A stroke is sudden loss of brain function that develops when an artery supplying oxygen-rich blood to the brain becomes blocked or ruptures. Areas of the brain commonly affected by stroke are those that control movement, speech, vision, and sensation.
While the immediate consequences of a stroke may appear drastic, half of all people who have one recover more or less completely the first time around. Unfortunately, one-third of first strokes are fatal, making prevention and the reduction of risk factors for a stroke extremely important.
Return to Top
Sudden weakness or numbness affecting the face, arm, or leg on one side of the body
Abrupt dimming, blurring, or loss of vision, often in one eye only
Slurred speech, loss of speech, or difficulty understanding speech
Sudden, severe headache with no obvious cause
Sudden dizziness, loss of balance, or trouble walking
Mental confusion, memory loss, or a sudden loss of consciousness
Nausea and vomiting, which may accompany any of these symptoms.
Return to Top
The majority of strokes are known as blockage (or ischemic) strokes because a clot actually blocks oxygen-rich blood from getting to or circulating around the brain. Areas of potential blockage often develop inside artery walls that have stiffened and narrowed over time because of an accumulation of fatty plaque deposits (a condition known as atherosclerosis). When a blood clot, called a thrombus, actually forms on the plaque, it slows or stops blood flow through the artery and leads to the death of vital brain cells.
In another scenario, a clot forms elsewhere in the body and starts traveling in the bloodstream until it gets trapped by a narrowed blood vessel. These moving blood clots are called emboli, and they can land anywhere. Not surprisingly, they cause the most damage when they get stuck in one of the blood vessels that feeds the brain.
Less common than blockage strokes are hemorrhagic strokes, which are caused by the rupture of a blood vessel in the brain, with bleeding in or over the surface of the brain. Also known as cerebral hemorrhage, this type of stroke develops when a weakened area in the wall of an artery, called an aneurysm, eventually becomes so worn out that it ruptures, leaking blood into the brain and interrupting circulation in the area. High blood pressure is often blamed for aneurysms. In contrast to blockage strokes, hemorrhagic strokes are fatal in 80% of cases.
Risk factors for stroke fall into two categories: those that can't be controlled and those that can.
Uncontrollable risk factors include:
Age. The risk of stroke doubles with each decade past age 55.
Gender. Slightly more men than women have strokes.
Race. African-Americans tend to be at higher risk.
Genetics. Having relatives who have had a stroke or TIA increases your risk.
Diabetes. This illness increases your risk, although it's not entirely clear why.
Controllable risk factors include:
High blood pressure. This condition increases your stroke risk by a staggering four to six times. It can weaken vessel walls in the brain and is the single most controllable risk factor for stroke. Both lifestyle changes and medications can be effective at reducing high blood pressure.
Heart disease. Specifically, atrial fibrillation can cause irregular heartbeats and a pooling of blood in the heart that enables blood clots to form. If these clots travel to the brain, a stroke can develop. Atrial fibrillation can be successfully treated in most cases.
High cholesterol. This condition increases your stroke risk by clogging blood vessels leading to the brain. It can also lead to atherosclerosis, a narrowing of coronary arteries and a roughening of the inside of artery walls. This raises stroke risk by making it easier for dangerous clots to form.
Sleep apnea. This breathing problem can increase blood pressure and promote blood clots, causing a stroke.
Return to Top
Although strokes remain a leading cause of death, especially in the elderly, the outlook for people who have had a stroke has improved dramatically in recent years. That's because so much has been learned about risk factors for stroke and how important it is to aggressively treat such triggers as high blood pressure and atherosclerosis. Prevention measures do pay off: The incidence of stroke keeps dropping.
Heed warning signs! The average stroke patient waits more than 12 hours before seeking emergency medical help. This is a big mistake. The faster you get treatment once warning signs develop, the better your chances for recovery. Brain cells are precious; they perish quickly without oxygen.
