Stroke

Stroke

What Is Stroke?

A stroke occurs when a clot suddenly interrupts the blood supply to part of the brain or when a blood vessel within the brain bursts, spilling blood into the surrounding space. As a result, some brain cells die immediately while others remain at risk of dying. These damaged cells can linger in a compromised state for several hours. Fortunately, timely treatment can save these compromised cells.

There are two forms of stroke: ischemic stroke and hemoorrhagic stroke. Ischemia is the term used to describe the loss of oxygen and nutrients to brain cells when there is inadequate blood flow. An ischemic stroke occurs when an artery supplying the brain with blood suddenly becomes blocked, which decreases or stops blood flow to the brain. Ultimately, this causes a brain infarction, or death of brain cells. This type of stroke accounts for approximately 80 percent of all strokes. Blood clots are the most common cause of artery blockage and brain infarction.

Clotting of the blood is both necessary and beneficial because it stops bleeding and allows repair of damaged areas of arteries or veins. However, when blood clots develop in the wrong place, such as within an artery in the brain, they can cause devastating injury. Studies indicate that clotting problems become more frequent as people age. Blood clots may form in an artery within the brain or they may travel to the brain from other parts of the body. Either condition leads to identical end results: Brain tissue will die due to lack of oxygen and nutrients. Ischemic strokes can also occur if arteries within the brain become narrowed. This, too, reduces blood flow and increases the likelihood that clots will develop. Narrowed arteries are the result of the buildup of sludge (cholesterol, fatty substance, cellular debris) as commonly seen in atherosclerosis.

Hemorrhagic strokes occur when an artery within the brain bursts, spewing blood into the surrounding tissue. This upsets not only the blood supply but also the delicate chemical balance brain cells need to function. This type of stroke, which accounts for approximately 20 percent of all strokes, can occur in several ways. One common cause is an aneurysm, a weak or thin spot on an artery wall. These weak spots stretch or balloon out over time under high arterial pressure. The thin walls of these ballooning aneurysms can rupture and spill blood into the space surrounding brain cells. Hemorrhage also occurs when arterial walls break open. For instance, a plaque-encrusted artery wall eventually loses its elasticity and becomes thin and brittle. This makes the artery prone to cracking. Combined with high blood pressure, a brittle artery wall is at risk of giving way and spewing blood into the surrounding brain tissue.

Who Is At Risk For Stroke?

Some people are at higher risk for stroke than others are. Some risk factors can be controlled, but others cannot. Among the factors that cannot be altered are one's age, gender, race and ethnicity, and family history. The risk of stroke increases with age, so seniors are at higher risk than the general population. For every decade after age 55, the risk of stroke doubles; two-thirds of all strokes occur in people over 65 years old. What's more, people over 65 have a seven-fold greater risk of dying from stroke than the general population. And, the incidence of stroke is increasing proportionately with the increase in the senior population. When the relatively large baby boomer population moves into the over-65 age group, stroke and other disease will have an even greater impact on the health care field.

Gender also plays a role in stroke risk. Although men have a higher risk for stroke (1.25 times higher), more women die from it. (Men are usually younger when they have a stroke, and therefore they have a higher rate of survival than women.)

The incidence of stroke is higher when a family history of the disease exists. Additionally, the incidence is higher in certain ethnic groups such as African Americans, whose risk is almost double that of Caucasians. Studies also show that twice as many African Americans who suffer a stroke die from the event compared to Caucasians. Among other ethnic populations in the United States, including Hispanics, Asians, and Native Americans, the incidence of stroke is similar to that for Caucasians.

Modifiable risks encompass behavioral choices and lifestyle patterns that increase one's risk of stroke. Among these risks, hypertension is by far the most portent modifiable risk factor. Maintaining proper weight, avoiding excess salt (sodium), exercising regularly, and using prescribed antihypertensive medications can all reduce stroke risk. Another modifiable risk factor is cigarette smoking, which has been linked to the buildup of fatty substances in the carotid artery, the main neck artery supplying blood to the brain. Blockage of this artery is the leading cause of stroke in Americans. Also, smoking carries many other health hazards: nicotine raises blood pressure; carbon monoxide reduces the amount of oxygen reaching the brain; and cigarette smoke makes the blood thicker, thereby increasing one's risk for clots.

Common heart disorders such as coronary artery disease, valve defects, irregular heartbead, and enlargement of one of the heart's chambers can result in blood clots that may break loose and block vessels in or leading to the brain. To reduce risk, physicians now frequently prescribe medications such as aspirin to help prevent clot formation. In more serious cases, surgery may be recommended to clean out clogged arteries.

Symptoms Of Stroke?

