… It was a day, like any other, that Armenouhi (fictitious name of a patient), a 38-year-old housewife, sat down to dinner with her husband and five-year-old son. Suddenly, she felt the most intense and excruciating headache she had ever experienced. She asked her husband for her high blood pressure pill. Her hand just didn’t feel right. After a few minutes, she tried to get up but had trouble bearing weight in her lower right limb, she turned to her husband and tried to tell her what was happening, but her words didn’t come out right. Her husband went to call 911 and upon returning he found Armenouhi on the ground, unconscious…
INTRODUCTION
A. What is a stroke or “brain attack”? A stroke, or brain attack, is caused by a sudden loss of blood flow to the brain or by bleeding inside the head. Each can cause brain cells to stop working or die. When nerve cells in the brain die, the function of the body parts they control is damaged or lost. Depending on the part of the brain affected, people may lose speech, senses, muscle strength, vision, or memory. Some people make a full recovery; others are severely disabled or die.
B. How common is it? Each year, about 700,000 people in the United States have a stroke. That’s about one person every 45 seconds. And one person dies of a stroke every 3 minutes, or almost 170,000 a year. This means that stroke is the third leading cause of death in the country after heart disease and cancer. It is the leading cause of disability in adults. The cost of stroke in the US ranges from $30 to $40 billion per year.
C. What are the symptoms? The symptoms of a stroke may not be as dramatic or painful as a heart attack. but the results can be just as life threatening. Stroke is an emergency. Get medical help right away and know when the symptoms started. Common symptoms include:
o Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body
o Sudden confusion, difficulty speaking or understanding speech
o Sudden trouble seeing in one or both eyes
o Sudden trouble walking, dizziness, loss of balance or coordination
o Sudden severe headache with no known cause
D. How is it diagnosed?
o Neurological examination
o Neuropsychological evaluation, to examine how well the brain is working when performing certain functions, such as remembering, solving problems, processing information. It is also used to document areas of weakness and strength.
o Brain imaging tests (CT or CT scan, MRI, or MRI) to understand the type, location, and extent of the stroke
o Tests showing blood flow and bleeding sites (ultrasound and carotid and transcranial angiography)
o Blood tests to detect bleeding or clotting disorders
o EKG (electrocardiogram) or an ultrasound (echocardiogram) examination of the heart to identify cardiac sources of blood clots that could travel to the brain
II. CAN STROKE BE PREVENTED?
The good news is that about 50% of all strokes can be prevented with medical care and simple lifestyle changes.
How can I personally prevent it? Some risk factors, such as age (stroke risk factors double with every decade after age 55), sex (men have a slightly higher risk of stroke than women), race (men African-Americans have twice the risk of stroke than most other racial groups), and a family history of stroke cannot be changed. However, many others can be controlled. Most of the controllable factors relate to the health of the heart and blood vessels. Doing these things can help you prevent a stroke:
o Have regular medical checkups
o Control high blood pressure
o Don’t smoke and quit if you do.
o Treat heart disease, especially an irregular heartbeat called “atrial fibrillation”
o Improve your diet: Avoid excess fat, salt and alcohol
oExercise
o Manage diabetes
o Seek immediate medical attention for warning signs
B. How can medicine prevent it? Some people are at risk of stroke due to known health factors, such as high blood pressure, diabetes, and heart disease. Also, having had a stroke puts you at higher risk of having another stroke. Fortunately for people in these situations, there are medical treatments that can help prevent a stroke:
1) Antiplatelets and anticoagulants. Doctors may prescribe antiplatelet drugs (such as aspirin) and blood thinners (such as warfarin) to reduce the blood’s ability to clot.
2) Angioplasty and stents To remove blockages, doctors may pass a balloon angioplasty through a major vessel in the leg or arm to reach the affected vessel. Sometimes a steel screen called a “stent” is inserted into a vessel to expand its diameter and improve blood flow.
3) Carotid Endarterectomy In this surgical procedure, a blockage of the carotid artery in the neck is removed.
third WHAT ARE SOME TREATMENT OPTIONS?
Once the doctor completes the diagnostic tests, the treatment is chosen. For all stroke patients, the goal is to prevent further brain damage. If the stroke is caused by blocked blood flow to the brain, treatment may include:
o t-PA (tissue plasminogen activator), a blood-thinning drug that is injected within three hours after the onset of a non-bleeding stroke
o Drugs that thin the blood, including blood thinners (warfarin) and antiplatelet drugs (aspirin or ticlopidine); a combination of sustained-release aspirin and dipyridamole
o Surgery that opens the inside of the narrowed blood vessels in the neck (carotid endarterectomy)
If bleeding is the cause of the stroke, treatment may include:
o Medications that maintain normal blood clotting
o Surgery to remove blood from the brain or decrease pressure on the brain
o Surgery to repair broken blood vessels
o Blockage of bleeding vessels by inserting a coil
o Medications that prevent or reverse inflammation of the brain
o Inserting a tube into a hollow part of the brain to reduce pressure
IV. AND THE REHABILITATION?
After a stroke, a person may have some disability. Disability depends on the size and location of the stroke. The right side of the brain controls the left side of the body; in right-handed people it is important for attention and visuospatial skills. The left side of the brain controls the right side of the body; in right-handed people (and in 50 percent of left-handed people) it controls language: speaking and comprehension. Language disorders are also called “aphasias.”
Rehabilitation helps restore function lost from damage caused by a stroke. During rehabilitation, most people will get better. However, many do not fully recover. Unlike skin cells, nerve cells that die do not recover and are not replaced by new cells. However, the human brain is adaptable. People can learn new ways of functioning, using undamaged brain cells.
This rehabilitation period is often challenging. The patient and family work with a team of physical, occupational, and speech therapists, along with nurses and doctors. Most of the improvement will take place in the first three to six months of the process. But some people can make excellent progress over longer periods.
Staying healthy,
Dr Haygoush Kalinian
neuropsychologist
Phone: (949) 481-8414
Fax: (949) 481-8415