So act on stroke warning signs with the same speed you'd respond to heart attack symptoms. To get this point across, some doctors like to refer to strokes as "brain attacks." After all, the stroke doesn't happen to the heart, as many people mistakenly believe. It happens to the brain, the most fragile organ in the body.
The primary reason that people don't heed warning signs is that they don't know what the warning signs are. Do you? A recent study found that half of the adults surveyed could only name one warning sign. In fact, there are several; see the Key Symptoms section above.
TIAs. Many full-blown blockage (clot-caused) strokes are preceded by strokelike episodes called transient ischemic attacks (TIAs). Typically lasting 5 to 20 minutes, these episodes involve a brief obstruction in an artery that supplies blood to the brain. Symptoms come on suddenly and may include weakness or numbness in a limb, language disturbances, dizziness, or even partial blindness.
These symptoms are similar to those of a stroke, but don't lead to permanent neurological damage. They are very important warnings, however, that a stroke may be on its way. Experiencing a TIA warrants immediate medical attention; once the cause is pinpointed, a lot can be done to lessen the chance that a full-blown stroke will follow.
Return to Top
Doctors treating someone who's had a stroke can now do a lot more to control and even reverse the stroke-related damage than they could even a few years ago. Many medications are currently under development, and a handful of sophisticated new prevention and treatment agents are already in use.
Of course, the kind of drug that doctors give depends on how many minutes have passed since the stroke started and the type of brain cell damage that has occurred. Considerations include whether the damage was caused by a blood clot, by bleeding in the brain, or by another cause.
Generally, stroke patients are now treated with a combination of agents rather than a single one. When given quickly and accurately, customized combinations have demonstrated a remarkable capacity to preserve brain function and increase the patient's chances for full recovery.
During rehabilitation, certain drugs (Dantrium, Baclofen) can make a big difference in many patients who struggle with muscle spasticity. In addition, Botulinum toxin (Botox) is often used to lessen spasticity that causes pain; in this treatment, physical medicine specialists carefully paralyze small areas of the affected muscles with injections of this bacterium.
Return to Top
Some TIAs are caused by a blockage of one or both of the large carotid arteries that carry blood up the neck into the head. In these cases, surgery can clean out the plaque in the carotids and improve blood flow through them. This procedure, called a carotid endarterectomy, is only recommended for certain patients, however, because there's a risk that plaque along the vessels may get loosened and cause a ministroke. Getting a second opinion is often a good idea before committing to such a surgical procedure.
Return to Top
Initial medical treatment is aimed at minimizing brain damage and correcting the causes of the stroke. After a few days, however, the focus turns to rehabilitation to help replace or even restore lost functions.
Rehabilitation. When you have a stroke, it's not simply your ability to move, speak, or feel sensation that can be compromised. You may also lose data stored in the area of the brain that was deprived of blood and oxygen.
Generally, strokes affect only one side of the brain. If it's the side that houses speech, your ability to speak may be imperiled, even though your thoughts and emotions remain intact. If the stroke occurs on the side of your brain that controls movement, muscle activity on the other side of your body may be affected.
The brain and nervous system house a databank, which is developed from infancy on, that deals with planning and accomplishing different movements and tasks. It's this fragile databank that is so vulnerable during a stroke. In most cases, damaged data can be retrieved. During rehabilitation, many stroke patients successfully relearn essential relationships, like that between the right and left sides of the body or between thoughts and actions.
In the best-case scenario, a stroke patient is evaluated by a team of health-care providers--a personal physician, neurologist or physical medicine specialist, nursing-care coordinator, and physical, occupational, and speech therapists--who together create a customized plan for rehabilitation and physical therapy. Some hospitals now offer specialized programs for stroke care and recovery, similar to special cardiac and cancer care programs.
Physical therapy. Older rehabilitation methods for stroke tended to teach people to compensate for their losses by working with their unaffected side and adding canes, braces, and walkers for support. This approach, however, sometimes created excess nervous tension in the "healthy" tissues, leading to painful spasticity in the working muscles.
