A Stroke means that some part of the brain has died; it’s called a “cerebrovascular accident” (CVA) in medicalese. Transient Ischemic Attack (TIA) means that part of the brain hasn’t gotten enough oxygen (“Ischemia“). TIA’s are temporary, & the brain recovers fully, but there’s great risk for a future complete Stroke.
How permanent a Stroke is can be hard to tell at the beginning. There may be improvement during the first week, even up to 3 or 6 months. But, in general, the bigger the stroke in terms of disability, and the bigger the size of brain damage (infarction) on MRI, the less recovery there’ll be.
Causes of Strokes — Strokes & TIA’s occur for various reasons. Some of these include:
1. Atherosclerosis, which means “hardening of the arteries;” it’s caused by age, hypertension, smoking, diabetes, high cholesterol, and heredity. When arteries aren’t healthy, plaques of cholesterol and blood clots form in them. If this affects one of the 4 large arteries that feed the brain, a piece of clot can break off, get swept into the brain, and block the circulation to a certain part. Also, plaques forming inside the brain’s arteries can gradually narrow the circulation & cut it off.
2. Clots from the Heart get swept up to the brain & cut off circulation there. The most common cause of this is Atrial Fibrillation, a type of irregular heart rhythm, which allows clots to form. Other conditions that do this include Heart Attacks (in the first month), artificial heart valves, and certain heart diseases.
3. Certain Diseases that allow blood to clot inside the arteries, which is definitely abnormal (instead of when exposed to air, like when getting a cut). Some types of Lupus can do this, and Sickle Cell Disease, but there are many others. Certain birth control pills can rarely do this. We think of these conditions when patients under age 45 have Strokes.
4. Brain Hemorrhages (Bleeding: the amount of blood may be little, but the damage great). This may occur from a ruptured aneurysm, extremely high blood pressure, stimulant drug use (amphetamines or cocaine), trauma, and various rare diseases. We think of these conditions when patients under age 45 have Strokes.
Symptoms of Stroke & TIA — This all depends on the part of the brain that’s affected. Some common manifestations of Stroke, occurring suddenly, include:
- Weakness or paralysis of one side of the body, often with loss of sensation. If it’s unlucky enough to be the dominant side (right side if you’re right-handed, etc.), there’s usually loss of speech called “aphasia” (the patient understands completely, creates speech in their mind, but nerve death stops the thought from being spoken).
- Sudden blindness in one eye.
- Vertigo, double vision, slurred speech, trouble swallowing, &/or hoarseness (see Vertigo)
- Loss of coordination and balance, with inability to walk
- “Locked-In,” meaning complete paralysis of all muscles except eye movement. But the person can feel & think completely normally.
- Coma (and often death).
Treatment for Stroke — Once a stroke has occurred there’s little treatment available. Rehab might help. We certainly give medications to prevent another stroke. But there’s no way to undo damage; the body will cure itself to the extent possible.
However, when a Stroke has just begun, there’s treatment to stop it from progressing. For that to be most successful, it has to be given within the first 3 hours, possibly 6 hrs (but 3 is much better). And that time frame includes delay in the emergency room for a CT scan to determine exactly what kind of stroke (to be sure there’s no bleeding involved).
This treatment should all be done at an emergency room of a hospital designated as a specialized Stroke Center, where they’re very used to the techniques & move fast. A small ER won’t be equipped at all. It’s well worth the extra time for an ambulance to drive to a Stroke Center.
MORAL — If you or loved one (or anyone) begins to have any symptoms above, that don’t go away in 5 minutes, call 911. Tell the ambulance crew you think it’s a stroke, insist on transport to the nearest Stroke Center’s emergency room.