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Stroke

What Is a Stroke?

A stroke is a type of brain injury. Symptoms depend on the part of the brain that is affected. People who survive a stroke often have weakness on one side of the body or trouble with moving, talking, or thinking.

Most strokes are ischemic (is-KEE-mic) strokes. These are caused by reduced blood flow to the brain when blood vessels are blocked by a clot or become too narrow for blood to get through. Brain cells in the area die from lack of oxygen. In another type of stroke, called hemorrhagic (hem-or-AJ-ic) stroke, the blood vessel isn't blocked; it bursts, and blood leaks into the brain, causing damage.

Strokes are more common in older people. Almost three-fourths of all strokes occur in people 65 years of age or over. However, a person of any age can have a stroke.
A person may also have a transient ischemic attack (TIA). This has the same symptoms as a stroke, but only lasts for a few hours or a day and does not cause permanent brain damage. A TIA is not a stroke but it is an important warning signal. The person needs treatment to help prevent an actual stroke in the future.

A stroke may be frightening to both the patient and family. It helps to remember that stroke survivors usually have at least some spontaneous recovery or natural healing and often recover further with rehabilitation.

How Stroke Affects People

Effects on the Body, Mind, and Feelings

Each stroke is different depending on the part of the brain injured, how bad the injury is, and the person's general health. Some of the effects of stroke are:

• Weakness (hemiparesis--hem-ee-par-EE-sis) or paralysis (hemiplegia--hem-ee-PLEE-ja) on one side of the body.
This may affect the whole side or just the arm or the leg. The weakness or paralysis is on the side of the body opposite the side of the brain injured by the stroke. For example, if the stroke injured the left side of the brain, the weakness or paralysis will be on the right side of the body.

• Problems with balance or coordination.
These can make it hard for the person to sit, stand, or walk, even if muscles are strong enough.

• Problems using language (aphasia and dysarthria).
A person with aphasia (a-FAY-zha) may have trouble understanding speech or writing. Or, the person may understand but may not be able to think of the words to speak or write. A person with dysarthria (dis-AR-three-a) knows the right words but has trouble saying them clearly.

• Being unaware of or ignoring things on one side of the body (bodily neglect or inattention).
Often, the person will not turn to look toward the weaker side or even eat food from the half of the plate on that side.

• Pain, numbness, or odd sensations.
These can make it hard for the person to relax and feel comfortable.

• Problems with memory, thinking, attention, or learning (cognitive problems).
A person may have trouble with many mental activities or just a few. For example, the person may have trouble following directions, may get confused if something in a room is moved, or may not be able to keep track of the date or time.

• Being unaware of the effects of the stroke.
The person may show poor judgment by trying to do things that are unsafe as a result of the stroke.

• Trouble swallowing (dysphagia--dis-FAY-ja).
This can make it hard for the person to get enough food. Also, care must sometimes be taken to prevent the person from breathing in food (aspiration--as-per-AY-shun) while trying to swallow it.

• Problems with bowel or bladder control.
These problems can be helped with the use of portable urinals, bedpans, and other toileting devices.

• Getting tired very quickly.
Becoming tired very quickly may limit the person's participation and performance in a rehabilitation program.

• Sudden bursts of emotion, such as laughing, crying, or anger.
These emotions may indicate that the person needs help, understanding, and support in adjusting to the effects of the stroke.

• Depression.
This is common in people who have had strokes. It can begin soon after the stroke or many weeks later, and family members often notice it first.

Depression After Stroke

It is normal for a stroke survivor to feel sad over the problems caused by stroke. However, some people experience a major depressive disorder, which should be diagnosed and treated as soon as possible. A person with a major depressive disorder has a number of symptoms nearly every day, all day, for at least 2 weeks. These always include at least one of the following:

• Feeling sad, blue, or down in the dumps.
• Loss of interest in things that the person used to enjoy.

