Stroke: What You Need to Know
What Is a Stroke?
A stroke is a medical emergency. It happens when a blood vessel in the brain bursts or, more commonly, when a blockage happens. Without treatment, cells in the brain quickly begin to die. This can cause serious disability or death. If a loved one is having stroke symptoms, call 911 right away.
Call 911 right away about signs of a stroke, which may include sudden:
- Numbness or weakness of the body, especially on one side
- Vision changes in one or both eyes, or trouble swallowing
- Severe headache with an unknown cause
- Problems with dizziness, walking, or balance
- Confusion, trouble speaking or understanding others
The FAST test helps spot symptoms. It stands for:
- Face drooping:Ask for a smile. Does one side droop?
- Arm weakness or numbness.
- Speech:Can the person repeat a simple sentence? Do they have trouble or slur words?
- Time to call 911:Don’t delay.
Time = Brain Damage
Every second counts. Without oxygen, brain cells begin dying within minutes. Once brain tissue has died, the body parts controlled by that area won’t work right. This makes stroke a top cause of long-term disability. There are clot-busting drugs that can curb brain damage, and they must be given in a short time — usually within 3 hours of when symptoms start.
Tests may start when you’re still in the ambulance. Once you get to the ER, you’ll get imaging tests such as a CT scan, MRI, or ultrasound. You may get other types of tests, such as an EKG (checks your heart’s electrical activity) and an EEG (checks your brain’s electrical activity).
This is the most common type of stroke: Nearly nine out of 10 fall into this category. An ischemic stroke happens when a blood clot blocks the supply of blood to or in the brain. The clot may start in that spot or travel through the blood from elsewhere in the body. Clogged arteries are a top cause.
Hemorrhagic strokes happen when a weakened blood vessel in the brain bursts. The result is bleeding inside the brain that can be hard to stop. The most common cause is high blood pressure. Other causes include aneurysms and AVMs (arteriovenous malformations), which weaken blood vessels in the brain.
Transient ischemic attacks, often called “mini-strokes,” are also an emergency. When they happen, blood flow is temporarily hampered in part of the brain, causing stroke-like symptoms. When the blood flows again, the symptoms stop. You can’t tell at the time if it’s a stroke or TIA. So call 911. Having a TIA is also a warning sign, so see your doctor if you think you’ve had one.
Ischemic strokes: The goal is to restore blood flow. A clot-busting medication called tPA is very good at dissolving clots and cutting the chance of long-term damage, but it must be given in time — usually within 3 hours.
Hemorrhagic strokes: These are harder to manage. Treatment usually involves trying to control high blood pressure, bleeding, and brain swelling.
Ischemic strokes: Clogged arteries are a top cause. Plaque made of fat, cholesterol, and other things builds up in the arteries, leaving less space for blood to flow. A blood clot may lodge in this narrowed space and cause an ischemic stroke. All that plaque makes it easier for a clot to form and can also rupture, blocking blood flow.
Hemorrhagic strokes: These can happen if uncontrolled high blood pressure bursts a weakened artery.
Your chance of having a stroke rises with age and if you have:
- Had a stroke or TIA before
- Heart disease
- High blood pressure
- High cholesterol
- Sickle cell disease
Smoking, heavy drinking, and not being active also raise your risk.
What’s On Your Plate?
Eating too much fat and cholesterol can cause plaque to narrow arteries. Too much salt may lead to high blood pressure. Eating plenty of fruits, vegetables, whole grains, and fish may help lower your stroke risk.
Lowering Your Risk
Find out if you have any conditions that you need to treat to help prevent a stroke. That may mean taking medicine and also boosting healthy habits, from the foods you eat to being active and not smoking. It’s never too late to start.
Life After a Stroke: What to Expect From Recovery
Whether a stroke causes long-term effects depends on how severe it was, where in the brain it struck, and how quickly the stroke got treated. After a stroke, many people have physical problems such as numbness in the arms or legs and trouble with walking, vision, swallowing, talking, or understanding. These issues may be permanent, but not always. Rehabilitation is key for regaining lost skills and adapting to damage that can’t be undone.
PT and OT
Muscle weakness, as well as balance problems, are very common after a stroke. This can affect walking and other daily activities. Physical therapy (PT) helps you regain strength, balance, and coordination. For fine motor skills, such as using a knife and fork, writing, and buttoning a shirt, occupational therapy (OT) can help.
Some people have trouble speaking after a stroke. For them, speech and language therapy is key to regaining as much of that ability as possible. A speech therapist can also help if someone has trouble swallowing.
A lot of stroke survivors and their loved ones feel difficult emotions, including anxiety and sadness. You don’t have to deal with that alone, especially if it starts to affect your daily life. A psychologist or mental health counsellor can help you manage these emotions and watch for signs of depression, which is common after a stroke — and can be treated.
Preventing Another Stroke
After a stroke or TIA, avoiding another one is a top priority. While your risk is higher than someone who’s never had a stroke, that risk drops over time — and there are things that help lower that risk. Medication, healthier habits and, for some people, surgery may be part of your doctor’s recommendations.
After a stroke, if you have conditions such as high blood pressure, diabetes, high cholesterol, atrial fibrillation, or heart disease, your doctor will prescribe medication to treat them. People at high risk may need to take anti-platelet medicines, such as aspirin, to help prevent blood clots. Some people may need anti-clotting drugs, such as warfarin.
What to Check
Taking your medication is key. But so are these things:
- Exercise. If you have your doctor’s permission, slowly add more active time to your day. And cut down on time spent sitting.
- Weight. Ask your doctor what habits will help you be your healthiest at any size, and discuss whether weight loss is part of that.
