What is Stroke?
A stroke occurs when the blood supply to part of the brain is suddenly interrupted or when a blood vessel in the brain bursts, spilling blood into the spaces surrounding brain cells. In the same way that a person suffering a loss of blood flow to the heart is said to be having a heart attack, a person with a loss of blood flow to the brain or sudden bleeding in the brain can be said to be having a “brain attack.”
Brain cells die when they no longer receive oxygen and nutrients from the blood or when they are damaged by sudden bleeding into or around the brain. Ischemia is the term used to describe the loss of oxygen and nutrients for brain cells when there is inadequate blood flow. Ischemia ultimately leads to infarction, the death of brain cells which are eventually replaced by a fluid-filled cavity (or infarct) in the injured brain.
When blood flow to the brain is interrupted, some brain cells die immediately, while others remain at risk for death. These damaged cells make up the ischemic penumbra and can linger in a compromised state for several hours. With timely treatment these cells can be saved. The ischemic penumbra is discussed in more detail in the Appendix.
Even though a stroke occurs in the unseen reaches of the brain, the symptoms of a stroke are easy to spot. They include sudden numbness or weakness, especially on one side of the body; sudden confusion or trouble speaking or understanding speech; sudden trouble seeing in one or both eyes; sudden trouble walking, dizziness, or loss of balance or coordination; or sudden severe headache with no known cause. All of the symptoms of stroke appear suddenly, and often there is more than one symptom at the same time. Therefore stroke can usually be distinguished from other causes of dizziness or headache. These symptoms may indicate that a stroke has occurred and that medical attention is needed immediately.
There are two forms of stroke: ischemic – blockage of a blood vessel supplying the brain, and hemorrhagic – bleeding into or around the brain.
Life After a Stroke
The time it takes to recover from a stroke varies—it can take weeks, months, or even years. Some people recover fully, while others have long-term or lifelong disabilities.
Ongoing care, rehabilitation, and emotional support can help you recover and may even help prevent another stroke.
If you’ve had a stroke, you’re at risk of having another one. Know the warning signs of a stroke and transient ischemic attack (TIA) and what to do if they occur. Call 9–1–1 as soon as symptoms start.
Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room. During a stroke, every minute counts.
Ongoing Care
Lifestyle changes can help you recover from a stroke and may help prevent another one. Examples of these changes include quitting smoking, following a healthy diet, maintaining a healthy weight, and being physically active. Talk with your doctor about the types and amounts of physical activity that are safe for you.
Your doctor also may prescribe medicines to help you recover from a stroke or control your stroke risk factors. Take all of your medicines as your doctor prescribes.
If you had an ischemic stroke, you may need to take anticoagulants, also called blood thinners. These medicines prevent blood clots from getting larger and keep new clots from forming. You’ll likely need routine blood tests to check how well these medicines are working.
The most common side effect of blood thinners is bleeding. This happens if the medicine thins your blood too much. This side effect can be life threatening. Bleeding can occur inside your body cavities (internal bleeding) or from the surface of your skin (external bleeding).
Know the warning signs of bleeding so you can get help right away. They include:
Unexplained bruising and/or tiny red or purple dots on the skin
Unexplained bleeding from the gums and nose
Increased menstrual flow
Bright red vomit or vomit that looks like coffee grounds
Blood in your urine, bright red blood in your stools, or black tarry stools
Pain in your abdomen or severe pain in your head
A lot of bleeding after a fall or injury or easy bruising or bleeding also may mean that your blood is too thin. Call your doctor right away if you have any of these signs. If you have severe bleeding, call 9–1–1.
Talk with your doctor about how often you should schedule followup visits or tests. These visits and tests can help your doctor monitor your stroke risk factors and adjust your treatment as needed.
Rehabilitation
After a stroke, you may need rehabilitation (rehab) to help you recover. Rehab may include working with speech, physical, and occupational therapists.
Language, Speech, and Memory
You may have trouble communicating after a stroke. You may not be able to find the right words, put complete sentences together, or put words together in a way that makes sense. You also may have problems with your memory and thinking clearly. These problems can be very frustrating.
Speech and language therapists can help you learn ways to communicate again and improve your memory.
Muscle and Nerve Problems
A stroke may affect only one side of the body or part of one side. It can cause paralysis (an inability to move) or muscle weakness, which can put you at risk for falling.
Physical and occupational therapists can help you strengthen and stretch your muscles. They also can help you relearn how to do daily activities, such as dressing, eating, and bathing.
Bladder and Bowel Problems
A stroke can affect the muscles and nerves that control the bladder and bowels. You may feel like you have to urinate often, even if your bladder isn’t full. You may not be able to get to the bathroom in time. Medicines and a bladder or bowel specialist can help with these problems.
Swallowing and Eating Problems
You may have trouble swallowing after a stroke. Signs of this problem are coughing or choking during eating or coughing up food after eating.
A speech therapist can help you with these issues. He or she may suggest changes to your diet, such as eating puréed (finely chopped) foods or drinking thick liquids.
Emotional Issues and Support
After a stroke, you may have changes in your behavior or judgment. For example, your mood may change quickly. Because of these and other changes, you may feel scared, anxious, and depressed. Recovering from a stroke can be slow and frustrating.
Talk about how you feel with your health care team. Talking to a professional counselor also can help. If you’re very depressed, your doctor may recommend medicines or other treatments that can improve your quality of life.
Joining a patient support group may help you adjust to life after a stroke. You can see how other people have coped with having strokes. Talk with your doctor about local support groups or check with an area medical center.
Support from family and friends also can help relieve fear and anxiety. Let your loved ones know how you feel and what they can do to help you.
