Strokes are a devastating event where part of the brain loses its supply of oxygen and sugar. This causes neuron damage or death. Its being renamed a “brain attack.” The goal is to save as much brain tissue as possible. If stroke symptoms develop you should call 911 right away. Signs include weakness on one side of the body, difficulty speaking and swallowing, and the tongue deviating to the side.
There are different types of strokes: “Ischemic stroke” means brain tissue died due to the lack of blood. When you have an acute stroke, the brain will “autoregulate” the blood pressure, keeping it high enough to perfuse areas that are injured buy not dead. Unless its over 200, physicians allow the brain to control the blood pressure.
A “thrombotic stroke“ occurs when a blood clot travels from the heart to the brain. Atrial fibrillation (a fib)” can cause your blood to pool and develop these clots. Some patients have clots in the heart for other reasons which can break loose. These clots cause huge damage if they travel from the heart to the brain. You may need an echocardiogram to make sure the clots aren’t coming from deep inside the heart. The treatment is anticoagulation for most patients. Warfarin, Xarelto (rivaroxaban), aspirin, Pradaxa (dabigatran) and Eliquis (apixaban) are used to prevent the next stroke. Having one stroke puts you at a significantly increased risk of getting another one. Sometimes long term heart monitoring is needed to identify a stroke caused by episodic a fib.
“Embolic” strokes means a scab formed on the inside of an artery. The scab breaks loose and goes to the brain. The patient will need studies of the carotid arteries to see if there is any “plaque” there. Surgery and sometimes angioplasty and a stent are treatments to prevent the next stroke. Controlling blood pressure and cholesterol are important in preventing future embolic strokes.
“Lacunar infarcts means small “lakes” of fluid in the brain where the brain tissue died. These rarely cause symptoms. Keeping the blood pressure less than 130/80 and taking a statin to lower cholesterol reduce the risk of the next stroke.
“Hemorrhagic stroke” means a blood vessel ruptures and bleeds into the brain. This is usually caused by years of high blood pressure. Aneurysms can rupture and cause a hemorrhagic stroke. These strokes tend to be bad with poor outcomes.
A “TIA” (transient ischemic attack) is diagnosed when she stroke symptoms go away relatively quickly, usually minutes to hours. Any longer than that the diagnosis is a stroke or “CVA” (“cerebral vascular event.”)
“Amaurosis fugax” occurs when a piece of plaque breaks loose and goes to the retinal artery. Its like a lamp shade being pulled down in one eye. Its treated as a stroke and TIA.
Emergency rooms are equipped to deal with strokes. If you have a stroke that didn’t bleed you can be given “clot busting” medication acutely. Sometimes the clot can be removed with a catheterization technique. Time is of the essence, however.
A neurologist in Boca Raton found the injection the “biological” “Enbrel” into the spinal fluid can make some strokes go away, even years later. I encourage you to visit their website: www.strokebreakthrough.com.
Strokes commonly cause nursing home admissions and long term care. They are best prevented. Unless it was a TIA, physical therapy will be needed to cope with the neurological consequences of a stroke. If the stroke is in the left middle cerebral artery you may never be able to speak again, although you can still curse because it comes from a different part of the brain.