- Tobacco. If you smoke, make it a priority to quit.
A healthier diet is also a big part of lowering your risk.
Eat more vegetables, fruits, whole grains, fish, nuts, and low-fat dairy products. Cut back on saturated fat (found mainly in animal products but also in coconut and palm oils), salt, and added sugar.
It’s like a cross between the traditional Mediterranean diet and the DASH diet, and it includes vegetables, berries, fish, beans, nuts, whole grains, poultry, olive oil, and a little bit of red wine. Eating this way may help slow down a decline in mental skills after a stroke, according to a study of 106 stroke survivors.
Carotid Artery Surgery
Some strokes are due to narrowed carotid arteries, which are on both sides of the neck and bring blood to the brain. People who’ve had a mild stroke or TIA for this reason may be candidates for carotid endarterectomy. The surgeon removes plaque from the lining of the carotid arteries. Ask your doctor about the risks, benefits, and recovery, which may take several weeks.
Balloon and Stent
Doctors can sometimes treat a clogged carotid artery without major surgery. A procedure called angioplasty involves guiding a catheter to the carotid artery and inflating a tiny balloon to widen the narrowed area. A metal tube, called a stent, can be inserted and left in place to keep the artery open. You’ll likely stay in the hospital for a night and get back to your usual activities in a few days.
Stroke Rehabilitation to Regain Arm Movement
After a Stroke: Spasticity, Weakness, and Paralysis
Many people lose the use of their arm and hand after a stroke. Many also experience spasticity, uncontrollable muscle tightness, and stiffness, which make movement difficult. According to Stroke Connect, experts estimate that 20-50% of stroke survivors have some spasticity. Paralysis or weakness on one side of the body happens to about 80% of people. This usually happens on the opposite side of the body from where the stroke occurred in the brain. In rehab, you’ll work with a health care team to regain use of your arm.
Stroke Rehab Begins Right Away
Stroke rehabilitation begins once your condition has stabilized — as soon as 24 to 48 hours after your stroke. Early, individualized therapy helps improve your chance of recovery. After leaving the hospital, you’ll continue rehabilitation at an inpatient or an outpatient clinic, a nursing facility, or at home. While some stroke survivors recover fully, others will always have some disability.
Stretching Exercises Improve Range of Motion
Stretching exercises promote blood flow and make it easier to move your arm. Your therapist will start by gently stretching your hand, arm, and shoulder in a full range of motion. They can also show you how to use your unaffected hand to gently stretch the wrist, fingers, and thumb on your opposite hand.
Exercises to Help Rebuild Your Strength
Strengthening the muscles in your hand and arm will help improve your grip and ability to use your limb. An early arm exercise involves holding your weak arm with your strong arm and rocking it back and forth like a baby. As you gain strength and mobility, you can use squeeze balls, wrist weights, or hand weights to tone and build muscle.
Electrical Stimulation Therapy
A stroke interferes with your brain’s ability to send messages to the nerves in your muscles. This can make it difficult to move and control your arm and hand. Electrical stimulation (ES) therapy is a safe way to stimulate the nerves that make your muscles contract. ES may help you regain control over your limb, improve muscle tone, and reduce pain and spasticity.
Constraint-Induced Movement Therapy
At some point in your recovery, your therapist may have you wear a restraining device on your functioning arm. You’ll then be asked to use your affected hand and arm as much as possible to do repetitive tasks. This type of therapy is thought to increase brain plasticity — the ability to repair itself. It may also help you regain function in your affected hand.
Practice Fine Motor Skills
Fine motor skills are small, precise movements you make with your hand and fingers. You can build this skill by tracing a design with a pen, shuffling cards, using a pegboard, or picking up small beans and putting them in a cup. As with all rehabilitation exercises, repetition is important to help retrain your brain. You need to practice daily, just as you would if you were learning to play the piano.
Spasticity Treatment: Oral Medications
Drug therapy for spasticity is often used in addition to physical exercises and stretching. Oral muscle relaxant medications help reduce large areas of spasticity by interfering with the nerve signals that cause muscles to contract. However, these medications may cause side effects such as drowsiness and weakness. Talk with your doctor or pharmacist to learn more.
Injections to Help Spasticity
For spasticity in a few select areas, you may benefit from a targeted therapy. A doctor can inject you with botulinum toxin, phenol, or both. Botulinum treatments block the release of nerve chemicals involved in muscle contraction. Phenol injections serve as nerve blocks in affected muscles, which helps with spasticity. Effects of both treatments usually last about three to six months. Depending on the medication, side effects can include pain, swelling, soreness, fatigue, and muscle weakness.
Intrathecal Baclofen Therapy for Spasticity
Another option may be intrathecal baclofen therapy. For this, a small pump is surgically implanted to administer muscle relaxant medicine to the spinal fluid. It can be useful when someone has severe spasticity or hasn’t done well on oral medications. The pump uses a smaller amount of baclofen medication than when it’s taken by pill, so it can cut down on some side effects. But there still are possible side effects and complications; talk to your doctor.
Occupational Therapy: Relearning Life Skills
One of the most important parts of your recovery is relearning daily living skills so that you can be mobile and independent. An occupational therapist (OT) will show you how to work around your disabilities so that you can change your clothes, take a shower on your own, cook, clean, and if possible, drive a car. Your OT will also help you set up your home to make it safer and easier to move around in.
Stick With Rehabilitation: Keep Setting New Goals
The first three months after a stroke are when most people make the biggest gains in their recovery. But by continuing to set new goals for yourself and exercising every day, you can see progress even years later. Practicing new skills helps the undamaged part of your brain take over new functions. Scientists are just beginning to understand how powerful our brains are, so it’s worth sticking with it.