Unfortunately, over the years I have had the displeasure of witnessing the aftermath of patients who have had a stroke.

Many of them were not able to return home following their hospitalization. They required a long-term care facility because they were unable to perform the activities of daily living. These were individuals who had great jobs with great benefits. They were forced to apply for disability because they could no longer work. Their families now had to help care for them.

Cerebral vascular accidents, or strokes as they are commonly known, are basically blood flow interruptions in the brain. These brain attacks can either be ischemic [not enough blood transfusion due to a clot] or hemorrhagic [bleeding in the brain from a leaky blood vessel or a ruptured aneurysm.] The sequelae from these vascular events depend upon the location of the affected vessels and the size of the area involved.

87% of the strokes that occur are ischemic in nature. Hypertension is the number one risk factor for this type of stroke. When a blood clot or plaque forms somewhere in the body, such as the heart, it can travel to the brain and cause blockages in the vessels there. This is known as an embolic stroke.

Roughly 15% of people with irregular heart rhythms known as atrial fibrillation, have embolic strokes. Basically, the left atrium of the heart does not have normal contractility and that causes blood to pool, eventually forming clots which then travel to the brain.

Clots can also originate in the vessels supplying blood to the brain. These are known as thrombotic strokes and are a result of atherosclerosis-plaque build-up. People with high cholesterol experience these types of strokes.

In contrast, the hemorrhagic strokes result from conditions such as high blood pressure, over treatment with blood thinners, and aneurysms. Another less common cause of bleeding in the brain is the rupture of an arteriovenous malformation, an abnormal tangle of vessels that were present at birth.

The brain makes up only about 2% of human body weight but requires about 15-20% of the body’s blood supply. Red blood cells are important for carrying not only oxygen to the brain but carbohydrates, amino acids, fats, hormones, and vitamins. If a disruption occurs in that supply, brain cells will immediately start to die resulting in permanent brain damage. 

Occasionally, mini-strokes (transient ischemic attack - TIA) occur in which brief episodes of decreased blood flow cause symptoms like those in strokes. TIAs do not leave permanent damage like those seen in cerebral vascular accidents since the vessel blockages are temporary. However, TIAs are warning signs that more ominous problems are looming, and full-blown strokes are likely in the future.

There are numerous risk factors for strokes, many of whom are modifiable. For example, heavy drinking, being overweight or obese, the use of illicit drugs such as cocaine or methamphetamines, or physical inactivity are all risk factors that are mostly self-induced but possess potential for change.

Family history also contributes to future stroke risk. Controlling blood pressure, managing high cholesterol appropriately, and maintaining regular check-ups with your primary care provider are all recommendations for reducing stroke risks. 

Arm or leg weakness, facial drooping, and speech problems are a few of the more common symptoms exhibited by stroke victims. I have had family members of my patients report how their loved ones were engaging in normal conversation when suddenly their speech became incoherent.

Unfortunately, patients make the sometimes-fatal error of deciding to just wait and see if the symptoms resolve spontaneously instead of proceeding directly to the emergency room. The window of opportunity to improve stroke outcomes is within three hours. Therefore, there is little time to waste during a brain attack. Go to the ER as soon as possible!

Your family doctor,

Denise Hooks-Anderson, MD, FAAFP

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