Stroke - Signs and Symptoms

Stroke is often referred to by doctors as a cerebrovascular accident, but the term is not an accurate one since stroke is rarely an ‘accident’. The underlying conditions of a stroke (called cerebrovascular disease) are usually present for years before a stroke occurs, although the symptoms of a stroke may occur suddenly.

There are sometimes quite specific warning signs of an impending stroke. By recognizing the warning signs and taking action, you may be able to prevent a stroke or reduce its severity. It is important to be able to recognize the warning signs in order to get medical help as quickly as possible.

Transient Ischaemic Attacks

Transient ischaemic attacks (TIAs) are caused by a temporary cut in blood supply to the brain, due to the partial blockage of an artery by a blood clot or debris. TIAs have the same symptoms as a stroke, but they are temporary and do not usually cause long-term brain damage.

A TIA, or mini-stroke, is a warning of an impending stroke. A person who has had a TIA is at greater risk of having a stroke or heart attack. Early identification of symptoms and a diagnosis from your doctor greatly reduces the chances of a major stroke.

A TIA is:

Transient – symptoms usually last for less than 24 hours.

Ischaemic – failure of blood flow to part of the brain or eye.

Attack – sudden onset of symptoms, which vary from person to person depending on which part of the brain or eye is starved of blood.

Symptoms

Symptoms of a TIA are very similar to those of a stroke. They can include:

• A numb or weak feeling in the face, arm or leg

• Trouble speaking or understanding

• Unexplained dizziness

• Blurred or poor vision in one or both eyes

• Loss of balance or an unexplained fall

• Difficulty swallowing

• Headache (usually severe or of abrupt onset) or unexplained change in the pattern of headaches

• Confusion

• Unconsciousness.

The FAST test is an easy way to recognize and remember the signs of stroke or a TIA. Using the FAST test involves asking three simple questions. If the person has a problem with any of these functions, dial 911 for an ambulance immediately.

FAST stands for:

Facial weakness – can the person smile; are their mouth or eyes drooping?

Arm weakness – can the person raise both arms?

Speech difficulty – can the person speak clearly and understand what you say?

Time to act – act FAST and call 911 immediately.

If you suddenly experience any of these symptoms, get to a hospital immediately. Remember, stroke is a life-threatening emergency. Symptoms Occur in a Variety of Ways

The warning signs or symptoms of stroke may occur alone or in combination. They may last a few seconds or up to 24 hours, and then disappear. These signs are mini-strokes and should not be ignored. They indicate a hidden problem with blood flow, which could trigger a stroke. The severity of the symptoms depends on the area of the brain affected and the cause.

Where to Get Help

If you experience symptoms of a stroke, dial 911 for an ambulance or get to the emergency department of your nearest hospital immediately. Call your doctor. Call the National Stroke Association at 1 - 800 – STROKES or 1 - 800 - 787 - 6537

Things to Remember

The symptoms of stroke can occur suddenly.

Transient ischaemic attacks (TIAs) are an important warning sign that a stroke may occur in the future.

Early identification of symptoms and a diagnosis from your doctor greatly reduces the chances of a major stroke.

Stroke - The After Effects

Stroke is the interruption of blood to the brain. The most common type of stroke is ischaemic, caused by a blood clot blocking an artery or vessel. The brain cells in the immediate area are permanently damaged and those in the surrounding areas are affected by the reduced blood flow.

Once brain cells are permanently damaged, their functions stop with them. The functions that are lost depend on which areas of the brain were affected by the stroke and how severely. A person who suffers from a small stroke may recover with only minor disabilities, while a major stroke can permanently disable or even cause death. Many survivors also have emotional changes, with a tendency to laugh or cry for no apparent reason and then to stop just as suddenly. A

Window of Opportunity

Brain cells (neurones) lack the ability to regenerate. When brain cells in the immediate area are starved of oxygen and nutrients by a stroke, they quickly die. Brain cells in the surrounding areas are then at dire risk. If medical treatment is prompt, there is every chance that these compromised brain cells can be saved, minimizing the damage.

If a stroke is suspected, it is very important to seek medical help immediately. It can mean the difference between life and death, or minor versus major disabilities.

Different Parts of the Brain

The brain can be considered as a four-part organ, which includes the right and left hemispheres, the cerebellum and the brain stem. A stroke has different effects, depending on which part of the brain is targeted during the attack.

The Right Hemisphere

Some of the major functions of the right hemisphere include perception and control of the left side of the body. A stroke which affects the right hemisphere can cause many changes, including:

• The inability to judge distances, which can lead to falls or loss of hand-to-eye coordination

• Short-term memory loss

• Neglecting or ignoring anything situated to the left of the body

• Impulsive behavior

• Paralysis of the left side of the body (‘left hemiplegia’).

The Left Hemisphere

Some of the major functions of the left hemisphere include speech and control of the right side of the body. A stroke affecting the left hemisphere can cause many changes, including:

• Paralysis of the right side of the body (‘right hemiplegia’)

• Various problems with speech and communication

• Short-term memory loss.

