- brain attack
- cerebrovascular accident
What is going on in the body?
- stroke from cardiogenic embolism, a condition in which blood clots travel from the heart. Blood clots from the heart may be caused by an irregular heartbeat called atrial fibrillation, severe congestive heart failure, and heart attack.
- stroke from atherosclerosis, which occurs when the arteries supplying the brain are narrowed by plaque formation on the vessel walls
- stroke from carotid stenosis, which is a blockage in one of the carotid arteries in the neck
- arteritis, or artery inflammation, in an artery that supplies the brain. This may be due to a condition called temporal arteritis, for example.
- stroke from carotid dissection. A carotid dissection occurs when one of the carotid arteries in the neck is torn by an injury and blood flow to the brain is blocked.
- polycythemia vera, a blood cancer that causes blood cells to multiply and the blood to thicken. The thickened blood prevents normal oxygenation of brain cells.
- stroke caused by cholesterol or plaque from an artery in the neck. When the cholesterol or plaque travels and blocks an artery supplying the brain, a stroke occurs.
- severe migraine headaches, which cause constriction of the blood vessels within the brain and deprive brain cells of oxygen
- high blood pressure
- abnormal bleeding from blood-thinning medications, such as warfarin or heparin
- hemophilia A or hemophilia B, which are blood disorders that prevent normal blood clotting
- low numbers of platelets, a type of blood cell involved in blood clotting. Low platelet counts are seen in a number of diseases and conditions, including acute infections and a severe allergic reaction known as anaphylactic shock.
- rupture of a cerebral aneurysm, or weakened blood vessel wall within the brain
- sickle cell disease, an inherited condition that results in abnormal red blood cells
- a group of abnormal blood vessels within the brain known as an arteriovenous malformation (AVM)
- head injuries
- eclampsia, a complication of pregnancy that causes high blood pressure in the mother
What are the causes and risks of the condition?
- well-documented modifiable, and
- less well-documented or potentially modifiable.
- increasing age. A person's risk of stroke increases each year after age 55.
- race. Strokes occur approximately twice as often in blacks and Hispanics as they do in whites.
- gender. Men have a 50% higher chance of stroke than women.
- family history of stroke or transient ischemic attack (TIA). A TIA is a short, reversible episode of stroke-like symptoms that may serve as an early warning sign of stroke.
- high blood pressure
- asymptomatic carotid stenosis, or narrowing of one of the arteries in the neck
- sickle cell anemia, a blood disorder that forms abnormal red blood cells
- high cholesterol levels in the blood, including total cholesterol and LDL or "bad cholesterol." Low levels of HDL or "good cholesterol" are also cause for concern.
- atrial fibrillation, an abnormal heart rhythm
- sedentary lifestyle
- alcohol abuse
- high blood levels of homocysteine, a blood component sometimes associated with a higher risk of stroke
- drug abuse
- blood disorders, such as blood that clots easily or deficiencies of various blood components
- hormone replacement therapy (HRT). The AHA currently states that the risk of stroke associated with HRT appears low but needs further study.
- use of birth control pills, or oral contraceptives (especially in women over age 35 or smokers)
- inflammatory processes, such as a chronic infection with Chlamydia
- People who were treated for high blood pressure with thiazide diuretics, such as hydrochlorothiazide, had a significantly lower stroke risk than people on ACE inhibitors or calcium channel blockers.
- Women ages 39 to 50 who ate more fish and omega-3 polyunsaturated fatty acids had a reduced risk of stroke. This was particularly true in women who did not take aspirin regularly.
- Women ages 15 to 44 who had 2 drinks of wine a day had a 40% to 60% lower risk of stroke than women who did not drink alcohol.
- Phenylpropanolamine, a compound contained in appetite suppressants and cold remedies, significantly increased the risk of hemorrhagic stroke in women 18 to 49 years of age. The Food and Drug Administration (FDA) has since asked manufacturers to remove phenylpropanolamine from their products.
What can be done to prevent the condition?
- measurement of
blood pressurein adults at least every 2 years to screen for high blood pressure
- weight control
- physical activity
- moderation in
- for those who smoke,
- medications to treat high blood pressure if the person's blood pressure is over 140/90 after 3 months of these lifestyle modifications, or if the initial blood pressure is over 180/100
- smoking cessation using nicotine patches, counseling, and formal smoking programs
- control of blood sugar levels in a person with diabetes through medication, diet, and exercise
- the use of ramipril (i.e., Altace) in people with diabetes. A recent study showed that people with diabetes have a 33% lower risk of ischemic stroke if they take ramipril.
- careful evaluation of asymptomatic carotid stenosis to determine the need for surgery. Coronary artery surgery, such as an endarterectomy, may be indicated. An endarterectomy opens the narrow portion of the artery and increases the blood flow to the brain. People with carotid stenosis should also work closely with their healthcare professionals to control other risk factors for stroke.
- semiannual screening of children with sickle cell anemia, using ultrasound to determine the child's risk of stroke
- treatment of atrial fibrillation with blood thinners such as aspirin or warfarin (i.e., Coumadin), depending on the person's age and other risk factors
- monitoring of high levels of total cholesterol or LDL, as well as low levels of HDL. Depending on the blood levels and the person's other risk factors, medications to lower cholesterol may be given.
- Measures to reduce less well-documented or potentially modifiable risks for stroke may include:
- weight reduction in overweight persons
- 30 or more minutes of moderate exercise a day for most individuals. People with heart disease or disabilities should be in a medically supervised exercise program.
- a healthy diet for preventing heart disease, containing at least 5 fruits and vegetables a day
- for those who drink alcohol, drinking in moderation. The AHA defines moderate drinking as no more than 2 drinks a day for men and 1 drink a day for women.
- seeking treatment for drug abuse
- monitoring of blood levels of homocysteine. For most individuals, a well-balanced diet following the food guide pyramid will provide enough folic acid and B vitamins to maintain a healthy homocysteine level. For people with elevated homocysteine levels, supplements containing folic acid and B vitamins may be recommended.
- avoiding the use of oral contraceptives in women with other stroke risk factors
How is the condition diagnosed?
Long Term Effects
What are the long-term effects of the condition?
What are the risks to others?
What are the treatments for the condition?
- severe headache
- weakness or numbness of the face, arm, or leg, especially on one side of the body
- trouble walking or loss of balance, known as ataxia
- speech impairments, including trouble speaking or understanding speech
- visual impairments
What are the side effects of the treatments?
What happens after treatment for the condition?
How is the condition monitored?
Harrison's Principles of Internal Medicine, 1998, Fauci et al.