemic stroke (SITS-ISTR): An observational study.
Lancet. Published online September 15, 2008
(doi:10.1016/S0140-6736(08)61339-2).
Heart Protection Study Collaborative Group (2004).
Effects of cholesterol-lowering with simvastatin on stroke and other major
vascular events in 20,536 people with cerebrovascular disease or other
high-risk conditions. Lancet, 363(9411):
757-767.
Biller J, et al. (1998). Guidelines for carotid
endarterectomy: A statement for healthcare professionals from a special writing
group of the Stroke Council of the American Heart Association. Circulation, 97(5): 501-509.
Mayer SA, et al. (2005). Subarachnoid hemorrhage. In
LP Rowland, ed., Merritt's Neurology, 11th ed., pp.
328-338. Philadelphia: Lippincott Williams and Wilkins.
Yadav JS, et al. (2004). Protected carotid-artery
stenting versus endarterectomy in high-risk patients. New England Journal of Medicine, 351(15): 1493-1501.
Mas J-L, et al. (2006). Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. New England Journal of Medicine, 355(16): 1660-1671.
Brahmanandam S, et al. (2008). Clinical results of
carotid artery stenting compared with carotid endarterectomy. Journal of Vascular Surgery, 47(2): 343-349.
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Adams RJ, et al. (2003). Coronary risk evaluation in
patients with transient ischemic attack and ischemic stroke: A scientific
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on Clinical Cardiology of the American Heart Association/American Stroke
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Stroke Association Stroke Council. Stroke, 37(6):
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College of Chest Physicians evidence-based clinical practice guidelines (8th
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Latchaw RE, et al. (2003). Guidelines and
recommendations for perfusion imaging in cerebral ischemia. Stroke, 34(4): 1084-1104.
Sacco RL, et al. (2006). Guidelines for prevention of
stroke in patients with ischemic stroke or transient ischemic attack.
Stroke, 37(2): 577-617.
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prevention: Scientific review. JAMA, 288(11): 1388-1395.
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Credits
Author
Monica Rhodes
Editor
Kathleen M. Ariss, MS
Associate Editor
Pat Truman, MATC
Primary Medical Reviewer
Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer
Richard D. Zorowitz, MD - Physical Medicine and Rehabilitation
This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
Adams HP Jr, et al. (2007). Guidelines for the early
management of adults with ischemic stroke: A guideline from the American Heart
Association/American Stroke Association Stroke Council, Clinical Cardiology
Council, Cardiovascular Radiology and Intervention Council, and the
Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in
Research Interdisciplinary Working Groups: The American Academy of Neurology
affirms the value of this guideline as an educational tool for neurologists.
Stroke, 38(5): 1655-1711.
Fung TT, et al. (2004). Prospective study of major
dietary patterns and stroke risk in women. Stroke, 35:
2014-2019.
Wassertheil-Smoller S, et al. (2003). Effect of
estrogen plus progestin on stroke in postmenopausal women. The Women's Health
Initiative: A randomized trial. JAMA, 289(20):
2673-2684.
American Heart Association (2008). Heart disease and stroke statistics-2008 update (At-A-Glance version). Available online: http://www.americanheart.org/presenter.jhtml?identifier=3037327.
Stroke Prevention by Aggressive Reduction in
Cholesterol Levels (SPARCL) Investigators (2006). High-dose atorvastatin after
stroke or transient ischemic attack. New England Journal of Medicine, 355(6): 549-559.
O'Regan C, et al. (2007). Statin therapy in stroke
prevention: A meta-analysis involving 121,000 patients. American Journal of Medicine, 121(1): 24-33.
U.S. Department of Health and Human Services (2008).
2008 Physical Activity Guidelines for Americans (ODPHP
Publication No. U0036). Washington, DC: U.S. Government Printing Office.
Available online:
http://www.health.gov/paguidelines/pdf/paguide.pdf.
Lee CD, et al. (2003). Physical activity and stroke
risk: A meta-analysis. Stroke, 34(10):
2475-2481.
The ATLANTIS, ECASS, and NINDS rt-PA Study Group
Collaborative (2004). Association of outcome with early stroke treatment:
Pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials.
Lancet, 363(9411): 768-774.
Hacke W, et al. (2008). Thrombolysis with alteplase 3
to 4.5 hours after acute ischemic stroke. New England Journal of Medicine, 359(13): 1317-1329.
Wahlgren N, et al. (2008). Thrombolysis with alteplase
3-4.5 h after acute ischemic stroke (SITS-ISTR): An observational study.
Lancet. Published online September 15, 2008
(doi:10.1016/S0140-6736(08)61339-2).
Heart Protection Study Collaborative Group (2004).
Effects of cholesterol-lowering with simvastatin on stroke and other major
vascular events in 20,536 people with cerebrovascular disease or other
high-risk conditions. Lancet, 363(9411):
757-767.
Biller J, et al. (1998). Guidelines for carotid
endarterectomy: A statement for healthcare professionals from a special writing
group of the Stroke Council of the American Heart Association. Circulation, 97(5): 501-509.
Mayer SA, et al. (2005). Subarachnoid hemorrhage. In
LP Rowland, ed., Merritt's Neurology, 11th ed., pp.
328-338. Philadelphia: Lippincott Williams and Wilkins.
Yadav JS, et al. (2004). Protected carotid-artery
stenting versus endarterectomy in high-risk patients. New England Journal of Medicine, 351(15): 1493-1501.
Mas J-L, et al. (2006). Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. New England Journal of Medicine, 355(16): 1660-1671.
Brahmanandam S, et al. (2008). Clinical results of
carotid artery stenting compared with carotid endarterectomy. Journal of Vascular Surgery, 47(2): 343-349.