The Cerebellum

Some of the major functions of the cerebellum include coordination and balance. A stroke affecting the cerebellum can cause many changes, including:

• Dizziness

• Nausea and vomiting

• Loss of coordination

• A tendency to unbalance and fall

• Slurred speech.

The Brain Stem

Some of the major functions of the brain stem includes breathing, heart rate and blood pressure. A stroke that affects the brain stem can cause many changes, including:

• Complete paralysis

• Coma

• Double vision

• Swallowing difficulties

• Death.

Living with the Effects of Stroke

In some cases, the effects of a small stroke can be overcome and the person can live an almost completely normal life. In other cases, the disabilities are severe and permanent. Support and understanding from family and friends, plus intensive rehabilitation from health care professionals, can always improve a stroke survivor’s quality of life. Home Health Support, a division of Senior Home Support, can provide the following workers to help stroke victims.

• Speech Therapists – to maintain or improve speech and communication and assess swallowing difficulties.

• Occupational Therapists – to teach coping strategies and new skills, and help adapt the family home to better cater for the needs of the stroke survivor.

• Physical Therapists – to maintain or improve the movement and functioning of the body.

Where to Get Help

• Your doctor

• Your specialist

• Speech therapist

• Occupational therapist

• Physical therapist

In an emergency, always dial 911 to call an ambulance

Things to Remember

• A stroke has different effects, depending on which part of the brain is targeted during the attack.

• If a stroke is suspected, it is important to seek medical help immediately.

• Health care professionals who can help improve a stroke survivor’s quality of life include speech, occupational and physical therapists.

Stroke - The Risk Factors

Stroke is influenced by different risk factors. Some of these – age, gender and family history – are beyond your control. However, you can substantially reduce your overall risk by making healthy changes to your diet and lifestyle.

High Blood Pressure

Blood pressure is a measurement of the force your blood puts on blood vessel walls as it travels through your body. High blood pressure is medically known as ‘hypertension’ and is one of the most important risk factors in stroke.

Normal blood pressure is around 120/80. High-normal blood pressure is between 120/80 and 140/90. If your blood pressure is consistently over 140/90, you have high blood pressure. The levels for normal blood pressure are a guide only. In general the lower your blood pressure, the lower your risk of stroke. Your doctor can talk to you about your blood pressure and risk of stroke and may recommend treatment if required.

You can control hypertension by reducing your weight, exercising regularly, eating a low salt, low fat and high fiber diet, and taking anti-hypertensive medication (if necessary).

Cigarette Smoking

Smoking can increase your risk of stroke by increasing blood pressure and reducing oxygen in the blood.

Diabetes

Diabetes can damage your entire circulatory system and is a risk factor for stroke. Type 1 usually occurs from a young age and is treated with insulin injections. Type 2 usually occurs from 30 years of age onwards and is treated with either tablets or, in some cases, insulin. Talk to your doctor about controlling diabetes if you are diabetic.

Other Important Risk Factors

High Cholesterol

High cholesterol is a contributing factor to blood vessel disease, which often leads to stroke. To reduce cholesterol in your blood, eat foods low in saturated fat. Choose lean meats and low fat dairy products, and limit your intake of eggs. Your doctor may prescribe medication to lower your cholesterol but diet changes and exercise are still important.

Obesity

Being overweight or obese can increase the risk of stroke. Too much body fat can contribute to high blood pressure and high cholesterol and may lead to heart disease and type 2 diabetes. If you are unable to maintain your weight within recommended levels, ask a doctor or nutritionist for help.

Alcohol

Your risk of stroke can be reduced with moderate alcohol intake (one to two glasses a day). Excessive amounts of alcohol can raise blood pressure and increase your risk of stroke.

Diet and Exercise

A diet low in fat and salt will reduce your risk of stroke. Eating a balanced diet of fresh foods (wherever possible) is recommended. Avoid processed or canned foods as they can be high in sodium, or salt. Check a food’s sodium content in the list of ingredients on the label (low salt food has a level of less than 120mg/100g).

A good balance between exercise and food intake is important to maintain a healthy body weight. People who participate in moderate activity are less likely to have a stroke. Try to build up to at least 30 minutes of moderate physical activity most days of the week. Talk to your doctor about an exercise program – people with high blood pressure should avoid some types of exercises.

Irregular Pulse (arterial fibrillation)

You are more at risk of stroke if you have an irregular pulse due to the condition atria fibrillation (AF). Your doctor can diagnose this condition and advise you on how best to manage this if it happens. If you experience symptoms such as palpitations, weakness, faintness or breathlessness, it is important to see a doctor for diagnosis and treatment.

Risk Factors Beyond Your Control

Stroke is influenced by some risk factors that are outside a person’s control. These include:

Age – the majority of people who suffer from stroke are 65 years or older.

Gender – men are at higher risk than women.

Family history – a family history of cerebrovascular disease may make you more susceptible to stroke.

Statistics on Stroke

Almost one in five people who experience a stroke are under the age of 55. Men are more likely to suffer a stroke and at a younger age. One in three people die within a year of having a stroke. Stroke kills more women than breast cancer.