Warning signs are clues that the brain is not receiving enough oxygen. If you observe one or more of these signs of a stroke in a senior client, call 911 immediately:

  • sudden numbness or weakness of face, arm, or leg, especially on one side of the body
  • sudden confusion or trouble speaking or understanding
  • sudden trouble seeing in one or both eyes or having double vision
  • sudden trouble walking, dizziness, loss of balance or coordination, or drowsiness
  • sudden severe headache with no known cause
  • nausea or vomiting

Sometimes the warning signs may last only a few moments and then disappear. These brief episodes, known as transient ischemic attacks or TIAs, are sometimes called "mini-strokes". Although brief, they identify an underlying serious condition that won't go away without medical help. Unfortunately, since they clear up, many people ignore them. Paying attention to these signals may save your life.

Treatment for Stroke

The type of stroke therapy a patient receives largely depends on the stage of disease. Generally, there are three treatment stages for stroke: prevention, therapy immediately after stroke, and post-stroke rehabilitation.

Therapies to prevent either a first stroke or a recurrent stroke are based on treating an individuals underlying risk factors. Acute stroke therapies strive to halt a stroke in progress by quickly dissolving the blood clot causing the stroke or to stop the bleeding from a hemorrhagic stroke with surgery. The purpose of post-stroke rehabilitation is to overcome disabilities that result from stroke damage.

Rehabilitation Therapy

Stroke is the number one cause of serious adult disability in the United States and can be devastating to both the stroke victim and his or her family. Some disabilities that can result from a stroke are paralysis, cognitive deficits, speech problems, emotional difficulties, daily living problems, and chronic pain. Although stroke is a disease of the brain, it often affects the entire body, so available therapies can help rehabilitate some post-stroke patients.

One common disability that results from stroke is paralysis on one side of the body, known as hemiplegia. A relate disability, though not as debilitating as paralysis, is one-sided weakness or hemiparesis. Paralysis or weakness may also affect only one part of the body such as the face, an arm, or a leg.

The brain has two hemispheres, each of which controls the opposite side of the body. Because of this, a person who suffers a stroke in the left himisphere will have right-sided paralysis or paresis. Conversely, a person with a stroke in the right hemisphere of the brain will display deficits on the left side of the body. As a result of a stroke, a person may have problems with even the simplest of daily activities0walking, dressing, eating, or using the bathroom. Motor deficits can result, affecting balance and coordination. Some stroke patients also have trouble eating and swallowing, a condition known as dysphagia.

For most stroke patients, physical therapy (PT) is the cornerstone of the rehabilitation process. A physical therapist combines training, exercises, and physical manipulation of the stroke patients body to help restore movement, balance, and coordination. The goal of PT is to help the stroke victim relearn basic activities such as walking, sitting, standing, lying down, and the switching from one type of movement to another.

Like physical therapy, occupational therapy (OT) also involves exercise and training to help the stroke patient relearn everyday activities such as eating, drinking and swallowing, dressing, bathing, cooking, reading and writing, and toileting. The goal of the occupational therapist is to help the patient provide their own care by becoming independent or semi-independent.

Speech and language problems arise when brain damage occurs in the language centers of the brain. Due to the brain's great ability to learn and language centers of the brain. Due to the brain's great ability to learn and change (called brain plasticity), other areas can adapt to take over some of the lost functions. Speech therapy helps stroke patients relearn language and speaking skills or learn other forms of communication. Speech therapy is appropriate for patients who have no deficits in cognition or thinking but have problems understanding speech or written words or have problems forming speech. A speech therapist trains stroke patients to improve their language skills. If necessary, a speech therapist will help a stroke victim learn alternative ways of communicating or will assist the patient in developing coping skills to deal with the frustration of not being able to communicate fully.

With time and patience, stroke survivors should be able to regain some, and sometimes all, of their language and speaking abilities, depending on the extent of damage from the stroke. Many stroke patients develop psychological problems such as depression, anxiety, frustration, and anger. When this occurs, mental health treatment or medication may alleviate some issues. Sometimes, it is beneficial for family members of the stroke patient to also seek psychological follow-up.

Aspirin Therapy

Recent studies indicate that aspirin can reduce the risk of heart attacks and ischemic strokes and can reduce the risk of death or complications from a heart attack. Aspirin thins the blood, allowing it to circulate more easily and decreasing the likelihood of blood clots. Thus, many people believe that if someone is having a heart attack, the person should be given aspirin Despite these apparent benefits, aspirin therapy should be provided only under the direction of a physician who can monitor side effects and potential negative consequences.Aspirin can be very hard on the stomach lining and may produce ulcers in some people. Reducing the blood's ability to clot can have very negative consequences when other conditions exist, such as wet macular degeneration or hemorrhagic stroke. Aspirin may also interact with other medications the senior may be taking. For people who are not at risk of heart attack or stroke, the potential dangers of aspirin therapy may outweigh the benefits. It is increasingly common for physicians to prescribe low doses of aspirin for patients who have had an angioplasty, heart attack, or ischemic stroke. The best advice is for seniors to ask their physicians about the possible value of aspirin for their specific condition.

The above information was provided by the Society of Certified Senior Advisors (SCSA)