Stroke is a brain injury of which we should all be aware. If an ischemic stroke, or one due to a blood clot or embolus (a clot which travels from the heart or veins) occludes the arteries to the brain and lodges there, stopping blood flow to the brain, there is treatment that is available under certain conditions. 87% of strokes are due to lack of blood flow to the brain because of a clot forming in the arteries that carry blood to the brain, or traveling through the circulatory system from somewhere else in the body.
There is another type of stroke which requires consultation with a neurosurgeon. This type of stroke is a hemorrhagic stroke, caused by rupture of one of the arteries that directly supplies blood to brain tissue. Blood supply, and therefore oxygen supply to the brain is interrupted in the region supplied by the affected artery.
These two types of stroke are treated very differently. However, it is essential that the signs of a stroke,, which are the same in both kinds of stroke, be recognized. This will allow early intervention and treatment, which begins with a call to 911. Early treatment may prevent permanent neurologic damage from the death of brain cells. Brain cells deprived of oxygen will die after a short period of time, and this is called an infarction.
If you recognize any of the signs of a stroke In yourself or someone near you, it is essential that you call 911 immediately. This is preferable to driving to the emergency department yourself, as early intervention may be initiated. The paramedics will begin the evaluation and will supply supplemental oxygen on the way to the emergency department. If they recognize the signs of a stroke in your evaluation, they can notify the receiving hospital.
Some common signs of a stroke are sudden onset of weakness, typically on one side of the body and/ or face. A drooping face and difficult with speech or swallowing may indicate stroke. Difficulty walking or sudden loss of ability to control your movements on one side of your body is another sign, as is loss of coordination or balance. You may bump into walls as you walk, or be unable to express the words you are trying to say.
A common test that you can do at home to give you an idea if you might be having a stroke is called the Cincinnati Stroke Test. The test requires you to do the following things:
- Observe facial droop by trying to smile and show your teeth
- Hold out both arms , palms up, for 10 seconds, and if one arm drifts down- ward or you are unable to lift it, that is a sign of motor weakness.
- Say out loud “You can’t teach an old dog new tricks.” If you have difficulty saying this, you are having a sign of a stroke.
Consider, if you have diabetes, that you may have low blood sugar, which has symptoms similar to a stroke. Drink some orange juice while waiting for the ambulance. Your symptoms may resolve.
When the paramedics arrive, they will assess you with the Cincinnati Stroke Test, and they will check your blood glucose level. They will also supply supplemental oxygen, and they will begin to ask you or whoever witnessed the onset of symptoms a series of questions which will help to determine if you are a candidate for a fibrinolytic drug, or a “clot buster.” Time from onset of symptoms is critical, as there is a window of 3- 4 ½ hours during which the drugs can be helpful.
When you arrive at the ER, the most critical action will be an emergency CT scan of your brain, which will determine is you are having an ischemic (clot) stroke or a hemorrhagic (bleeding) stroke. The doctor and nurses will also perform a more detailed series of tests to determine your neurologic function, and they will start and IV and send routine blood work to the lab. They will perform an EKG.
After your CT scan determines is you have a bleeding stroke or a clot, the appropriate consultant will be summoned. Time is critical to restoring blood flow to the brain, so things will move very quickly.
If your symptoms begin to resolve, you may have what is called a transient ischemic attack, a TIA or “mini-stroke.” However, a neurologist will be consulted, as this may precede a true stroke, and the physician can prescribe drugs to attempt to avoid that problem.
If you don’t meet certain criteria, you will not be eligible for a “clot buster.” In that case, you will be given aspirin to attempt to keep platelets from forming a larger clot, and you will be observed. If you have permanent neurologic deficits from your stroke, you will probably have months of rehabilitation to attempt to restore function in the damaged area of the brain. Sometimes adjacent areas of the brain will compensate for the damaged region.
Even with treatment, you may suffer permanent neurologic damage from a stroke. Learn to recognize the signs of stroke, and don’t be afraid to call 911 if you aren’t certain about unusual symptoms.
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