Stroke prevention

Lifestyle-related factors that increase your risk of stroke include:

• High blood pressure

• Cigarette smoking

• Diabetes

• High blood cholesterol levels

• Heavy drinking

• Low fiber, high fat diet

• Lack of exercise

• Use of birth control pills.

Everyone can reduce their risk of having a stroke by making a few simple lifestyle changes. High blood pressure Hypertension may cause thickening of the artery walls, resulting in narrowing and eventual blockage of the vessel (ischaemic stroke). In atherosclerosis (hardening of the arteries), the pressure of your pumping blood could ‘hose off’ debris from damaged artery walls. The circulating debris (embolism) can cause a stroke by lodging in and blocking a blood vessel of the brain.

Strategies to reduce high blood pressure include:

• Have your blood pressure regularly checked by your doctor.

• Maintain a healthy weight for your height.

• Exercise regularly.

• Choose a low fat, high fiber diet.

• Reduce or eliminate salt from your diet.

• Limit your alcohol intake to four standard drinks per day (for men) and two standard drinks per day (for women).

• Stop smoking

• Take antihypertensive medications to help control high blood pressure.

Cigarette smoking

Smoking can double or even quadruple your risk of stroke. Some of the chemical ingredients in cigarette smoke (such as nicotine and carbon monoxide) accelerate the process of atherosclerosis. Clots are more likely to form because smoking thickens the blood and makes clotting factors, such as platelets, much more ‘sticky’. Cigarette smoke forces arteries to constrict – a narrowed diameter makes it harder for the thickened blood to move through the vessels.

Strategies to quit smoking include:

• See your doctor for information and advice.

• Decide on a strategy, such as ‘cold turkey’ or using nicotine replacement therapy.

• Keep a smoking diary so that you are aware of your smoking triggers (such as stress or boredom).

• Decide on a quit date.

• Ask your family and friends for support.

• Don’t be discouraged by a slip-up. If you smoke a cigarette, put it behind you and keep going.

Diabetes

Diabetes is a chronic condition characterized by the body’s inability to utilize blood sugar. A person with diabetes is around twice as likely to have a stroke as someone of the same gender and age that doesn’t have diabetes. This is because the high blood sugar levels contribute to the development of atherosclerosis. It is very important that diabetes be kept under control.

Strategies to reduce the effects of diabetes include:

• See your doctor regularly for check-ups.

• Monitor your blood sugar levels regularly.

• Maintain a healthy weight for your height.

• Exercise regularly.

• Choose a high fiber, low fat diet.

• If you are on medication, make sure you are taking it correctly.

High cholesterol level

Cholesterol is a fat-like substance that is made by the human body. It has many essential roles to play, but it becomes a problem if levels in the blood are too high. Blood cholesterol contributes to the formation of a substance called athero, which sticks to artery walls and leads to atherosclerosis.

Strategies to lower blood cholesterol levels include:

• Have your blood cholesterol levels checked regularly by your doctor.

• Switch to a high fiber diet.

• Reduce your intake of saturated fats (commonly found in animal products).

• See your doctor for information and advice. Medications may be recommended.

Heavy drinking

Some studies have indicated that drinking moderate amounts of alcohol (such as one or two standard drinks per day) can actually reduce the risk of stroke. However, people who drink heavily are three times more likely to have a stroke, regardless of their age. It is important to limit your alcohol intake.

Suggestions include:

• Women should limit their consumption to no more than two standard drinks per day.

• Men should limit their consumption to no more than four standard drinks per day.

• Both men and women should have at least two alcohol-free days every week.

• See your doctor for information and referral if you are finding it difficult to limit your alcohol intake.

Low fiber, high fat diet

Various studies show that diet is an important risk factor in the development of stroke.

Suggestions include:

• Limit or moderate salt intake.

• Choose fresh rather than processed foods.

• Increase your intake of vegetables, fruit and whole grains.

• Cut out or reduce sugary and fatty foods like cakes and junk food.

Lack of exercise

A sedentary lifestyle increases the likelihood of obesity, high blood pressure and high blood cholesterol levels. These are all important risk factors for stroke.

Suggestions include:

• Choose a range of activities you enjoy.

• Start your new exercise program slowly and only increase the intensity and duration as you become fitter.

• Exercise with a friend or join a team sport to add a fun social element to the activity.

• Remember to warm up and cool down.

• See your doctor for a check-up if you haven’t exercised for a while.

• Contact a physiotherapist or gymnasium instructor for advice and information regarding appropriate exercise.

• Try to get moderate exercise for at least 30 minutes on (at least) five days of the week.

Where to Get Help

Your doctor

Call the National Stroke Association at 1 - 800 – STROKES or 1 - 800 - 787 - 6537

Things to Remember

Stroke may occur due to blockage of a blood vessel in the brain or rupture of a blood vessel, causing bleeding in the brain or into the space surrounding the brain. Many strokes are avoidable and can be caused by unhealthy diet and lifestyle choices. Some of the major risk factors for stroke include high blood pressure, cigarette smoking and diabetes.