Stokes

by Dr. Karen Leggett December 18, 2019

General Information

Strokes occur when there is an interruption of blood flow to part of the brain. The most common cause of the interruption of blood flow is the plugging of an artery inside or leading to the brain. The plug is most often a blood clot or an embolus. An embolus is a piece of clot or other material broken off from somewhere else in the circulatory system. This kind of stroke, caused by interruption of blood flow, is an ischemic stroke and is the major cause of stroke in elderly patients. TIAs are small, reversible strokes. When blood flow is temporarily insufficient for part of the brain, the brain tissue will not function properly. The changes that the patient experiences are real but reversible. The affected part of the brain loses function while the blood flow is insufficient, but it does not die, which would cause permanent loss of function.

In an effort to prevent additional strokes or, if the patient has only TIAs, to prevent the development of stroke, aspirin is administered. Aspirin impairs blood clotting by its effect on a tiny blood element called a platelet. Platelets are essential for normal clotting of blood.

Important Points in Treatment
Aspirin is a potent drug in the modification of blood clotting. Individual patients vary in their sensitivity to aspirin. Often it takes a higher dose of aspirin to achieve the desired effect than is required for the prevention of heart attacks. The usual dose of 325 milligrams of aspirin daily may be modified in some patients.

Additional medicines such as Persantine or Trental may be added in some cases to potentiate (increase) the effect of the aspirin.

Large doses of aspirin may be associated with the development of bruising or the onset of bleeding from the gastrointestinal tract. These complications may limit the use and effectiveness of aspirin in some patients.

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There is any evidence of bleeding while on aspirin therapy. Bleeding may occur in the urine, in the stool (as bright red blood, maroon-colored stools, or black stools), or in the skin as bruising.

Hemorrhagic Stroke

General Information
Strokes result from death of an area of brain tissue. When blood flow stops, the affected area of brain tissue loses its source of oxygen and nutrition and dies. This is an ischemic stroke. Bleeding into the space surrounding the brain (the subarachnoid space) or bleeding directly into the brain also can interrupt the flow of oxygen and nutrients and cause the death of brain tissue. The bleeding not only interrupts the flow of blood but also causes pressure on the tissues and can increase the pressure inside the skull enough to be life threatening. Strokes of this sort are hemorrhagic strokes.

Bleeding is usually associated with a history of chronic high blood pressure. Bleeding may occur because of a weakness in a blood vessel (an aneurysm). Bleeding from an aneurysm can occur in older patients with or without high blood pressure. Control of blood pressure to normal levels is important in the prevention of both hemorrhagic and ischemic strokes. Injury, as from falls, is another possible cause of bleeding. Treatment with blood thinners (anticoagulants) or aspirin also may increase the risk of bleeding into and around the brain.

Important Points in Treatment

Stroke is a medical emergency.
Whenever a stroke occurs, your physician will undertake to identify quickly the cause of the stroke. This will allow the possible selection of treatment that may arrest the further development of brain damage and perhaps enhance the degree of recovery possible.

If bleeding has occurred from an aneurysm, surgery may be necessary to stop the bleeding and prevent it from occurring again. The blood pressure may need careful control if elevated. Injury that has led to bleed- ing may have its own special needs. If treatment to limit blood coagulation (blood thinners) becomes overzealous, coagulation factors may need to be corrected.
Successful management of recovery and rehabilitation begins when the physician diagnoses the stroke. It requires enthusiastic participation of family and friends to get the maximum benefit possible.

Therapy to prevent further strokes, if needed, involves drugs that must be taken with care and on schedule.

Notify Our Office If ...

You have any sign of focal weakness, slurring of speech, or change in alertness. Stroke is a medical emergency, at least until the cause is established and controlled.

Stroke Recovery and Rehab

General Information
After a stroke, there is a period of neurologic recovery. The extent and completeness of this recovery vary with the location and amount of damage to brain tissue. The speed with which recovery occurs varies with the same factors and with the cause of the damage to the brain. Small strokes that cause few neurologic changes may allow a patient to return quickly to normal activity. The larger the area of damaged brain tissue or the more profound the symptoms produced, the slower the recovery. Recovery after plugging of blood flow is faster than recovery after bleeding into the brain, which, as a rule, causes more profound damage.

After hemorrhage, recovery may take many months, and full recovery may not be achieved. However, recovery of function can occur even when the brain tissue itself does not recover. This is the result of rehabilitation and retraining to find alternatives for restoration of normal function.

Important Points in Treatment
During a period of neurologic recovery, much of the rehabilitation effort is devoted to preservation of joint movement and maintenance of muscle strength. Restoration of bowel and bladder control also is a goal. Equally important are measures to reduce the development of complications such as thrombosis and emboli to the lungs, a risk in immobilized patients.

Rehabilitation activities begin as early as possible. Early efforts focus on retention of joint motion, prevention of spastic deformities, and prevention of the development of pressure sores. Rehabilitation may begin before the changes caused by the stroke have completely stabilized.

Once the neurologic changes have stabilized, rehabilitation progresses. Patients with paralysis of one side of the body begin by sitting up and then by undertaking transfer (getting from bed to chair and back). Various exercises, including standing, are gradually introduced according to each patient’s needs. Some patients need braces to help their walking; others may require speech therapy.

