What Causes A Stroke?

The brain controls the entire body and is responsible for all our thoughts, feelings, movements, and senses. Controlling all of these elements requires a large amount of oxygen which is supplied by the blood vessels. If this supply of oxygen is stopped by a blood vessel that is bleeding or blocked the affected area of the brain may be permanently damaged which leads to a stroke.

Strokes are far more complex than they first appear and there are countless symptoms, treatments, and possible outcomes of a stroke. In this post we will explore some of the most common of these symptoms, signs, causes, and outcomes of a stroke.

If you or a loved one is a stroke survivor this guide will help you to understand what happened and how you can move forward and continue living a full life with the assistance of a stroke rehabilitation facility.

What are the Symptoms of a Stroke?

A stroke can affect nearly any area of the brain and lead to different symptoms. However, there are certain sets of symptoms that are very common in a stroke. There are major blood vessels that supply large areas of the brain. When one of these large vessels is blocked the areas of the brain will lose blood-flow and generally affect patients in the same way although there can be exceptions.

What are the Most Common Signs and Symptoms of Stroke

The most common signs of stroke can be recognized by the acronym FAST.

• Face: Drooping of one side of the face is one of the most common signs of stroke. You may notice that one side of the mouth is drooping down, one eye cannot open, or the wrinkles on one side of the forehead are lost.
• Arms: Weakness of one arm is another common sign of stroke. If you put both arms out in front of you and one begins to drop down or cannot stay elevated it is a sign that a stroke may be occurring. This often occurs in combination with drooping of the face and/or weakness of a leg on the same side.
• Speech: Slurring of speech, losing the ability to speak, or speech that makes no sense is another sign of stroke. While this can also be caused by other conditions a sudden change in the ability to speak should always be considered an emergency.
• Time: While not a symptom, time is included in the acronym FAST because it is critical to the treatment of a stroke. There are several treatments that can help with severe stroke but they are all dependent on time. If blood flow to an area of the brain is blocked for more than 4 hours the damage is generally irreversible. For this reason a suspected stroke should be treated as soon as possible!

Notice that most of these symptoms affect one side of the body. This is because the brain has two sides, each with its own blood flow. In almost every stroke only one side of the brain is affected, meaning that only one side of the body is affected. If you notice that one side of your or a loved one’s body is weak, you cannot move one arm or leg well, or half of the face looks abnormal, call an ambulance as soon as possible!

What are Some of the Less Common Signs and Symptoms of Stroke

Some of the less common stroke symptoms are seen with severe strokes and specialized types of stroke.

• Numbness and tingling in one side of the body or one limb
• Sudden loss of consciousness
• Sudden loss of vision or vision changes
• Dizziness, lightheadedness, or a sensation that the room is spinning
• Confusion

Each of these symptoms may be the sign of a stroke. In almost all cases if you experience one of these symptoms for the first time a medical professional will recommend evaluation as soon as possible. While they may not be a sign of stroke they may be the sign of another serious medical condition. If you have one of these symptoms regularly you should seek advice from your doctor regarding when to seek emergency treatment.

What are the Most Common Types of Stroke?

The types of stroke can be divided into two rough categories, those that block a blood vessel and those that damage a blood vessel and lead to blood spilling into the brain. There are also several conditions that lead to stroke symptoms but are not directly due to issues with blood flow. The types of strokes are:

• Thrombotic stroke
• Embolic stroke
• Hemorrhagic stroke

What are the Major Differences Between the Stroke Types?

The main difference between the major stroke types are how they block blood flow to an area of the brain.

• Embolic Stroke: The most common type of stroke, an embolic stroke results from a blood clot in another area of the body traveling to the brain and becoming stuck in a blood vessel. Atrial fibrillation, a common heart condition, is the most common cause of this type of stroke.
• Thrombotic Stroke: Conditions such as diabetes, high blood pressure, and high cholesterol are the most common causes of thrombotic stroke.
• Hemorrhagic Stroke: This type of stroke is less common but also the most severe. A hemorrhagic stroke results from a blood vessel in the brain bursting and releasing blood into the tissue of the brain. This both reduces blood flow through the vessel and compresses the brain tissue around the stroke, destroying more brain tissue than the other two types of stroke.

How is a Stroke Diagnosed?

