Understanding Stroke

A stroke, also referred to as a cerebral vascular accident (CVA) or a brain attack, is an interruption in the flow of blood to cells in the brain. When the cells in the brain are deprived of oxygen, they die. A stroke occurs when a blockage in an artery prevents blood from reaching cells in the brain or an artery ruptures inside/outside the brain, causing a hemorrhage.

Many don’t realize that stroke needs the same emergency treatment as a heart attack and every second is critical to the victim’s care, survival and subsequent quality of life. The more you know about stroke and its warning signs, the more prepared you can become to find treatment.

Stroke Symptoms

Warning signs of stroke may include a combination of the following symptoms:

• Sudden numbness or weakness of the face, arm or leg, particularly when it happens on one side of the body
• Confusion, trouble speaking or understanding others
• Vision problems in one or both eyes, such as dimness, blurring, double vision, or loss of vision
• Loss of balance or coordination, dizziness and trouble walking
• Severe headache with no known cause

Types of Stroke

Ischemic

Accounts for eighty percent of all strokes suffered. They are caused when blood vessels become clogged. Some ischemic strokes are preceded by stroke-like symptoms called transient ischemic attacks (TIAs) that can occur months before the stroke. Also called a warning stroke, a TIA is caused by a temporary blockage of a blood vessel. TIA symptoms, which are similar to those of a stroke, come on quickly and improve within 10 to 20 minutes. The loss of vision in a TIA may be described as a feeling that a shade is being pulled down over your eyes. TIAs typically do not cause long-lasting damage to the brain. 

Hemorrhagic

Fewer strokes are categorized as hemorrhagic, which occur when weakened blood vessels inside the brain rupture (such as a tangle of defective blood vessels and capillaries called arteriovenous malformations (AVMs) or when an aneurysm (a thin spot on an artery wall) at the base of the brain bursts. Every year, an estimated 30,000 people in the United States experience a ruptured cerebral aneurysm according to the American Association of Neurological Surgeons. Symptoms more specific to hemorrhagic stroke include headache, nausea and vomiting, neck stiffness, seizures, sudden changes in mental state and lethargy. Hemorrhagic strokes usually occur in the daytime and during physical activity. The symptoms typically begin very suddenly and evolve over several hours. 

Detection and Diagnosis

• Cerebral Computed Tomography (CT) Scan: The first and most important test after a stroke is a CT scan, which is a series of X-rays of your brain that can help identify whether there is bleeding. This test will help your doctor determine whether the stroke is ischemic or hemorrhagic.
• Magnetic Resonance Imaging (MRI) Scan: Uses a magnetic field and pulses of radio wave energy to make pictures of organs and structures inside the body. In many cases, MRI gives information that cannot be seen on an X-ray, ultrasound, or computed tomography (CT) scan. An MRI can determine the amount of damage to the brain and help predict recovery.
• Cerebral Angiography: The gold standard test used to visualize the blood vessels which supply the brain. An angiogram is considered minimally invasive and is performed through the artery in the leg. A small tube (catheter) is navigated with X-ray guidance to the blood vessels in the neck. X-ray pictures are then obtained of the blood vessels in the neck and brain. An angiogram helps to identify blockages that cause ischemic stroke. This test also identifies aneurysms and arteriovenous malformations, which cause hemorrhagic stroke. An angiogram can help to lay the groundwork for treatment.

Treatment Options

For an Ischemic Stroke

If your stroke is diagnosed within three hours of the start of symptoms, you may be given a clot-dissolving medication called tissue plasminogen activator (t-PA), which can increase your chances of survival and recovery. However, if you had a hemorrhagic stroke, use of t-PA would be life-threatening. If IV t-PA doesn’t work, t-PA and other clot-dissolving agents can be delivered directly to the area of blockage with the angiogram technique and very small catheters. If these medications don’t work, the clot can potentially be removed with fine-grasping instruments or the blocked vessel can be re-opened with stents. Learn about the Comprehensive Stroke Center at GW Hospital's treatments and results for ischemic stroke >

For a Hemorrhagic Stroke

Initial treatment of a hemorrhagic stroke is difficult. Efforts are made to control bleeding, reduce pressure in the brain, and stabilize vital signs, especially blood pressure. There are few medications available to treat hemorrhagic stroke, so procedures typically used include surgery, endovascular treatment and diagnostic neuroangiography. Learn about the Comprehensive Stroke Center at GW Hospital's treatments and results for hemorrhagic stroke >

After a stroke, some patients need assistance with functional skills that may have been affected during the event. The Acute Rehabilitation Team at the George Washington University Hospital offers stroke rehabilitation services to help patients on their path to recovery. 

Risk Factors

• High blood pressure
• Diabetes
• High cholesterol
• Coronary artery disease
• Smoking (including second-hand smoke)
• Heavy alcohol usage
• Physical inactivity
• Being overweight
• Use of birth control pills, anticoagulants and steroids
• Hormone replacement therapy
• Use of cocaine and other illegal drugs
• Heart conditions such as atrial fibrillation, endocarditis and cardiomyopathy

Prevention

Taking the following steps can help you control risk factors and other medical conditions that could lead to a stroke:

• Have regular medical checkups. Work with your doctor to control your high blood pressure. This is especially important if you also have diabetes.
• Become more active. The more physically active you are, the greater the reduction in risk. Exercise can also help raise HDL (“good”) cholesterol levels in your body, which also reduces the risk of stroke.
• Get tested for high cholesterol, heart disease (especially atrial fibrillation), diabetes or disorders that affect your blood vessels.
• Don’t smoke. Daily cigarette smoking increases the risk of stroke by two times.
• Take cholesterol-lowering medications called statins if you have high cholesterol or have had a heart attack, TIA or stroke