What is a stroke?

A stroke, also called a brain attack, occurs when blood flow to the brain is interrupted by a blocked or burst blood vessel. When the brain's blood supply is cut off, brain cells don't get the oxygen and nutrients they need. Brain cells can't live without a constant supply of nutrients. If brain cells are deprived of oxygen and nutrients for even a short time, they become injured and may die.

One way a stroke occurs is that blood vessels to the brain become narrowed or clogged, cutting off blood flow to brain cells. A brain attack caused by lack of blood reaching the brain is called an ischemic stroke. Ischemic stroke accounts for about 85 percent of all stroke cases. Hemorrhagic stroke accounts for the remaining 15 percent of cases and results from a weakened vessel that ruptures and bleeds into the surrounding brain. As the blood seeps out, the accumulating blood compresses the surrounding brain tissue.

What are the warning signs and symptoms of a stroke?

Think e-F-A-S-T (FAST from the University of Cincinnati).

e = Eyes. Deviation of the eyes or sudden or temporary loss of all or part of your vision.

F = Face. Sudden facial numbness or weakness especially on one side of the body.

A = Arm. Sudden arm and/or leg numbness or weakness especially on one side of the body.

S = Speech. Slurred speech or difficulty speaking or understanding what is being said.

T = Time. Time to call 911. Time is brain.

Stroke is a medical emergency. Do not ignore the warning signs of a stroke. If you or someone you know is experiencing any of the above symptoms, immediately call 9-1-1 to get emergency care as quickly as possible.

Early treatment can increase your chance of survival and diminish the likelihood of permanent brain damage.

RISK FACTORS

Risk factors for stroke can be classified into two general types: those that cannot be treated (non-modifiable risk factors) and those that can be treated (modifiable risk factors).

Risk factors that cannot be treated are:

• Age (getting older)



• Gender (being male)



• Race (being African American)



• Prior stroke



• Family history

Stroke risk factors that can be treated through diet, medication and /or intervention are:

• Hypertension/High Blood pressure: Elevated blood pressure is considered the most important risk factor for brain attack. On average, an elevated or high blood pressure above 140/90 places you at a higher risk of brain attack. You can control your high blood pressure by having your blood pressure checked regularly, seeing your physician if your blood pressure is high, taking medications your physician prescribes for you on a regular basis, reducing the amount of fat and salt in your diet, and by exercising a little each day.



• Heart Disease: If you have heart disease, it should be aggressively treated. It is important that you take your heart medications as ordered and have all necessary blood work completed as ordered by your physician. This is particularly important if you have atrial fibrillation (irregular heartbeat).



• Cigarette Smoking: Smokers have a much higher risk for brain attack than non-smokers, especially when in combination with other risk factors. For those who quit smoking, risk of stroke declines significantly.



• Transient Ischemic Attacks (TIAs): TIA is a warning episode and a strong indicator of a stroke. Recognize the warning signs of stroke and obtain appropriate treatment to prevent a major stroke from occurring.



• Diabetes: Diabetes cannot be cured, but by maintaining near normal glucose, blood pressures and cholesterol levels can reduce the risk of stroke due to diabetic complications.



• Elevated Blood Cholesterol/Lipids: Reducing your dietary intake of saturated fats and cholesterol can help reduce your risk of stroke.



• Asymptomatic Carotid Bruits (Broo-ee): This is an irregular sound that a doctor can detect by listening. If you have bruit, your physician may order a carotid ultrasound or duplex test.



• Excessive Alcohol Intake: Excessive use of alcoholic beverages increases the risk for hemorrhagic brain attack, through an occasional drink has not been shown to be harmful. If you do drink, use moderation.



• Stress: Excessive stress causes an increase in your blood pressure and puts a strain on your body. Stress is a major factor for brain attack. If you are under a lot of stress, seek ways to relieve or reduce the stress you encounter. Relaxation techniques and getting regular exercise are two effective ways to reduce the effects of stress.



• Obesity: Being overweight puts a strain on the heart and may contribute to high blood pressure. To control your weight, eat a well-balanced diet that is low in fat. Limit the amount of red meats, eggs and dairy products in your diet and exercise on a regular basis.



• Exercise: Active people with low body fat content tend to have lower cholesterol levels and normal blood pressure. Lack of exercise leads to excessive weight, another contributing factor for brain attack. By getting some form of exercise for only 30 minutes three or four times per week, you can lower your risk.

Other risk factors that have a relationship to stroke occurrence, but are not well documented include:

• Geographical Location-especially the southern U.S., known as the “Stroke Belt”
  
• Socioeconomic Factors (poorer, less-education people have higher rates of stroke)
  
• Excessive Alcohol Intake: Excessive use of alcoholic beverages increases the risk for hemorrhagic brain attack, through an occasional drink has not been shown to be harmful. If you do drink, use moderation.
  
• Certain Kinds of Drug Abuse

If you are at risk for stroke (e.g. have one or more risk factors), it is important to talk to your physician. Many of the risk factors for stroke listed above can be modified to lessen your risk of stroke. You can prevent the risk for brain attack by simply leading a healthy life and by working on lessening the impact of the above risk factors.

What are the treatment options for a stroke?

Because their mechanisms are different, the treatments for the two main types of stroke are different.

Ischemic stroke

Ischemic stroke is treated by removing obstruction and restoring blood flow to the brain.
The most promising treatment for ischemic stroke is the FDA-approved clot busting drug t-PA, which must be administered within a three-hour window from the onset of symptoms. Generally, only 3 to 5 percent of those who suffer a stroke reach the hospital in time to receive treatment. Sutter also has the ability to offer intra-arterial t-PA that can be given up until 6 hours from the time of symptoms. Anticoagulants such as warfarin and aspirin interfere with the blood's ability to clot and can play an important role in preventing stroke worsening. Carotid endarterectomy is a procedure in which blood vessel blockage is surgically removed from the carotid artery. Doctors use balloon angioplasty and implantable steel screens called stents to treat cardiovascular disease in which mechanical devices are used to remedy fatty buildup clogging the vessel.

Hemorrhagic stroke

For hemorrhagic stroke, caused by an aneurysm or arteriovenous malformation (AVM), surgical treatment is often recommended to either place a metal clip at the base, called the neck, of the aneurysm or to remove the abnormal vessel comprising an AVM. Endovascular procedures are less invasive and involve the use of a catheter introduced through a major artery in the leg or arm, guided to the aneurysm or AVM where it deposits a mechanical agent, such as a coil, to prevent rupture.

Sutter Stroke Program

Besides immediate response to acute strokes presenting the emergency department, the Stroke Program at Sutter Health is involved in several cutting edge research trials. This includes several neuroprotective drugs, medications that save the brain from stroke, and new medical devices and procedures, used to minimize damage to the brain after a stroke.

Should you or someone you know have a stroke, the Sutter Heath Stroke team will develop a treatment plan specific to the severity of your condition. Your doctor will monitor your health carefully to prevent further brain damage. Then your doctor may recommend therapy to deal with consequences of stroke. This may include physical, speech and occupational therapy.

Click here for more information on Stroke from the Sutter Neuroscience Institute.

To view our Stroke animation click here.

---

back to top