STROKE (Cerebrovascular Accident)

General Information

DEFINITION--A sudden decrease in the blood supply to part of the brain, damaging the area so it cannot function normally.

BODY PARTS INVOLVED--Central nervous system; musculoskeletal system.

SEX OR AGE MOST AFFECTED--Adults over 60.

SIGNS & SYMPTOMS--

The following symptoms may vary according to the site of brain damage:

• Inability to speak; inability to move part of the body; loss of consciousness.
• Sudden heaviness in an arm or leg or numbness and inability to control muscles.
• Headache; vision disturbances; confusion; dizziness; loss of bowel and bladder control.

CAUSES--

Usually hardening of the arteries (atherosclerosis) or high blood pressure. These may result in the following:

• Thrombosis, in which blood flow is blocked by a narrow or closed artery.
• Embolism, in which a small part of an artery wall or a small blood clot from a diseased artery or heart travels to the brain.
• Cerebral hemorrhage, in which a blood vessel to the brain ruptures and bleeds into surrounding brain tissue.
• Rupture of an aneurysm of a small artery to the brain.

RISK INCREASES WITH

• Smoking; obesity; diet that is high in fat or salt; high blood pressure.
• Diabetes mellitus; coronary-artery disease; previous transient ischemic attacks (TIA).
• Family history of stroke; excess alcohol consumption; age over 60.

HOW TO PREVENT

• Exercise regularly; eat a diet that is low in fat; don't smoke.
• Control of any chronic disorder (e.g., diabetes).
• Have your blood pressure checked regularly. If it is high, see your doctor.
• Get medical advice about taking 1 aspirin tablet daily. Studies indicate this may affect blood clotting enough to decrease the chance of cerebral thrombosis or embolism.
• If you have blockage of a carotid artery, surgery can reduce the chance of having a future stroke.

What To Expect

DIAGNOSTIC MEASURES--

• Medical history and exam by a doctor.
• Laboratory studies of spinal fluid and blood.
• X-rays of the head, ECG and CT scan (See Glossary for both).

APPROPRIATE HEALTH CARE

• Doctor's treatment.
• Hospitalization for acute care (with close monitoring of cardiac and pulmonary function; electrolyte and fluid levels).
• Surgery (sometimes) to remove a clot in an artery to the brain.
• Nursing-home care (sometimes).
• After the acute period, physical therapy, occupational therapy and speech therapy.

POSSIBLE COMPLICATIONS

• Pneumonia; depression.
• Pressure sores from prolonged bed rest.
• Permanent or temporary loss of memory.
• Permanent paralysis or disability.

PROBABLE OUTCOME--

• Stroke causes death, permanent damage or disability in 2/3 of all cases. In the rest, recovery without long-term disability is possible.
• A mild stroke may be the forerunner of more severe attacks. For stroke survivors, partial disability may last for months.

How To Treat

GENERAL MEASURES--

• Once the acute period of a stroke is over, the follow-up care will depend on the degree of disability. The patient and the family should be involved in the aspects of rehabilitation that are planned by the doctor and the support team.
• Ongoing care may be provided at home or in extended care facility.

MEDICATION--Your doctor may prescribe:

• Anticoagulant drugs to reduce the chance of clot formation.
• Antihypertensive drugs, if you have high blood pressure.
• Pain medicine as needed.
• Stool softeners to aid bowel movements.

ACTIVITY--

• If you have lost muscle control, therapy will help you to regain basic skills, such as eating, dressing and toilet functions.
• Following a stroke, consider installing ramps at entries to the house and hand bars next to tubs and toilets.

DIET--At first, may require feeding tube, then progress to pureed, soft or regular diet. Eat a diet that is low in salt and low in fat.

Call Your Doctor If

• You have symptoms of a stroke or observe them in someone else. This is an emergency!
• The following occurs during treatment: Fever; pressure sores; worsening symptoms.