A person may also have other physical or psychological symptoms, including:

• Feeling slowed down or restless and unable to sit still.
• Feeling worthless or guilty.
• Increase or decrease in appetite or weight.
• Problems concentrating, thinking, remembering, or making decisions.
• Trouble sleeping or sleeping too much.
• Loss of energy or feeling tired all of the time.
• Headaches.
• Other aches and pains.
• Digestive problems.
• problems.
• Feeling pessimistic or hopeless.
• Being anxious or worried.
• Thoughts of death or suicide.

If a stroke survivor has symptoms of depression, especially thoughts of death or suicide, professional help is needed right away. Once the depression is properly treated, these thoughts will go away. Depression can be treated with medication, psychotherapy, or both. If it is not treated, it can cause needless suffering and also makes it harder to recover from the stroke.

Brain Basics: Preventing Stroke

If you're like most Americans, you plan for your future. When you take a job, you examine its benefit plan. When you buy a home, you consider its location and condition so that your investment is safe. Today, more and more Americans are protecting their most important asset--their health. Are you?

Stroke ranks as the third leading killer in the United States. A stroke can be devastating to individuals and their families, robbing them of their independence. It is the most common cause of adult disability. Each year more than 500,000 Americans have a stroke, with about 145,000 dying from stroke-related causes. Officials at the National Institute of Neurological Disorders and Stroke (NINDS) are committed to reducing that burden through biomedical research.

Types of Strokes

What is a Stroke?
A stroke, or "brain attack," occurs when blood circulation to the brain fails. Brain cells can die from decreased blood flow and the resulting lack of oxygen. There are two broad categories of stroke: those caused by a blockage of blood flow and those caused by bleeding. While not usually fatal, a blockage of a blood vessel in the brain or neck, called an ischemic stroke, is the most frequent cause of stroke and is responsible for about 80 percent of strokes. These blockages stem from three conditions: the formation of a clot within a blood vessel of the brain or neck, called thrombosis; the movement of a clot from another part of the body such as the heart to the neck or brain, called embolism; or a severe narrowing of an artery in or leading to the brain, called stenosis. Bleeding into the brain or the spaces surrounding the brain causes the second type of stroke, called hemorrhagic stroke.

Two key steps you can take will lower your risk of death or disability from stroke: know stroke's warning signs and control stroke's risk factors. Scientific research conducted by the NINDS has identified warning signs and a large number of risk factors.

What are Warning Signs of a Stroke?

Warning signs are clues your body sends that your brain is not receiving enough oxygen. If you observe one or more of these signs of a stroke or "brain attack," don't wait, call a doctor or 911 right away!

• Sudden weakness or numbness of the face, arm, or leg.
• Sudden dimness or loss of vision, particularly in one eye.
• Sudden difficulty speaking or trouble understanding speech.
• Sudden severe headache with no known cause.
• Unexplained dizziness, unsteadiness or sudden falls, especially with any of the other signs.

Other danger signs that may occur include double vision, drowsiness, and nausea or vomiting. Sometimes the warning signs may last only a few moments and then disappear. These brief episodes, known as transient ischemic attacks or TIAs, are sometimes called "mini-strokes." Although brief, they identify an underlying serious condition that isn't going away without medical help. Unfortunately, since they clear up, many people ignore them. Don't. Heeding them can save your life.

What are Risk Factors for a Stroke?

A risk factor is a condition or behavior that occurs more frequently in those who have, or are at greater risk of getting, a disease than in those who don't. Having a risk factor for stroke doesn't mean you'll have a stroke. On the other hand, not having a risk factor doesn't mean you'll avoid a stroke. But your risk of stroke grows as the number and severity of risk factors increases.

Stroke occurs in all age groups, in both sexes, and in all races in every country. It can even occur before birth, when the fetus is still in the womb. In African-Americans, the death rate from stroke is almost twice that of the white population. Scientists have found more and more severe risk factors in some minority groups and continue to look for patterns of stroke in these groups.

