Charlotte, NC
Barshana Adhikary, MS4
Bibhusan Basnet, MD
Stroke is one of the leading causes of death and disability in the United States. It can happen at any time or place. A stroke can come on suddenly, and its effects can be devastating. If you suspect someone is suffering from a stroke, call 911 immediately. Time is of the essence in the treatment of stroke.
An ischemic stroke is caused by decreased blood flow to the brain, damaging brain cells. A stroke is usually caused by a blocked blood vessel. When a blood vessel is blocked, oxygen and nutrients cannot be delivered to brain cells. The brain cells then stop functioning and die.
You might have also heard of a transient ischemic attack (TIA) or a mini stroke. A mini stroke is a temporary episode of brain dysfunction due to decreased blood flow. This sometimes precedes a stroke.
Stroke is one of the leading causes of death and disability in the United States. It can happen at any time or place. A stroke can come on suddenly, and its effects can be devastating. If you suspect someone is suffering from a stroke, call 911 immediately. Time is of the essence in the treatment of stroke.
You can have various symptoms when the brain lacks blood flow. Your symptoms depend on what part of the stroke affected the brain.
Some common signs of ischemic strokes include:
If you think someone may be having ischemic strokes, you can use the FAST Mnemonic to check.
F: Face: Look in the mirror and smile or ask the person to smile. Check if one side of the face is drooping.
A: Arms: Raise both arms. Check if you can raise both arms fully and if one arm glides downwards when you lift both arms.
S: Speech: Repeat a simple phrase, like “Hello, I live in the US.” Note if the speech is slurred or if they have difficulty speaking.
T: Time: Act fast. Time is critical during a stroke.
Your symptoms might differ from your neighbor, friend, or family members. If you see any of these signs or are even concerned about a stroke, call 911 right away. Some treatments for stroke work are effective only in the first few hours after the symptoms appear.
It is essential to understand the risk factors for stroke. Common risk factors for ischemic strokes include
We understand that you can not change some risk factors like your family history of stroke, age, race, or ethnicity. However, you can work on modifiable risk factors such as high blood pressure, diabetes, and smoking, and adopt a healthy lifestyle to lower your chances of stroke.
Your doctor will take a detailed history and examine for signs of stroke. An imaging study of the brain is needed to diagnose a stroke. Computed Tomography (CT) of the brain is the most common imaging study to detect a stroke. The CT scan is widely available in hospitals and can be performed quickly. A quick CT scan of the head helps ensure that there is no bleeding in the brain. The changes caused in your brain by an ischemic stroke might not be evident on a CT scan within a few hours. In this case, Magnetic Resonance Imaging (MRI) of the brain will help get a better picture of the brain tissue, areas affected by stroke, and blood vessels supplying the brain with oxygen. Your doctor will also have you take other imaging studies, such as an ultrasound of the carotid arteries which are large blood vessels around the neck, and an ultrasound of the heart commonly called an Echocardiogram.
You will be admitted to a hospital and monitored closely after a stroke. In addition to your treatment for stroke, your doctor will monitor your blood pressure closely along with the electrical activity of the heart with a heart monitor. Your doctor will also require blood tests to check for diabetes and cholesterol levels to gauge risk factors for stroke for a better treatment plan.
Prompt attention and treatment are crucial for stroke treatment. If you notice any warning signs of stroke, you need to call 911 immediately. Since strokes attack the brain, a person having a stroke may not be able to call 911 as they might not be able to reach a phone or even talk over the phone. Time is the most critical factor in stroke treatment. The faster you can get to a hospital and seek medical help, the better your chances of recovery. Do not wait to see if the symptoms get better on their own.
Immediate stroke treatment can save someone’s life and improve the chances of a successful recovery. For instance, if a patient with a stroke gets medical help in the first few hours after a stroke, doctors can inject thrombolytic medicines into their bloodstream to dissolve blood clots. Thrombolytics are most effective only within 4.5 hours of the onset of stroke symptoms. Depending on the blocked artery in the brain, TPA restores blood flow to the brain in an estimated 10% to 50% of cases. TPA decreases the risk of long-term disability after acute ischemic stroke but is associated with increased brain bleeding risk. Thus, if TPA is given more than 4.5 hours after stroke symptoms begin, it can cause more damage.
Your doctor will weigh the risks and benefits of this strong intravenous blood thinner and take your consent before giving it to you. Therefore, when possible, it is essential to record the exact time that you or someone around you first noticed stroke symptoms and the time that you have last seen well.
