Stroke is a life-threatening condition that requires immediate medical attention and emergency care. It occurs when the blood supply to the brain is blocked or limited, leading to cell death and permanent brain injury. The symptoms of a stroke can vary, but often include weakness or numbness on one side of the face or body, slurred speech, and severe headaches. Stroke is the leading cause of adult disability in the US, with approximately 795,000 cases reported annually. Ischemic strokes, caused by blood clots, are the most common type, accounting for 87% of cases. Hemorrhagic strokes, caused by bleeding in the brain, are less common but more lethal, contributing to 40% of stroke-related deaths. The risk factors for stroke include high blood pressure, high cholesterol, smoking, physical inactivity, obesity, and diabetes. Recognizing the signs of a stroke and acting quickly is crucial, as prompt medical intervention can significantly improve the chances of recovery and reduce potential disabilities.
Characteristics | Values |
---|---|
Face | Has the person's face changed? Is the mouth drooping on one side? Is their smile straight or lopsided? |
Arms | Can they raise both arms? Can they hold them up, or do the arms drift down? |
Speech | Is their speech slurred or difficult to understand? Can they repeat a simple sentence? |
Time | If the answer to any of the above is yes, call 911 without delay. |
Vision | Are there vision problems affecting one or both eyes? |
Coordination | Are there coordination problems and loss of balance? |
Headache | Are they experiencing a severe and sudden headache? |
Consciousness | Have they lost consciousness? |
What You'll Learn
Recognising the signs of a stroke
- Weakness or numbness on one side of the face or body
- Vision problems in one or both eyes
- Difficulty talking or understanding speech
- Loss of coordination and balance
- A sudden, severe headache
- Loss of consciousness
To help identify the signs of a stroke, remember the acronym FAST:
- Face: Has the person's face changed? Is their mouth drooping on one side? Can they smile straight?
- Arms: Can they raise both arms?
- Speech: Is their speech slurred or difficult to understand?
- Time: If the answer to any of the above is 'yes', call the emergency services immediately.
Other signs and symptoms of a stroke can include:
- Sudden confusion or trouble speaking or understanding others
- Sudden trouble walking, dizziness, or loss of balance
- A sudden, severe headache with no known cause
If you suspect someone is having a stroke, act quickly. Call the emergency services and, while waiting for help to arrive, help the person to lie down on their side with their head slightly elevated to promote blood flow. Loosen any restrictive clothing to help them breathe more easily, and check for breathing and a pulse if they are unconscious. Do not give them anything to eat or drink, and write down the time that the symptoms started, or when they were last seen acting normally.
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What to do if someone is having a stroke
If you suspect someone is having a stroke, it is important to act quickly as human nerve tissue is rapidly lost as the stroke progresses. Call 911 immediately and do the following while waiting for help to arrive:
- Write down the time the symptoms started or when the person was last seen "normal". This will help emergency teams act efficiently.
- Help the person lie down. Keep the victim on their side with their head slightly elevated to promote blood flow.
- Loosen any restrictive clothing to help them breathe more easily.
- Do not give the person aspirin or anything to eat or drink.
- Check for breathing and a pulse if the person is unconscious. Begin CPR immediately if there is no pulse.
Remember, the longer the delay in treatment, the more damage can be done to the brain.
- Sudden numbness or weakness of the face, arms, or legs
- Sudden confusion or trouble speaking or understanding others
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking, dizziness, or loss of balance or coordination
- Sudden severe headache with no known cause
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Types of stroke
There are two main types of stroke: ischemic strokes and hemorrhagic strokes. This classification is based on what causes the lack of blood flow to the brain. Strokes can be deadly or cause lasting brain damage, so getting medical attention immediately is crucial.
Ischemic Strokes
Ischemic strokes are the most common type of stroke, accounting for about 87% of all stroke cases in the US. They occur when a blood vessel supplying blood to the brain is blocked or "clogged", causing brain cells and tissues to begin to die within minutes due to lack of oxygen and nutrients. Ischemic strokes are often caused by a blood clot or a buildup of fatty substances called plaque.
Ischemic strokes are subdivided into two main categories: thrombotic and embolic. Thrombotic strokes involve a blood clot that originates in the brain, while embolic strokes result from a blood clot that forms elsewhere in the body and travels to the brain.
Hemorrhagic Strokes
Hemorrhagic strokes, on the other hand, are caused by a blood vessel in the brain bursting or leaking. This results in blood loss that creates pressure injury to the brain, damaging brain cells. Hemorrhagic strokes are rarer than ischemic strokes but progress more quickly and are usually more severe.
Hemorrhagic strokes can be caused by aneurysms, which are enlarged ballooning of blood vessels prone to rupture, or arteriovenous malformation, a congenital condition that sends blood from the arteries directly to the brain, bypassing the brain tissue. They can also be caused by trauma, such as head injury.
Hemorrhagic strokes have two subtypes, depending on where the bleeding occurs: intraparenchymal and subarachnoid. Intraparenchymal hemorrhages involve bleeding directly in the brain tissue, often resulting from high blood pressure. Subarachnoid hemorrhages occur when bleeding is in the subarachnoid space, between the brain and the surrounding membrane, and are often due to aneurysms or arteriovenous malformation.
Other Types of Strokes
In addition to the main categories of ischemic and hemorrhagic strokes, there are a few other types worth mentioning:
- Transient Ischemic Attack (TIA): Often called a "mini stroke", it resembles an ischemic stroke but lasts only a few minutes. While it may not cause permanent damage, it is a warning sign of a full ischemic stroke in the future.
- Cryptogenic Stroke: This is a stroke of unknown origin, where the cause cannot be determined.