What Are the Treatable Risk Factors?
Some of the most important treatable risk factors for stroke are:

High blood pressure. Also called hypertension, this is by far the most potent risk factor for stroke. If your blood pressure is high, you and your doctor need to work out an individual strategy to bring it down to the normal range. Some ways that work: Maintain proper weight. Avoid drugs known to raise blood pressure. Cut down on salt. Eat fruits and vegetables to increase potassium in your diet. Exercise more. Your doctor may prescribe medicines that help lower blood pressure. Controlling blood pressure will also help you avoid heart disease, diabetes, and kidney failure.

Cigarette smoking. Cigarette smoking has been linked to the buildup of fatty substances in the carotid artery, the main neck artery supplying blood to the brain. Blockage of this artery is the leading cause of stroke in Americans. Also, nicotine raises blood pressure; carbon monoxide reduces the amount of oxygen your blood can carry to the brain; and cigarette smoke makes your blood thicker and more likely to clot. Your doctor can recommend programs and medications that may help you quit smoking. By quitting, at any age, you also reduce your risk of lung disease, heart disease, and a number of cancers including lung cancer.

Heart disease. Common heart disorders such as coronary artery disease, valve defects, irregular heart beat, and enlargement of one of the heart's chambers can result in blood clots that may break loose and block vessels in or leading to the brain. The most common blood vessel disease, caused by the buildup of fatty deposits in the arteries, is called atherosclerosis. Your doctor will treat your heart disease and may also prescribe medication, such as aspirin, to help prevent the formation of clots. Your doctor may recommend surgery to clean out a clogged neck artery if you match a particular risk profile. If you are over 50, NINDS scientists believe you and your doctor should make a decision about aspirin therapy. A doctor can evaluate your risk factors and help you decide if you will benefit from aspirin or other blood-thinning therapy.

Warning signs or history of stroke. If you experience a TIA, get help at once. Many communities encourage those with stroke's warning signs to dial 911 for emergency medical assistance. If you have had a stroke in the past, it's important to reduce your risk of a second stroke. Your brain helps you recover from a stroke by drawing on body systems that now do double duty. That means a second stroke can be twice as bad.
Diabetes. You may think this disorder affects only the body's ability to use sugar, or glucose. But it also causes destructive changes in the blood vessels throughout the body, including the brain. Also, if blood glucose levels are high at the time of a stroke, then brain damage is usually more severe and extensive than when blood glucose is well-controlled. Treating diabetes can delay the onset of complications that increase the risk of stroke.

Do You Know Your Stroke Risk?
Some of the most important risk factors for stroke can be determined during a physical exam at your doctor's office. If you are over 55 years old, a worksheet in a pamphlet available from the NINDS can help you estimate your risk of stroke and show the benefit of risk-factor control.

The worksheet was developed from NINDS-supported work in the well-known Framingham Study. Working with your doctor, you can develop a strategy to lower your risk to average or even below average for your age.

Many risk factors for stroke can be managed, some very successfully. Although risk is never zero at any age, by starting early and controlling your risk factors you can lower your risk of death or disability from stroke. With good control, the risk of stroke in most age groups can be kept below that for accidental injury or death.

To obtain a copy of the worksheet, write or telephone requesting the pamphlet Brain Basics: Preventing Stroke from the NINDS Office of Scientific and Health Reports.

Americans have shown that stroke is preventable and treatable. A better understanding of the causes of stroke has helped Americans make lifestyle changes that have cut the stroke death rate nearly in half in the last two decades.

More than a million stroke survivors suffer little or no long-lasting disability from their strokes. Another two million, however, live with the crippling and lifelong disabilities of paralysis, loss of speech, and poor memory. Scientists at the NINDS predict that, with continued attention to reducing the risks of stroke and by using currently available therapies and developing new ones, Americans should be able to prevent 80 percent of all strokes by the end of the decade.
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National Institute of Neurological Disorders and Stroke
National Institutes of Health
Bethesda, MD 20892
NIH Publication No. 94-3440-b

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