Beyond these first steps, all rehabilitation is determined by individual needs. As discharge from rehabilitation approaches, an evaluation is done to determine the need for structural changes in and around the home to facilitate the maximum level of independent living.

Rehabilitation is a slow process that works best in a positive atmosphere of support from family and friends.

Successful management of recovery and rehabilitation begins when the physician diagnoses the stroke. It requires enthusiastic participation of family and friends to get the maximum benefit possible.

General Information
Strokes occur when there is an interruption of blood flow to part of the brain. The most common cause of the interruption of blood flow is the plugging of an artery inside or leading to the brain. The plug is most often a blood clot or an embolus. An embolus is a piece of clot or other material broken off from somewhere else in the circulatory system. This kind of stroke, caused by interruption of blood flow, is an ischemic stroke and is the major cause of stroke in elderly patients.

The importance of the diagnosis in ischemic strokes is directly related to the opportunity to limit the damage caused by the stroke and in some cases to reverse the effects. Strokes may vary widely in severity. These variations occur because of differences in the duration of the interruption in blood flow, amount of brain tissue involved, and location of the affected tissue in the brain. Strokes may have only temporary effects (often called transient ischemic attacks or TIAs) or may become so severe as to be life threatening. There are many gradations of severity in between.

There is some urgency in proceeding with the tests to make this diagnosis. Treatment to dissolve the clot that is obstructing the blood vessel in the brain must be undertaken within 3 hours of the onset of the stroke to be optimally effective. Important diagnostic studies in addition to the history and physical examination include some laboratory studies and an x-ray study called computer tomography (CT or CAT scan) of the brain. Other studies may be required as well. Completed strokes that are not candidates for treatment by dissolving the clot may still benefit from treatment to contain the extent of the damage.

Important Points in Treatment

Stroke is a medical emergency.

Whenever a stroke occurs, your physician will undertake to identify quickly the cause of the stroke. This will allow the possible selection of treatment either to try to dissolve the clot or obstruction to the flow of blood or to arrest further damage to the brain and perhaps can enhance the degree of recovery possible. Often when a cause cannot be identified, the use of blood thinners (anticoagulants) may be beneficial. All such therapy needs to be individualized for each patient.

Completed strokes may leave patients with a neurologic disability. The size, shape, and position of the underlying brain injury affect the extent of possible recovery. Even when the recovery of brain function is incomplete, it is possible to gain further benefit and restoration of abilities with rehabilitation. Rehabilitation involves retraining or adaptation to the neurologic defects. The nature of the brain injury sets the limits of recovery, but not all patients achieve full recovery and adaptation to deficits.

Specialized rehabilitation must be available, accessible, and affordable for the stroke patient to reach the limits of recovery. There may be a need to adjust housing and habits of living. These are challenges if one is well, and they are even greater challenges to the recovering stroke patient. Similar changes, both shortterm and long-term, may be required of the caregiver. The events of stroke happen quickly, whereas recovery is a slow and often difficult task. Community programs and support groups can help both patient and caregiver in this process of accommodation.

Successful management of recovery and rehabilitation begins at the diagnosis of stroke. It requires enthusiastic participation of family and friends to get the maximum benefit possible.
Therapy to prevent further strokes may involve drugs that must be taken with care and on schedule.

Notify Our Office If ...

The patient shows any sign of weakness, slurring of speech, or change in alertness. Stroke is a medical emergency, at least until the cause is known and controlled.

General Information
Strokes occur when there is an interruption of blood flow to part of the brain. The most common cause of the interruption of blood flow is the plugging of an artery inside or leading to the brain. The plug is most often a blood clot or an embolus. An embolus is a piece of clot or other material broken off from somewhere else in the circulatory system. This kind of stroke, caused by interruption of blood flow, is an ischemic strok and is the major cause of stroke in elderly patients. Interruption of blood flow can also occur if bleeding (hemorrhage) occurs in or around the brain, causing a hemorrhagic stroke. However, this is less common in elderly patients as a cause of stroke.

Strokes may vary widely in severity. These variations occur because of differences in the duration of the interruption in blood flow, amount of brain tissue involved, and location of the affected tissue in the brain. Strokes may have only temporary effects (often called transient ischemic attacks or TIAs) or may become so severe as to be life threatening. There are many gradations of severity in between.

A major stroke that causes weakness, paralysis, and difficulties with speech and thinking is readily apparent. Lesser strokes may occur and be noted only after several have occurred and there is a cumulative effect. Physical examination by your physician is often enough to begin to suspect the diagnosis. Your physician may need additional tests. These include lumbar puncture (spinal tap), computed tomography (CT) scanning, or magnetic resonance imaging (MRI) of the head and brain (very specialized kinds of x-rays), or angiography (angiograms: x-rays of the blood vessels in the head and brain). It is also possible that problems with the heart’s rhythm or with blood vessels in the neck or chest are contributory to the changes in blood flow to the brain.

Important Points in Treatment

Stroke is a medical emergency.

Successful management of recovery and rehabilitation begins at the diagnosis of stroke. It requires enthusiastic participation of family and friends to get the maximum benefit possible.
Therapy to prevent further strokes may involve drugs that must be taken with care and on schedule.

Notify Our Office If ...

You have any sign of weakness, slurring of speech, or change in alertness. Stroke is a medical emergency, at least until the cause has been established and controlled.