- Brainstem Stroke: This describes the location of the stroke rather than the cause. Brainstem strokes can be particularly debilitating as they affect essential functions like breathing, heartbeat, and consciousness.
- Recurrent Stroke: This refers to the condition of having multiple strokes. The risk of serious complications increases with each stroke.
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Risk factors for stroke
A stroke, or "brain attack", occurs when there is a blockage or disruption in the blood supply to the brain. This blockage can be caused by a blood clot or a buildup of fatty deposits and cholesterol, known as plaque. There are two main types of stroke: ischemic and hemorrhagic. Ischemic strokes, which account for about 87% of cases, are the result of a blockage in a blood vessel in the brain, typically due to a blood clot or plaque. Hemorrhagic strokes, on the other hand, are caused by a burst blood vessel in the brain, leading to bleeding and increased pressure in the nearby brain tissue.
While anyone can have a stroke at any age, certain risk factors can increase the likelihood of experiencing one. These risk factors can be broadly categorized into those that are controllable and those that are not.
Controllable Risk Factors:
- High blood pressure: Lowering blood pressure through lifestyle changes or medication can reduce the risk of stroke.
- High cholesterol and lipid levels: High cholesterol contributes to the thickening and hardening of arteries (atherosclerosis) due to plaque buildup.
- Heart disease: Abnormal heart rhythms, such as atrial fibrillation, and cardiac structural abnormalities, such as valvular heart disease, increase the risk of stroke.
- Diabetes: Diabetes causes a buildup of sugars in the blood, preventing oxygen and nutrients from reaching the brain.
- Smoking: Smoking nearly doubles the risk of an ischemic stroke.
- Alcohol consumption: Excessive alcohol intake raises blood pressure and increases the risk of stroke.
- Illegal drug use: Intravenous drug abuse, particularly cocaine, is linked to an increased risk of stroke from blood clots.
- Physical inactivity: Lack of physical activity can lead to health conditions that raise the risk of stroke, including obesity, high blood pressure, high cholesterol, and diabetes.
- Diet: A diet high in saturated fats, trans fats, and cholesterol is linked to stroke and related conditions like heart disease.
Uncontrollable Risk Factors:
- Age: The risk of stroke increases with age, with the chances of having a stroke more than doubling every 10 years after the age of 55.
- Race and ethnicity: In the United States, stroke occurs more frequently in Black, Alaskan Native, American Indian, and Hispanic adults compared to White adults.
- Gender: Stroke occurs more often in men, but women tend to have a higher lifetime risk due to their longer life expectancy. Additionally, women who take birth control pills or use hormone replacement therapy are at a higher risk.
- Family history and genetics: The risk of stroke is elevated in individuals with a family history of the condition. Certain genes, such as those determining blood type, also influence stroke risk.
- Previous stroke or transient ischemic attack (TIA): Individuals who have previously experienced a stroke or TIA are at a higher risk of having another stroke.
- Pregnancy: High blood pressure during pregnancy, such as from preeclampsia, increases the risk of stroke later in life.
- Location: Strokes are more prevalent in certain regions, such as the southeastern United States.
- Temperature and climate: Extreme temperatures are associated with a higher risk of stroke-related deaths.
- Social and economic factors: There is some evidence suggesting that strokes are more common among low-income individuals.
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Treatment options for stroke
Treatment for a stroke depends on whether it is ischemic or hemorrhagic. Ischemic strokes are caused by a blockage or narrowing of the arteries that carry blood to the brain. Hemorrhagic strokes are caused by bleeding in or around the brain.
Treating an ischemic stroke
The main treatment for an ischemic stroke is a medicine called tissue plasminogen activator (tPA), which breaks up blood clots that block blood flow to the brain. This must be given within 3 hours of the onset of symptoms, and the sooner treatment begins, the better the chances of recovery. If tPA cannot be used, an anticoagulant or blood-thinning medicine may be given to stop blood clots from forming or growing larger.
In some cases, a procedure may be required to open up blocked arteries and restore blood flow to the brain. This can be done through a thrombectomy, angioplasty and stenting, or a stent retriever.
Treating a hemorrhagic stroke
Treatment for a hemorrhagic stroke often involves reducing blood pressure to lower the pressure and strain on blood vessels in the brain. The patient will also be taken off any anticoagulant or blood-thinning medications that may have led to bleeding. Depending on the type of medication, the patient may be given vitamin K to help stop the bleeding.
There are several procedures that may be used to treat hemorrhagic strokes, including aneurysm clipping, blood transfusion, coil embolization, draining excess fluid, and surgery to remove pooled blood or relieve pressure on the brain.
Other care
In addition to treating the blockage or bleeding causing the stroke, patients may require additional treatments or tests. This may include breathing support, compression therapy, a feeding tube, fluids, and medicine to lower a fever. Rehabilitation plans are also recommended to help patients regain abilities they had before the stroke.
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Frequently asked questions
A stroke is a medical emergency and can be identified by sudden numbness or weakness in the face, arm, or leg, especially on one side of the body. Other signs include sudden confusion, trouble speaking or understanding speech, and sudden loss of vision in one or both eyes.
If you suspect someone is having a stroke, act F.A.S.T:
- Face: Ask the person to smile and check if one side of their face droops.
- Arms: Ask the person to raise both arms and check if one arm drifts downward.
- Speech: Ask the person to repeat a simple phrase and check if their speech is slurred or strange.
- Time: If you observe any of these signs, call the emergency services right away.
There are two main types of strokes:
- Ischemic stroke: This is the most common type and occurs when a blood clot or the narrowing of a blood vessel reduces blood flow to the brain.
- Hemorrhagic stroke: This occurs when a blood vessel in the brain bursts, causing blood to leak into or around the brain.