The diagnosis of a stroke is a three step process. It begins with a screening evaluation, then if a stroke is suspected a more formal evaluation of its severity is performed. Finally, imaging of the brain is performed with both a CT-scan and an MRI to determine the type of stroke and what treatment should be performed.

The Screening Evaluation

When you walk into an urgent care, emergency department, or doctors office they will evaluate for signs of stroke if you exhibit symptoms of a stroke. They will ask you a brief history of your symptoms and perform a neurological exam. This exam is focused on finding any facial droop, arm weakness, leg weakness, or signs of confusion and imbalance. If they suspect a stroke based on the screening exam and you are in an urgent care or doctors office they will transfer you to a local emergency room where the stroke protocol will be activated and treatment will begin as soon as possible.

The Formal Evaluation

The Cincinnati Stroke Scale is a standard exam that neurologists use to determine how severe a stroke is. They will perform a neurological exam that is much more intense than the screening exam and they assign a point value to each finding. This allows them to make recommendations as to the type of treatment required.

The CT-Scan and MRI

Finally, images of the brain will be taken to determine the type of stroke and how much of the brain is at risk. The CT-scan is a fast test that is best at showing if there is bleeding into the brain (a hemorrhagic stroke). The MRI is slower, is done after the CT-scan, and shows more detail, allowing neurologists to see how much of the brain is damaged and how much could potentially be saved with treatment.

After these three steps are completed, treatment will be decided.

Treatment of Stroke

The treatment of stroke is based on the type of stroke, the time since the stroke began, the severity of your symptoms, and the treatments that are available near you.

Treatment of Ischemic Stroke

Strokes that result from the blockage of a blood vessel (embolic strokes and thrombotic strokes) are treated in similar ways. This is the most common type of stroke and has the most complex treatment. There are two primary ways to treat ischemic stroke, tissue plasminogen activator (tPA) and neuroendovascular surgery.

Tissue Plasminogen Activator (tPA)

TPA is best described as a “clot buster.” While there are many medications that prevent blood clots, TPA is unique in that it is strong enough to actually dissolve blood clots. This medication is preferred in mild to moderate strokes and in areas where a neurosurgeon cannot be reached within a reasonable amount of time for more specialized treatment.

TPA has both benefits and risks, while it may dissolve clots and restore blood flow it can also cause bleeding throughout the body and in rare cases may lead to hemorrhagic strokes. tPA also can only be given within a small time frame, around 4 hours from when symptoms of stroke begin.

Neuroendovascular Surgery

Unlike TPA which can be given by any doctor, neuroendovascular surgery requires a neurosurgeon. “Neuroendovascular” stands for “brain surgery through the blood vessels” and refers to the process of threading a wire up through the blood vessels to remove blood clots from the brain. This process is very similar to how heart attacks have been treated for decades.
Neuroendovascular surgery is thought to be safer than tPA but requires a longer amount of time to set up, many years of training to perform, and is only available at specialized hospitals. Thankfully, it can be helpful up to 8 hours after a stroke begins. Because of this some patients are transported by helicopter from small hospitals to large specialty centers for this procedure.

Treatment of Hemorrhagic Stroke

Hemorrhagic strokes, which result in bleeding into the brain as opposed to a simple blockage of blood flow, are generally more severe than ischemic strokes. They generally require aggressive medical treatment and may require surgery if the bleeding does not stop on its own.

Medical Treatment

There are three key steps in the medical treatment of hemorrhagic strokes: controlling the blood pressure, making sure the blood can clot, and preventing the pressure in the head from bleeding from rising too high.

• Blood pressure: Lowering the blood pressure if it is high will help to slow the bleeding, potentially allowing the bleeding to stop or slowing the rate that damage is done to the brain. This is usually done with medications that are injected directly into the vein.
• Blood clotting: Making sure that there are no medical conditions that are preventing blood clotting is another critical step. The doctor will check how well your blood clots with lab tests and if necessary give medications and blood products that can help the blood to clot more effectively.
• Pressure within the head: The bleeding into the brain raises the intracranial pressure (ICP) within the skull. If the ICP rises too high it compresses the brain, cutting off blood flow to even larger areas. An ICP that increases too much is almost always deadly. There are fluids that can be injected into the veins that slow down the speed that the ICP rises, and surgery can be done to relieve the pressure.

