Strokes: Multiple Attacks In A Day, Possible?

Ischemic strokes are life-threatening medical emergencies that occur when a blockage prevents blood from reaching the brain. They are the most common type of stroke, accounting for about 87% of all cases. The blockages are typically caused by blood clots or fatty deposits, and symptoms include facial drooping, limb weakness, and slurred speech. As it is a medical emergency, seeking care within 2-3 hours of the first symptoms is vital to improve the chances of survival and reduce the likelihood of permanent damage. Treatment for ischemic strokes focuses on restoring blood flow to the affected area of the brain, primarily through the use of intravenous tissue plasminogen activator (tPA) to break up blood clots. While recovery from a stroke can take weeks or months, early intervention is crucial to optimising outcomes.

What are the symptoms of an ischemic stroke?

An ischemic stroke is a life-threatening medical condition that occurs when there is a blockage that keeps blood from reaching all areas of your brain. The symptoms of an ischemic stroke can vary from person to person and can range from mild to severe. Here are some of the most common symptoms:

• One-sided weakness or paralysis: This can include drooping or numbness on one side of the face, or weakness in one arm or leg.
• Aphasia: Difficulty with or loss of the ability to speak.
• Slurred or garbled speech: This is known as dysarthria.
• Loss of muscle control on one side of the face: This can include a drooping mouth or eyelids.
• Loss of sensation or abnormal sensations: This can occur on one side of the body and may include a sudden loss of vision, hearing, smell, taste, or touch.
• Double vision: This is known as diplopia.
• Loss of coordination or clumsiness: This is called ataxia.
• Dizziness or vertigo: This can include a loss of balance.
• Nausea and vomiting.
• Emotional instability and personality changes.
• Confusion or agitation.
• Memory loss: This can include short-term or long-term memory loss.
• Severe headaches: These are usually sudden and severe.
• Passing out or fainting.

It's important to recognize these warning signs and act quickly if you or someone you know is experiencing any of these symptoms. Immediate medical attention is crucial for the best chance of recovery and to prevent permanent brain damage.

What causes ischemic strokes?

Ischemic strokes are caused by a blockage that prevents blood from reaching the brain. This blockage can be the result of a blood clot or other debris in the blood vessels. Here are some specific causes of ischemic strokes:

• Atherosclerosis: This is the main cause of ischemic strokes and involves fatty deposits (plaques) that line the walls of blood vessels supplying blood to the brain.
• Thrombosis: This is the formation of a blood clot within a blood vessel supplying blood to the brain. It is often associated with atherosclerotic disease.
• Embolism: This occurs when a blood clot forms in the heart or large arteries of the upper chest or neck and then breaks loose, travelling through the bloodstream until it reaches smaller vessels in the brain.
• Lacunar stroke: This is a small vessel blockage caused by conditions such as hypertension, aging, smoking, and diabetes.
• Cardioembolism: This is an arterial blockage caused by an embolism originating in the heart.
• Large artery atherosclerosis: This involves significant narrowing or complete blockage of a major brain artery due to atherosclerosis.
• High blood pressure: This can contribute to blood vessel damage, making an ischemic stroke more likely.
• High cholesterol: Hyperlipidemia can increase the risk of ischemic stroke.
• Lifestyle factors: Smoking, alcohol use disorder, recreational drug use, and unhealthy diet can all contribute to the risk of ischemic stroke.
• Other medical conditions: Atrial fibrillation, heart defects, microvascular ischemic disease, and infected tissue in the bloodstream can increase the risk of ischemic stroke.

How is an ischemic stroke treated?

The treatment for an ischemic stroke depends on how long it has been since the onset of symptoms. The priority is to restore blood circulation to the affected areas of the brain to limit damage and preserve brain tissue.

Thrombolytic drugs can be used within the first three to four and a half hours after the onset of symptoms. These medications dissolve blood clots. However, after this time frame, they increase the risk of dangerous bleeding complications.

Another treatment option is endovascular mechanical thrombectomy, which involves removing the clot from the brain using a catheter-based approach. This procedure is also time-sensitive and is usually only possible within the first 24 hours after symptoms begin.

Supportive treatments may include:

• Mild hypothermia: Lowering body temperature can make brain cells more resistant to stroke-related damage.
• Blood sugar management: Maintaining optimal glucose levels in the blood is important for brain recovery.
• Blood thinners: These medications can prevent further blood clots but should only be used for ischemic strokes caused by clots.
• Oxygen: Supplemental oxygen can increase the oxygen available for the brain to use.

Stroke rehabilitation, including speech, physical, and cognitive therapy, can help individuals recover from a stroke and relearn certain functions.

It is important to note that a stroke is a life-threatening medical emergency, and immediate medical care is crucial to prevent permanent brain damage or death.

What are the risk factors for ischemic stroke?