Acute ischemic stroke is mainly caused by the blockage of large blood vessels in the brain. Specially trained neurologists or interventional radiologists may be able to treat the blockade by removing the blood clot in the vessel physically. This procedure is called mechanical thrombectomy. This procedure is usually beneficial if done within 24 hours after the first onset of stroke symptoms.
In this procedure, a catheter is guided to the affected blood vessel in the brain through an artery in the arm or leg. The process is monitored using continuous x-ray imaging to ensure there are no errors. Your neurologist can remove the blood clot using suction or a wire mesh trap. If you are a candidate for mechanical thrombectomy, your chances of recovery are better than with blood thinners alone.
However, these procedures require highly trained physicians and advanced equipment. Mechanical thrombectomy is also not available at every hospital. Smaller hospitals may transfer you to a larger facility where mechanical thrombectomy can be performed if you are a candidate for the procedure.
Patients after a stroke are generally asked to be on aspirin or clopidogrel (commonly known as Plavix) to reduce the risk of future strokes. Your neurologist may recommend being on a combination of aspirin and clopidogrel for a short term before transitioning you to an antiplatelet medication. Your doctor will also put you on a strict treatment plan for high blood pressure and cholesterol after a stroke.
Your doctor will advise you to quit t tobacco use if you smoke or chew tobacco products. Your doctor will either make you undergo screening for diabetes or intensify treatment for diabetes if you have uncontrolled diabetes to decrease your risk for a second stroke. Your doctor may discharge you home with a remote heart monitoring device to check for any irregular heart rhythm that could have led to a stroke. If cardiac arrhythmia as atrial fibrillation is found on home heart monitoring, you might be a candidate for stronger blood thinners (warfarin/Eliquis/Xarelto) to prevent further episodes of stroke.
Carotid arteries are the blood vessels on each side of the neck and carry blood and oxygen to the brain. Over time, narrowing of these arteries can occur, which is called carotid artery stenosis.
Doctors usually diagnose carotid artery stenosis with an ultrasound of the carotid arteries but sometimes use a computed tomography (CT) or magnetic resonance imaging (MRI) angiography of the neck to evaluate the anatomy and blood flow in the blood vessels. Most patients with carotid artery stenosis never have symptoms but when the carotid vessels are narrow, you might be at an increased risk of stroke. If someone has 70% stenosis and had a recent stroke, your doctor may consider you for carotid stenting, carotid endarterectomy, or Trans carotid Artery Revascularization (TCAR). The risks and benefits of this procedure should be discussed with a clinician, as not every patient benefit from it.
A stent is a hollow tube designed to fit and cover a blood vessel’s walls and allow blood to flow through it. Carotid artery stenting is a procedure where a small metal tube or stent is placed through the site of the stenosis to keep the artery open and restore blood flow through the vessels again.
People are often left with significant impairments after a stroke depending on the brain vessels involved. Some people are often left with weakness or numbness in their hands and legs. Some are left with vision problems, slurred speech, and issues with swallowing. Others face difficulties with language, balance, and coordination.
Rehabilitation after a stroke can be carried out in hospitals, nursing facilities, outpatient offices, clinics, or at home. Formal rehabilitation programs commonly last for up to 3 or 4 months, but if improvements are substantial, patients may continue their recovery in the program.
The main goals for a patient after a stroke are to regain function and independence and optimize recovery, possibly to their baseline health. The stroke rehabilitation process involves a multidisciplinary team, as noted below:
Physical therapists: Help with improving balance and walking.
Occupational therapists: Help with improving function in daily activities such as bathing, dressing, and putting on, among others.
Speech and language therapists: Treat issues with speech and language, swallowing, and thinking.
Physiatrists and rehabilitation neurologists: Medical doctors specializing in rehabilitation and coordinating care.
You can reduce your risk for stroke by adopting a healthy lifestyle. Learn your risk factors for stroke and make sustainable goals to make lifestyle changes.
Prevent or manage other health conditions, including high blood pressure, high cholesterol, diabetes, and obesity.
1. What are my chances of having a second stroke?
2. What lifestyle changes would help me prevent a second stroke?
3. What is the role of rehabilitation after a stroke? Do I need to be admitted to a rehabilitation center for a recovery program?
4. How long should I be on a blood thinner?
5. Do I need to take a blood thinner if I bleed easily?
What Is Acute Ischemic Stroke? | Cerebrovascular Disease | JAMA | JAMA Network
Warning Signs of a Stroke | Cerebrovascular Disease | JAMA | JAMA Network
Carotid Artery Stenting | Cerebrovascular Disease | JAMA | JAMA Network
Recovery After Stroke | Cerebrovascular Disease | JAMA | JAMA Network
NINDS Know Your Risk. Lower Your Risk Infographic (nih.gov)
