What is a stroke?
A stroke is an attack on the brain - similar to a heart attack. Stroke affects the arteries leading to and within the brain. It is the third cause of death in the United States, behind diseases of the heart and cancer and a major cause of disability. A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts. When that happens, part of the brain cannot get the blood (and oxygen) it needs, so it starts to die.
Pioneer Valley Hospital is a designated stroke receiving facility. This means that we have a dedicated “stroke team” that is called into action the moment we know a stroke patient is on the way to our hospital. Members of the stroke team include emergency physicians, neurologists, radiologists, and physiatrists working closely to provide acute intervention with the aim of providing the best possible outcome for each patient.
We work together with emergency medical services (EMS) agencies to identify stroke patients in the field so we have the right personnel and equipment ready to treat them as soon as they arrive at the hospital. It’s the approach recommended by the American Heart Association. And it’s what we do every day.
Critical to proper treatment of stroke is fast and accurate diagnosis. Clot-based strokes can be treated with clot-busting drugs but these drugs must be administered with 4.5 hours of the onset of symptoms. That is why it is essential to know the signs of a stroke and come to the emergency room immediately.
At Pioneer Valley Hospital, we have 24/7 coverage for important diagnostic procedures such as CT angiography, diffusion and perfusion MR imaging and cerebral angiography. These diagnostic services assist us in making the correct diagnosis and help us to identify the most appropriate treatment.
What is a stroke?
Stroke is a brain attack that affects the arteries leading to and within the brain just as a heart attack affects the arteries associated with the heart. It is the third cause of death in the United States, behind diseases of the heart and cancer. A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts. When that happens, part of the brain cannot get the blood (and oxygen) it needs, so it starts to die.
Signs of a stroke
Stroke is a medical emergency. Know these warning signs of stroke and teach them to others. Every second counts:
- Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
- Sudden confusion, trouble speaking or understanding
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking, dizziness, loss of balance or coordination
- Sudden, severe headache with no known cause
If you or someone with you has one or more of these signs, don't delay! Immediately call 9-1-1 or the emergency medical services (EMS) number so an ambulance (ideally with advanced life support) can be sent for you. Also, check the time so you'll know when the first symptoms appeared. It's very important to take immediate action. If given within 3.0 hours of the start of symptoms, a clot-busting drug called tissue plasminogen activator (tPA) may reduce long-term disability for the most common type of stroke. TPA is the only FDA-approved medication for the treatment of stroke within three hours of stroke symptom onset.
Some stroke risk factors are hereditary. Others are a function of natural processes. Still others result from a person's lifestyle. You can't change factors related to heredity or natural processes, but those resulting from lifestyle or environment can be modified with the help of a health care professional.
What risk factors for stroke can't be changed?
The chance of having a stroke approximately doubles for each decade of life after age 55. While stroke is common among the elderly, a lot of people under 65 also have strokes.
- Heredity (family history) and race
Your stroke risk is greater if a parent, grandparent, sister or brother has had a stroke. African-Americans have a much higher risk of death from a stroke than Caucasians do. This is partly due to higher risks of high blood pressure, diabetes and obesity among the African-American community.
- Sex (gender)
Stroke is more common in men than in women. In most age groups, more men than women will have a stroke in a given year. However, more than half of total stroke deaths occur in women. At all ages, more women than men die of stroke. Use of birth control pills and pregnancy pose special stroke risks for women.
- Prior stroke, TIA or heart attack
The risk of stroke for someone who has already had one is many times that of a person who has not. Transient ischemic attacks (TIAs) are "warning strokes" that produce stroke-like symptoms but no lasting damage. TIAs are strong predictors of stroke. A person who's had one or more TIAs is almost 10 times more likely to have a stroke than someone of the same age and sex who hasn't. Recognizing and treating TIAs can reduce your risk of a major stroke. If you've had a heart attack, you're at higher risk of having a stroke, too. TIA should be considered a medical emergency and followed up immediately with a health care professional.
What stroke risk factors can be changed, treated or controlled?
- High blood pressure
High blood pressure is the leading cause of stroke and the most important controllable risk factor for stroke. Many people believe the effective treatment of high blood pressure is a key reason for the accelerated decline in the death rates for stroke.
- Cigarette smoking
In recent years, studies has shown cigarette smoking to be an important risk factor for stroke. The nicotine and carbon monoxide in cigarette smoke damage the cardiovascular system in many ways. The use of oral contraceptives combined with cigarette smoking, greatly increases stroke risk.
- Diabetes mellitus
Diabetes is an independent risk factor for stroke. Many people with diabetes also have high blood pressure, high blood cholesterol and are overweight. This increases their risk even more. While diabetes is treatable, the presence of the disease still increases your risk of stroke.
- Carotid or other artery disease
The carotid arteries in your neck supply blood to your brain. A carotid artery narrowed by fatty deposits from atherosclerosis (plaque buildups in artery walls) may become blocked by a blood clot. Carotid artery disease is also called carotid artery stenosis. Peripheral artery disease is the narrowing of blood vessels carrying blood to leg and arm muscles. It's caused by fatty buildups of plaque in artery walls. People with peripheral artery disease have a higher risk of carotid artery disease, which raises their risk of stroke.
- Atrial fibrillation
This heart rhythm disorder raises the risk for stroke. The heart's upper chambers quiver instead of beating effectively, which can let the blood pool and clot. If a clot breaks off, enters the bloodstream and lodges in an artery leading to the brain, a stroke results.
- Other heart disease
People with coronary heart disease or heart failure have a higher risk of stroke than those with hearts that work normally. Dilated cardiomyopathy (an enlarged heart), heart valve disease and some types of congenital heart defects also raise the risk of stroke.
- Sickle cell disease (also called sickle cell anemia)
This is a genetic disorder that mainly affects African-American and Hispanic children. "Sickled" red blood cells are less able to carry oxygen to the body's tissues and organs. These cells also tend to stick to blood vessel walls, which can block arteries to the brain and cause a stroke.
- High blood cholesterol
People with high blood cholesterol have an increased risk for stroke. Also, it appears that low HDL (“good”) cholesterol is a risk factor for stroke in men, but more data are needed to verify its effect in women.
- Poor diet
Diets high in saturated fat, trans fat and cholesterol can raise blood cholesterol levels. Diets high in sodium (salt) can contribute to increased blood pressure. Diets with excess calories can contribute to obesity. Also, a diet containing five or more servings of fruits and vegetables per day may reduce the risk of stroke.
- Physical inactivity and obesity
Being inactive, obese or both can increase your risk of high blood pressure, high blood cholesterol, diabetes, heart disease and stroke. So go on a brisk walk, take the stairs, and do whatever you can to make your life more active. Try to get a total of at least 30 minutes of activity on most or all days.
What are other, less well-documented risk factors?
- Geographic location
Strokes are more common in the southeastern United States than in other areas. These are the so-called "stroke belt" states.
- Socioeconomic factors
There's some evidence that strokes are more common among low-income people than among more affluent people.
- Alcohol abuse
Alcohol abuse can lead to multiple medical complications, including stroke. For those who consume alcohol, a recommendation of no more than two drinks per day for men and no more than one drink per day for nonpregnant women best reflects the state of the science for alcohol and stroke risk.
- Drug abuse
Drug addiction is often a chronic relapsing disorder associated with a number of societal and health-related problems. Drugs that are abused, including cocaine, amphetamines and heroin, have been associated with an increased risk of stroke. Strokes caused by drug abuse are often seen in a younger population.
- Ischemic Stroke
The vessel clogs within
- Stroke Hemorrhagic
The vessel ruptures, causing blood to leak into the brain