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10 Things You Should Know About Ischemic and Hemorrhagic Stroke

By at April 11, 2011 | 12:50 pm | Print

10 Things You Should Know About Ischemic and Hemorrhagic Stroke

10 Things You Should Know About Ischemic and Hemorrhagic Stroke
by Sue Evans

Stroke is the third leading cause of death in the United States, following heart disease and cancer. Each year, over three quarters of a million people will suffer a stroke, and of that number, 134,000 will die.[1]  Stroke may also be referred to as a cerebrovascular accident, or CVA.

1.  Strokes can be divided into two categories: ischemic and hemorrhagic.

            a. Ischemic stroke occurs when blood supply to an area of the brain is interrupted by a clot in an artery. The brain tissue served by the artery dies. 87 percent of all strokes are ischemic. [2]

            b. Hemorrhagic stroke occurs when a weakened blood vessel within the brain ruptures.  These account for 13% of strokes. Aneurym, a ballooning of the wall of an artery, and arteriovenous malformation (AVM), cause weakening in vessels.  Blood from the ruptured vessel spilling into brain tissue causes swelling, irritation, and tissue death.

2.  Transient ischemic attacks, or TIAs, are precursors to a major stroke.  The patient may experience dizziness, loss of ability to speak or to move a limb, or temporary paralysis on one side of the face.  A person experiencing TIA should seek immediate medical attention for further diagnosis and treatment.

3.  There are several risk factors for both types of stroke.  They are grouped into two categories – modifiable factors and non-modifiable factors. [1]

            a. Modifiable factors include lifestyle factors such as diet, obesity, hypertension, illicit drug use, and tobacco smoking.

            b. Non-modifiable factors are age (risk of stroke rises with increasing age), gender (males have a higher incidence of both ischemic and hemorrhagic stroke than females), heredity, and race (black Americans have a higher incidence than whites). [1]

4.  Diagnosis of stroke is made through observation of signs and symptoms, and imaging methods such as CT and MRI.  Members of the public may help a possible stroke victim by learning the signs of stroke through “FAST”:

            a. Face: Ask the person to smile. Note whether his face droops on one side.

            b. Arms: Ask the person to raise her arms above her head. Note whether one arm is weak and lower than the other.

            c. Speech: Ask the person to speak. Note if her speech is slurred or she has difficulty forming words.

            d. Time:  Note the time the symptoms began, and call 911 if any or all of these signs are present.  “Clot-busting” medication given within three hours of onset of symptoms may prevent further damage. Visit the National Stroke Association on-line (http://www.stroke.org/site/PageServer?pagename=symp) to download a wallet card with the FAST signs.[3]

5.  Stroke may have varying effects upon both the brain and the body, depending on where in the brain it occurs.  If the stroke is on the left side of the brain, the patient may experience right-sided weakness or paralysis, language and speech difficulties (aphasia), and memory loss. Right brain stroke may cause left-sided weakness or paralysis, vision impairment, and memory loss.[2]  Hemorrhagic stroke typically affects the entire brain and may cause severe headache, unconsciousness, and death. Survivors of both types of CVA are often left with life-long physical and/or mental deficits despite rapid treatment.

6.  Treatment for stroke depends on both severity and type. “Clot-busting” drugs such as tissue plasminogen activator (TPA) may be given to dissolve a clot; however, this treatment is only effective if given within the first three hours following onset of symptoms.  Otherwise, treatment is supportive – pain relief, administration of anticoagulants, maintenance of airway and fluid status, physical therapy.  Treatment for hemorrhagic stroke caused by a ruptured aneurysm may involve clipping the affected artery, which requires open brain surgery. A newer and less-invasive method is endovascular coiling, in which platinum coils are delivered via catheter threaded through the patient’s carotid artery into the brain. The coils embolize, or clot-off, the tear in the artery wall. As with ischemic stroke, other treatment is supportive.[2]

7.  Stroke and its aftermath are expensive both in terms of health care costs and in human loss.  According to the AHA/ASA, “In 2010, the cost of stroke is estimated at $73.7 billion (direct and indirect costs), with a mean lifetime cost estimated at $140 048.” [1]

8. Although strokes are generally thought of as a disease of the elderly, children may also suffer a CVA.  Common causes are heart defects which create clots that travel to the brain, and neck injuries that damage blood vessels.  “Shaken baby syndrome” causes tearing of vessels within the brain and often results in impairment or death of the infant.  Cocaine/crack use has been linked to incidence of hemorrhagic stroke.[4]

9.  Stroke is the leading cause of long-term disability in the U.S.  15 to 30% of stroke victims are left permanently disabled.[1]

10. Steps to reduce your risk of stroke are similar to those for preventing heart disease:

            · Diagnose and treat hypertension

            · Avoid smoking and use of illicit drugs

            · Control diabetes

            · Exercise and eat a healthy, low-fat diet

            · Know cholesterol level and control if high

            · Drink alcohol in moderation

            · Be aware of the signs and symptoms of stroke and TIA

Sources

[1]  Guidelines for the Primary Prevention of Stroke. American Heart Association/American Stroke Association. Web. Accessed 24 March 2011. http://stroke.ahajournals.org/cgi/content/full/42/2/517

[2]   Stroke Association. Web. Accessed 24 March 2011. http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/Types-of-Stroke_UCM_308531_SubHomePage.jsp

[3]  National Stroke Association. Web. Accessed 24 March 2011. http://www.stroke.org/site/PageServer?pagename=symp

[4] Medscape. Web. Accessed 24 March 2011. http://emedicine.medscape.com/article/1174408-overview

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