Stroke
Do you know how the diseases we call Alzheimer’s and Parkinson’s got their names? Good. That means you have been reading this series of basic explanations of some of the various illnesses/conditions with which people suffer that often necessitate their having a caregiver.
Today, the topic did not get its name from a doctor, nor is it a progressive disease such as Alzheimer’s and Parkinson’s. It is an event in which most victims have a good chance for survival and recovery. Every year more than 795,000 people in America experience a stroke. About 140,000 of these are fatal, making it the third leading cause of death in our nation.
The medical term for this lack of blood supply to the brain – either through blockage or rupture – is cerebral (refers to cerebrum – part of the brain) vascular (relating to blood vessels) accident or CVA.
Where did stroke get its name? Over 2,400 years ago, Hippocrates, the father of medicine, first recognized stroke. Due to the sudden paralysis and physical changes, the term apoplexy which means struck down by violence in Greek was used to refer to this condition. At that time doctors had little knowledge of the anatomy and physiology of the brain and understood neither the cause nor possible treatment. In the mid-17th century Dr. Jacob Wepfer performed autopsies on patients who had died with apoplexy, leading to the discovery that these patients had bleeding in the brain and that a blockage in a blood vessel of the brain could cause apoplexy. In 1928, after years of study and research by medical science, apoplexy was divided into categories based on the cause of the blood vessel problem and was termed stroke or cerebral vascular accident. In recent years, brain attack is often used in the health care field to indicate that a brain attack is to the brain what a heart attack is to the heart – a sudden interruption of blood supply that requires emergency treatment.
What is a stroke? Basically, a stroke is a type of brain injury. As different parts of the brain control different functions in different areas, the effects are determined by the area of the brain that is injured and the severity of the injury. Survivors often have weakness on one side of the body. Results vary but may include physical disabilities such as an inability to walk or cognitive impairments such as the inability to speak or memory loss.
There are three main types of stroke. Almost 87 percent of all strokes are ischemic strokes. This occurs when an artery leading to the brain is clogged by a clot or other blockage.
An intracerebral hemorrhage is caused by the sudden rupture of an artery within the brain. The brain is compressed by the blood released by the ruptured artery.
A subarachnoid hemorrhage is also caused by the sudden rupture of an artery, but in this case the location of the rupture causes blood to fill the space surrounding the brain instead of inside it.
It each of these, the injury results in the death of brain cells as they are deprived of oxygen that is carried in the blood.
A transient (lasting for s short time) ischemic (refers to an inadequate blood supply to an organ) attack (TIA) is sometimes called a mini-stroke. These have the same symptoms as a stroke, but they are temporary and do not cause permanent brain damage. However, TIAs should be considered as a warning signal and medical treatment should be sought to help prevent an actual stroke.
What are symptoms and signs? The most commonly reported sign of stroke is sudden weakness or numbness on one side of the body – usually the face, arm or leg. Some people complain of a sudden intense headache, but others have no pain. Loss of sensation, impaired vision, trouble speaking or inability to understand others are other symptoms which are different for each victim.
The American Stroke Association has developed the acronym FAST to recognize signs and know when to call 911. All caregivers should learn this.
Face – ask the person to smile. Does one side of the face droop?
Arm – ask the person to raise both arms. Does one arm drift downward?
Speech – ask the person to repeat a simple sentence. Are the words slurred? Can the person repeat the sentence correctly, or does he/she have difficulty understanding?
Time – if the person shows any of these symptoms, time is important. Call 9-1-1 and get to the hospital immediately.
How do age and gender play a role? After the age of 55, the risk of stroke doubles for every decade. Seventy-five percent of all strokes occur at age 65 and older. Although strokes are more common in the elderly, a person of any age can have a stroke.
Because strokes have a higher incidence at older ages and women have a longer life expectancy, they experience more strokes than men. However, age-specific stroke rates are higher in men.
What are risk factors? Research indicates that 80% of strokes are preventable. Let’s look at some of the risk factors – ones you have control over as well as those you don’t.
Controllable risk factors include keeping your blood pressure at a healthy reading. Your stroke risk increases 4 – 6 times with a reading at or above 140/90. Maintain healthy cholesterol levels as cholesterol is the culprit that can clog arteries. If you have been diagnosed with diabetes, work with your doctor to get it under control, as this disease can increase risk 2- 4 times. Physical inactivity contributes to all of the above conditions as well as obesity, another risk factor. So, regular exercise is important in stroke prevention. Smoking doubles your risk and even moderate alcohol use may increase risk by 50%.
Uncontrollable risk factors include age, gender, race, and family history.
What are treatments? No two strokes have the same outcome. Some are minor. Others have very serious consequences or are fatal – about one in eight victims die within 30 days. But more than 80% of people who have a stroke survive. It is imperative to know that the more prompt the treatment, the better the chances for a good recovery.
The first step in treatment takes place in a hospital with “acute care” where the goal is survival, prevention of complications or another stroke, and addressing any other serious medical conditions. Each person’s individual needs will determine the exact steps taken.
During this time, many patients began “spontaneous recovery” when they regain some of the abilities they had lost.
Rehabilitation begins as soon as possible while the patient is still in acute care. This begins with the patient being encouraged to do for self and continues with a program developed specifically for his/her needs.
Many decisions for future care will need to be discussed with the health care team by the patient (if able) and the family during this time. Always feel free to ask questions about anything you do not understand and express any concerns you have.
The last stage in stroke recovery is returning to pre-stroke living. About 40% of stroke survivors will have disabilities that necessitate a caregiver. Although stroke has no cure, especially over the last few decades treatment has improved greatly and with supportive care and continued rehabilitation, most stroke victims can learn to deal with their physical, cognitive and emotional obstacles. As the patient and caregiver make changes and discover new ways to meet needs that will support recovery, a good quality of life can be attained.
Caring Quote: Recovering after a stroke can seem like a path that is both endless and full of obstacles. The key to resilience lies in staying optimistic and dedicating your efforts to getting better. Finding this motivation requires you to dig deep, and that’s the hardest of all. –Saebo’s Favorite Inspirational Quotes for Stroke Survivors