Stroke

A stroke, also called a brain attack, occurs when blood flow to part of the brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. Brain cells begin to die within minutes. Stroke is a medical emergency, and prompt treatment is crucial.

There are two main types of stroke: ischemic (caused by a blocked artery) and hemorrhagic (caused by a ruptured blood vessel). Stroke is a leading cause of death and disability worldwide, but many strokes can be prevented, and early treatment can significantly improve outcomes.

Stroke symptoms come on suddenly and may include:

Common Symptoms (Remember FAST):

• Face: Drooping on one side, numbness
• Arms: Weakness or numbness in one arm
• Speech: Slurred speech, difficulty speaking
• Time: Time to call emergency services immediately

Other Symptoms:

• Sudden severe headache
• Confusion or trouble understanding
• Vision problems in one or both eyes
• Dizziness, loss of balance, or coordination
• Numbness or weakness on one side of body
• Difficulty walking

Symptoms may vary depending on which part of the brain is affected.

Call Emergency Services (112 in Sweden) IMMEDIATELY if:

• Any stroke symptoms, even if they seem to go away
• Sudden numbness or weakness (face, arm, leg, especially one side)
• Sudden confusion or trouble speaking
• Sudden vision problems
• Sudden severe headache
• Sudden dizziness or loss of balance

Time is critical. Every minute counts. Don't wait to see if symptoms go away.

After a stroke, recovery involves:

1. Follow Treatment Plan:

   • Take medications as prescribed
   • Don't skip doses
   • Attend all appointments
   • Report side effects

2. Rehabilitation:

   • Physical therapy
   • Occupational therapy
   • Speech therapy (if needed)
   • Follow therapy program
   • Do home exercises

3. Lifestyle Changes:

   • Control blood pressure
   • Control diabetes (if present)
   • Don't smoke
   • Limit alcohol
   • Eat heart-healthy diet
   • Exercise as approved

4. Prevent Another Stroke:

   • Take medications to prevent clots
   • Control risk factors
   • Regular check-ups
   • Know warning signs

5. Support:

   • Join support groups
   • Family support
   • Don't isolate
   • Address depression if present

• Any stroke symptoms
• Sudden numbness or weakness
• Sudden confusion or speech problems
• Sudden vision problems
• Sudden severe headache
• Sudden dizziness or balance problems
• Even if symptoms seem to go away

• After stroke: Regular follow-up
• New or worsening symptoms
• Questions about recovery
• Need to adjust medications
• Concerns about rehabilitation

• Following treatment plan
• Attending rehabilitation
• Managing risk factors
• No new concerning symptoms

Diagnosing stroke involves:

1. Physical Examination:

   • Neurological assessment
   • Check for stroke signs
   • Medical history
   • Vital signs

2. Imaging Tests (urgent):

   • CT scan: Shows bleeding or blockage
   • MRI: More detailed brain images
   • Done immediately in emergency

3. Blood Tests:

   • Blood sugar
   • Clotting factors
   • Other tests

4. Other Tests:

   • Carotid ultrasound (neck arteries)
   • Echocardiogram (heart)
   • Angiography (blood vessels)
   • ECG/EKG (heart rhythm)

Immediate Treatment (time-critical):

1. Ischemic Stroke:

   • Clot-busting drugs (tPA): Must be given within hours
   • Thrombectomy: Remove clot mechanically
   • Time is critical

2. Hemorrhagic Stroke:

   • Control bleeding
   • Reduce pressure in brain
   • Surgery may be needed

Long-term Treatment:

1. Medications:

   • Antiplatelet drugs (aspirin, clopidogrel)
   • Anticoagulants (warfarin, etc.)
   • Blood pressure medications
   • Cholesterol medications
   • Other medications as needed

2. Rehabilitation:

   • Physical therapy
   • Occupational therapy
   • Speech therapy
   • Start as soon as possible

3. Lifestyle Changes:

   • Control risk factors
   • Healthy diet
   • Regular exercise (as approved)
   • Don't smoke
   • Limit alcohol

4. Surgery (in some cases):

   • Remove plaque from arteries
   • Repair aneurysms
   • Other procedures

Prevent stroke by:

• Control High Blood Pressure: Most important risk factor
• Don't Smoke: Smoking doubles stroke risk
• Control Diabetes: Keep blood sugar controlled
• Manage Cholesterol: Through diet and medications
• Maintain Healthy Weight: Obesity increases risk
• Exercise Regularly: At least 150 minutes per week
• Eat Heart-Healthy Diet:
  • Limit sodium
  • Increase fruits and vegetables
  • Limit saturated fats
• Limit Alcohol: Excessive alcohol increases risk
• Treat Atrial Fibrillation: Irregular heart rhythm increases risk
• Get Regular Check-ups: Early detection and treatment

Ischemic Stroke (most common):

1. Artery to brain becomes blocked
2. Usually by blood clot
3. Brain tissue doesn't get oxygen
4. Brain cells die
5. Functions controlled by that area are lost

Hemorrhagic Stroke:

1. Blood vessel in brain ruptures
2. Blood leaks into brain tissue
3. Pressure damages brain cells
4. Functions are lost

Risk Factors:

• High blood pressure (most important)
• Smoking
• Diabetes
• High cholesterol
• Atrial fibrillation
• Previous stroke or TIA
• Family history
• Age (risk increases with age)
• Race/ethnicity
• Other factors

• Risk increases with age
• May have multiple risk factors
• Recovery may be slower
• Higher risk of complications
• May need more support

• High blood pressure
• Diabetes
• Atrial fibrillation
• Previous stroke
• Need aggressive prevention
• Regular monitoring

Recovery Process:

• Varies widely by individual
• Depends on stroke severity
• Depends on area of brain affected
• Early rehabilitation important
• Can continue for months or years

Common Challenges:

• Weakness or paralysis
• Speech problems
• Memory problems
• Emotional changes
• Daily activities

Support Available:

• Rehabilitation services
• Support groups
• Family support
• Healthcare team
• Community resources

Many strokes can be prevented by controlling risk factors like high blood pressure, diabetes, and cholesterol, not smoking, exercising regularly, and eating a healthy diet.

Recovery varies widely. Some people recover quickly, others take months or years. Most recovery happens in the first 3-6 months, but improvement can continue longer.

Risk of another stroke is higher, but can be reduced with medications, controlling risk factors, and lifestyle changes. Follow your treatment plan closely.

It depends on your recovery and local regulations. You may need medical clearance and possibly a driving assessment. Discuss with your doctor.

A TIA (transient ischemic attack) is a "mini-stroke" with temporary symptoms that resolve. It's a warning sign that a full stroke may occur and requires immediate medical attention.