Learn more about strokes:
Types of Strokes
Ischemic strokes are about 80 percent of all strokes. The word ischemic refers to a lack of blood supply to an area of the brain that results in some of the cells dying. This happens when blood vessels to the brain become narrow or clogged, cutting off blood flow to the brain cells.
There are two types of ischemic strokes:
- Thrombotic strokes are caused by a thrombus. The thrombus forms on the build up of fatty materials or plaque inside the arteries.
- Embolic strokes occur when a tiny material breaks loose from an artery outside the brain and travels to the smaller vessels in the brain. Sometimes these tiny materials may come from the heart. This is a called a cardio-embolic stroke.
Hemorrhagic strokes make up about 20 percent of all strokes and occur when an artery in the brain leaks or breaks (ruptures).
There are two types of hemorrhagic strokes:
Intracerebral hemorrhage (ICH) occurs when there is bleeding within the brain itself. It is most often caused by high blood pressure and less often from the use of blood thinners (anticoagulants), aspirin, or clotting problems. Some patients are born with extra weak vessels that can break and bleed.
Subarachnoid hemorrhage (SAH) occurs when a blood vessel in the brain breaks or ruptures and bleeds into the space between the brain and the skull. This often is the result of an aneurysm that breaks or an arteriovenous malformation (AVM).
An aneurysm is a weak or thin spot on a blood vessel that balloons out and fills with blood, causing a bulge on the vessel. The bulge can be from the vessel leaking or breaking. Risk factors for the bulge to break include high blood pressure, smoking, alcohol and/or drug abuse, particularly cocaine.
An AVM is a tangle of arteries and veins in the brain or spinal cord that is always present at birth. Risk factors for an AVM break are the same as for aneurysms.
Transient Ischemic Attacks (TIA) are sometimes called “warning strokes.” A TIA occurs when blood flow to a certain area of the brain briefly stops. The person has the same signs of a stroke, but the signs go away completely. The difference between a stroke and a TIA is that the TIA is a warning sign. It never results in permanent damage and because of that it can never be seen on a CT scan or an MRI scan.
Signs of a stroke should never be ignored. Call 911.
The best way to prevent a stroke is identifying what factors increase your risk for having a stroke. There are two types of risk factors, those you can control and those you cannot control.
Uncontrollable Risk Factors
- Age - Strokes can occur at any age, but two-thirds of all strokes occur in people over the age of 65
- Gender - The incidence of stroke is slightly higher for men
- Race - African Americans and Hispanics have a greater risk for stroke than other races
- Family History - People who have a parent or sibling who have had a stroke are at a greater risk
- Personal History of Diabetes – Having diabetes triples a person’s risk for having a stroke
Controllable Risk Factors
- High Blood Pressure
- Heart Disease - especially atrial fibrillation, an irregular heart beat
- High Cholesterol
- Previous Stroke or TIA
- Excessive Alcohol Intake
- Excess Weight
- Lack of Exercise
- Illicit Drug Use - amphetamines, cocaine
- Carotid Stenosis - The carotid arteries on either side of the neck can collect plaque and interrupt blood flow to the brain
Other Risk Factors
- Blood Abnormalities - Sickle Cell, Leukemia, High Homocysteine, Polycythemia and others
- Infectious Diseases - TB, Syphilis, Endocarditis, HIV and others
- Inflammatory Diseases - Lupus, Vasculitis
- High-dose Estrogen - especially with cigarette smoking, hypertension and migraine
- Sleep Apnea – Patients who snore may have increased risk for future strokes and heart attacks
- How to Reduce Stroke Risk
How to recognize a stroke
Just remember to think FAST
The sooner a person arrives to the emergency room, the sooner treatment can begin and the better the chance for a successful recovery.
- Ask the person to smile.
- Does one side of the face droop?
- Ask the person to hold both arms up evenly.
- Does one arm drift downward?
- Ask the person to repeat a simple sentence.
- Are their words slurred or mixed up?
- If the person shows any of these signs, call 911 right away.
The Effects of a Stroke
Most strokes get better with time. How much time and how much better depends on each patient. What you will be able to do or not do depends on the area of the brain where your stroke occurred.
The brain is divided into four major parts:
- the right side (hemisphere)
- the left side (hemisphere)
- the cerebellum
- the brain stem
- Generally speaking, the left side of the brain controls the right side of the body, and the right side of the brain controls the left side of the body.
Left Side of the Brain
- weakness or not being able to move the right side of the body
- problems speaking
- problems thinking clearly
- confusion between left and right
- both eyes can’t see things on the right
- slow, cautious behavior
Right Side of the Brain
- weakness or not being able to move (paralysis) on the left side of the body
- both eyes can’t see things on the left
- not aware of the left side of the body
- loss of feeling on the left side of the body
- quick actions, without thinking
- lack of coordination
- loss of balance
- nausea and vomiting
- unstable vital signs (blood pressure, pulse, breathing)
- nausea and vomiting
- can’t move the body on both sides
- problems swallowing
- slurred speech
- double vision
Changes in emotions and mood
After a stroke, it is not uncommon for some people to laugh and cry without control. It may be helpful to distract the person so they do not feel embarrassed. These outbursts should occur less over time.
Ways to help a person’s memory are to:
- Have a fixed routine
- Keep what you say short
- Present new information one step at a time
- Use written reminders
Depression can be a problem after a stroke because the person may have trouble with daily activities or speaking as they did before the stroke.
Signs of depression include:
- changes in sleep
- unusual weight gain or loss
- lack of interest in things
- cries easily
- no expression on the person’s face
- These signs may not show until after the person has left the hospital. Let the doctor know how you feel. Depression can slow down your recovery.
You may feel uneasy or fearful of having sex because of the physical changes from the stroke. Share your feelings with your partner, and plan on having sex when you are rested and have had your personal care done. Try relaxing music or having a massage before lovemaking. Change positions to support your affected side, and consider other ways to show affection such as hugging, kissing and caressing.