In the early 1970s, a new British approach called neurodevelopmental treatment (NDT) began to gain credence. NDT concentrates on treating the side of the body that has been affected by the stroke. The goal is to capture and enhance any residual function in the damaged nerves and muscles. By the late 1980s and 1990s, the NDT approach had become the standard treatment for avoiding spasticity and helping people with brain damage recover as much function as possible.
Prevention. While continuing advances in treating stroke are exciting, the bottom line is that prevention remains the main weapon in combating stroke. If you have problems with high blood pressure, high cholesterol, diabetes, heart disease, artery blockages or arrhythmia, then you need to work with your doctor to get your medical condition under control.
The importance of approaching lifestyle changes seriously and taking often expensive medicines faithfully can be hard to appreciate. But many experienced physicians will tell you that their stroke patients are often those who never bothered to take their medicines and never showed up for regular examinations.
In addition to preventive lifestyle measures (stopping smoking, losing weight, eating a healthy diet, exercising regularly, relieving stress--all detailed below in the self-care section), your doctor may also prescribe anticoagulant drugs or advise you to take a low dose of aspirin on a regular basis to prevent blood clotting. This is thought to help prevent future ischemic strokes, but is not generally advised for survivors of hemorrhagic strokes.
Return to Top
Supplements that promote cardiovascular health can also help ward off strokes. Certain recommended supplements (including vitamin E, ginkgo biloba, and fish oil), however, could interfere with anticoagulant drugs. This means you need to consult your doctor before and while taking supplements for stroke prevention or treatment.
It is strongly suggested that you begin with a daily high-potency multivitamin and antioxidant complex. These will provide extra B vitamins, carotenes, vitamin C, and vitamin E. The B complex, vital in the health of your entire nervous system, also lowers homocysteine, an amino acid thought to increase your risk of arteriosclerosis. The carotenes and vitamins C and E are all potent antioxidants, which prevent free radicals from causing the precipitation of LDL ("bad") cholesterol.
Just a reminder: If you have a serious medical condition, it's always a good idea to check with your doctor before beginning a supplement program.
The following supplements are primarily designed for someone who has sustained an ischemic stroke or a TIA.
Ginkgo biloba has been shown in numerous studies to improve blood circulation to the brain. Potentially useful for both the prevention and treatment of stroke, ginkgo also promotes blood vessel health and inhibits blood clotting.
Phosphatidylserine (PS) is a naturally occurring form of fat found in abundant amounts in brain tissue. It is a main ingredient in serotonin, one of the chemicals involved in transmitting nerve impulses. Several studies indicate that phosphatidylserine supplements can slow age-related memory decline. The hope is that PS will similarly help stroke victims during their rehabilitation, particularly if memory loss is a problem.
Phosphatidylcholine (PC), a natural chemical found in the brain, is critical for supplying choline to produce the neurotransmitter, acetylcholine. Declining acetylcholine levels with age have been linked to age-related memory decline. For these reasons, taking phosphatidylcholine in supplement form makes a lot of sense for people recovering from memory loss from a stroke.
Coenzyme Q10, a naturally occurring compound present in all cells, may be useful for people who have had a TIA or an actual stroke because it appears to increase the energy-generating potential of each cell. It also helps boost heart function and heart-rhythm regularity.
Diets high in omega-3 fatty acids are well known for reducing the risk of arteriosclerotic disease. Consider taking flaxseed oil and fish oil on a regular basis, either in supplement form or by adding flaxseed oil to salads and eating more fish.
Essential to proper functioning of the entire cardiovascular system, the mineral magnesium has been shown to relax and widen blood vessels, lower blood pressure, improve circulation, and normalize irregular heartbeat.