Ischemic strokes are caused by a blockage that prevents blood from reaching the brain. They are the most common type of stroke, accounting for about 85% to 87% of all strokes.

There are several risk factors for ischemic stroke, some of which can be controlled or influenced by lifestyle choices, while others are beyond our control. Here are the key risk factors:

Lifestyle Risk Factors

• High Blood Pressure: This is a leading cause of stroke and often has no noticeable symptoms. It can be managed through lifestyle changes or medication.
• High Cholesterol: Consuming too many saturated or trans fats, as well as foods high in cholesterol, can lead to high cholesterol levels, which contribute to plaque buildup in the arteries.
• Diabetes: People with diabetes have a higher risk of carotid artery disease, which can lead to stroke. Diabetes can be prevented or managed through lifestyle changes.
• Obesity: Being overweight or obese can increase "bad" cholesterol and decrease "good" cholesterol levels, leading to a higher risk of stroke.
• Unhealthy Diet: A diet high in saturated and trans fats, cholesterol, sodium, and sugar can contribute to diabetes, plaque buildup, high blood pressure, and high cholesterol, all of which increase the risk of stroke.
• Physical Inactivity: Lack of physical activity can lead to high blood pressure, high cholesterol, and obesity, all of which are risk factors for stroke.
• Smoking: Smoking increases the risk of stroke by contributing to plaque buildup, making blood more likely to clot, increasing cholesterol levels, and damaging blood vessels.
• Alcohol Consumption: Drinking too much alcohol can raise blood pressure and increase the risk of stroke. It also raises triglyceride levels, a form of fat that can harden arteries.
• Recreational Drug Use: Misuse of recreational or prescription drugs can increase the risk of stroke.

Medical Risk Factors

• Previous Stroke or Transient Ischemic Attack (TIA): Having a previous stroke or TIA, also known as a "mini-stroke," significantly increases the risk of having another stroke.
• Heart Conditions: Common heart disorders, such as coronary artery disease, heart valve defects, atrial fibrillation, and enlarged heart chambers, can increase the risk of blood clots and stroke.
• Sickle Cell Disease: This blood disorder, which primarily affects Black children, can cause red blood cells to form an abnormal sickle shape, blocking blood flow to the brain and leading to stroke.
• Age: The risk of stroke increases with age, especially after 55, and the chance of having a stroke doubles every 10 years. However, stroke can occur at any age.
• Family History and Genetics: A family history of stroke, particularly at a young age, increases the risk. Certain genetic factors also play a role in high blood pressure, stroke, and related conditions.
• Pregnancy and Hormonal Factors: Pregnancy, use of birth control pills, and hormone replacement therapy can increase the risk of stroke in women.
• Race and Ethnicity: In the United States, stroke occurs more frequently in Black, Pacific Islander, Alaska Native, American Indian, and Hispanic adults compared to white adults.
• Sleep Apnea: Sleep apnea is a medical condition that can increase the risk of stroke.

It is important to note that addressing these risk factors through lifestyle changes, medical management, and regular health check-ups can help reduce the likelihood of experiencing an ischemic stroke.

What are the complications of an ischemic stroke?

An ischemic stroke occurs when a blood vessel supplying blood to the brain is blocked. This blockage prevents blood from reaching all areas of the brain, causing the affected brain cells to die due to a lack of oxygen and nutrients. The abilities controlled by the damaged areas of the brain are then lost.

Complications of an ischemic stroke may include:

• Brain edema, or swelling of the brain, caused by a build-up of fluid and pressure inside the skull. This can affect the flow of oxygen and blood to the brain and is a life-threatening condition requiring immediate treatment.
• Pneumonia, a lung infection caused by the inhalation of foreign substances due to swallowing problems or immobility.
• Urinary tract infections (UTIs) and bladder control problems, which can occur due to the use of catheters or a loss of bladder function.
• Seizures, resulting from abnormal electrical activity in the brain.
• Clinical depression, which can manifest as unwanted emotional and physical reactions to the changes and losses caused by the stroke.
• Pressure ulcers, also known as bedsores, which develop due to prolonged immobility and increased pressure on certain areas of the body.
• Limb contractures, caused by shortened muscles in the arms or legs due to reduced range of motion or lack of exercise.
• Shoulder pain, resulting from the lack of support of an affected arm due to weakness or paralysis.
• Deep vein thrombosis (DVT), or blood clots that form in the legs due to immobility.
• Bowel and bladder problems, including constipation and incontinence.
• Mobility problems and falls, which can be caused by muscle weakness or paralysis after a stroke.
• Transient ischemic attack (TIA), or "mini-strokes," which can lead to blood clots, swallowing difficulties, UTIs, and mobility issues.
• Aphasia, or difficulty in communicating and understanding speech due to brain damage.
• Headaches, which may occur due to the stroke or as a side effect of treatment.
• Involuntary muscle tightening, causing stiffness and reduced range of motion.

Frequently asked questions