Siberian ginseng works as an invigorating and fortifying herbal "adaptogen" tonic, apparently improving brain function during stressful situations and reinforcing the body's ability to withstand myriad types of physical and mental strain.
Vinpocetine, an herb derived from the seeds of the periwinkle plant, has not been as intensively researched as gingko but seems to help in a similar way by improving blood flow to the brain.
Return to Top
Stop smoking. If you've had a stroke or a TIA and don't wish to stop smoking, get your affairs in order. Smoking doubles stroke risk by forcing the heart to work harder and accelerating the clogging of arteries. It also damages blood vessel walls.
Cut back on alcohol. If you drink, don't overdo it. Small studies indicate that too much alcohol increases stroke risk, although moderate consumption (e.g., a 4-ounce glass of wine each day) might actually protect against stroke by boosting clot-busting compounds naturally present in the body.
Eat a healthy diet. This means one that's low in saturated fat, cholesterol, and salt, and high in fiber. The risk of stroke has been shown to drop in people who regularly consume fish and have five servings of fruit and vegetables daily. A widely reported January, 2001 article in the prestigious
Journal of the American Medical Association found that the more fish a woman ate (particularly fish rich in omega-3 fatty acids, such as salmon and tuna), the less likely she was to have a clot-related stroke.
Lose the excess pounds. If you're overweight, not only does extra weight strain your circulatory system, but it puts you at increased risk for high blood pressure, diabetes, and other stroke hazards.
Perform moderate aerobic exercise. And be sure to do it for at least 30 minutes a day every other day. Recent research indicates that moderately brisk walking can even make a difference.
Practice relaxation techniques. To relieve stress, practice yoga, deep breathing, or other relaxation techniques on a regular basis.
Return to Top
During stroke rehabilitation, certain alternative therapies are worth considering. Some may be helpful in reactivating stroke-damaged parts of the brain. Others may reduce muscle pain and stiffness from spasticity or help in relearning and recovering movement functions.
Most physical therapists feel that after a stroke the vast majority of useable function will probably be recovered within three to six months of conventional therapy. But alternative therapists have found that acupuncture, myofascial release, Feldenkrais, and certain other techniques can provide additional gains even if started several years following a stroke.
Hyperbaric oxygen. This high-tech treatment for stimulating the nervous system involves the use of hyperbaric (high-pressure) oxygen. Some people with brain injuries seem able to progress further in their therapy program after a series of sessions in such chambers. Unfortunately, not all parts of the country have hyperbaric oxygen chambers, which are best known as decompression chambers for helping deep-sea divers recover from the "bends."
Acupuncture. Several forms of scalp acupuncture are useful for stimulating the nervous system. Treating points on the scalp that relate to the central nervous system seems to help damaged (but not destroyed) brain cells to "wake up " and get back on the job.
In the hands of a skilled acupuncturist, needles and even laser beams may stimulate points and channels of affected hands and feet, possibly helping to jump-start lost sensation and motion. Acupuncture can also be beneficial in relieving the pain and stiffness of spastic muscles; the focus is on treating the "ouch points" in the muscles and around the affected joints.
The Feldenkrais method of "body education" is particularly valuable for people who have been left with loss of nerve and muscle function or who have poor joint movement and balance after a stroke. Feldenkrais practitioners are trained to help people "relearn" movements that they have lost.
Tight muscle patterns can also be addressed by such hands-on therapies as myofascial release, Rolfing, or myotherapy; all concentrate on releasing the nerve and muscle tension patterns that build up after a stroke.
At WholeHealthMD, we feel that all these therapies can play a useful role in stroke recovery and should be part of an integrated therapy plan. In choosing a practitioner, remember that both training and experience promote good outcomes. Make sure your practitioner is not only trained and certified in the basic complementary therapy method, but is also experienced in working with stroke rehabilitation.
Return to Top
Call an ambulance or seek immediate medical attention if you or someone you're with experiences any of the symptoms of a stroke.
Return to Top