Surgery

Surgery for hemorrhagic strokes is done to both relieve pressure within the skull from the bleeding, and to stop the bleeding. A neurosurgeon can remove part of the skull, a procedure known as a craniotomy, which allows the pressure within the head to be released. They can also block the blood vessel that is bleeding, leading to the hemorrhagic stroke. Unfortunately, this results in an ischemic stroke that cannot be treated, but this is almost always less dangerous than allowing the hemorrhagic stroke to continue.

What Healthcare Facilities do Patients with Strokes Require?

After a stroke is treated the patient is left with the results of having survived a potentially deadly condition. There are many facilities that play a role in the recovery from a stroke. Now that you have a better understanding of what leads to a stroke, the different types of strokes, and the treatment of strokes, we can discuss the steps that most patients take in their recovery.

Inpatient Facilities

Inpatient facilities are required during the most intense stage of treatment. Almost all patients with a stroke begin in an acute hospital setting or stroke center, receiving the treatments discussed above. After the immediate treatment of the stroke, the next few days to weeks are spent in an inpatient facility, with a focus on understanding why the stroke occurred, treating any complications of the stroke, and starting treatments to prevent future strokes.

Academic Medical Centers

Large medical centers often have many medical specialists and therapists that can provide treatment for even the most severe strokes. While these facilities can provide rehabilitation, therapy, and nursing care, they are not generally used long-term except for patients that have severe complications from their stroke, or other medical conditions that prevent them from transferring to another facility.

Regional Hospitals

Smaller local hospitals may lack some of the specialists that large medical centers provide but these hospitals are still well equipped to treat mild and moderate strokes. Patients with severe strokes are usually transferred to a large academic medical center. Patients with mild to moderate strokes are often treated and transferred to one of the other listed facilities for further care.

Subacute Facilities

Subacute care facilities provide treatment to stroke survivors that are medically safe to leave the hospital but require ongoing rehabilitation and/or nursing care. Patients have a large amount of choice in what subacute facility they choose and picking one that has the services they require for the best outcome is critical. Sierra Care provides subacute care services to a wide range of patients, including survivors of a stroke. Click here to learn more about subacute care.

Skilled Nursing Facilities

A skilled nursing facility, commonly called a nursing home, cares for patients that are unable to care for themselves at home. These facilities typically provide medications, perform personal hygiene, and ensure that patients are safe from a physical, mental, and medical standpoint. Nursing homes typically provide less aggressive rehabilitation and therapy and are primarily used for patients that are too ill to participate in therapy or do not wish to participate in therapy. It often acts as an intermediary between the hospital and other assisted living arrangements.

Subacute Rehabilitation

Facilities that offer subacute rehabilitation services are often selected for patients that have mild, moderate, or severe disability following a stroke but are not too ill to participate in therapy. These facilities not only care for a patient’s nursing needs, but provide ongoing physical therapy, occupational therapy, speech therapy, and regular assessment on recovery.

Sierra Care is an excellent example of a facility that provides subacute rehabilitation. Sierra Care and subacute rehabilitation facilities can speed recovery from a mild, moderate, or severe stroke. Giving you or your loved one a greater chance to return to the activities and daily routines that you enjoyed prior to your stroke.

Outpatient Rehabilitation and Care

Outpatient care is the ultimate goal following the treatment of a stroke. Outpatient programs are typically less intense than those at the subacute level and patients typically live at home or an assisted living facility and drive to an outpatient rehabilitation center, or in some cases therapists will come to their home. The patients that benefit most from outpatient care are those who have completed a course of inpatient rehabilitation. For these patients outpatient care not only leads to further improvement, but prevents the strength and skills gained in the inpatient rehabilitation facility from gradually slipping away.

Day Programs

Day programs act as a bridge between inpatient rehabilitation and true outpatient rehabilitation. Patients will attend several hours a day of therapy, skills training, and activities but return to their own homes at night.

These programs are great for patients that require intensive therapy to recover from a stroke but have minimal medical needs and are able to care for themselves at home. They are also ideal for patients that wish for a rapid return to the comfort of their homes and do not wish to stay in a medical facility.

Sierra Care offers day programs with the same therapists and medical specialists that make up our subacute team. Almost any patient can benefit from our day programs and stroke survivors are no different!

Home Healthcare Services

Home health services are designed for patients that are able to live independently at home but may require assistance with medical care. Services may be as minor as helping to set up a pill organizer once a week or as major as daily assessments by a nurse. Home healthcare is an important part of transitioning from an acute or subacute facility to home. Sierra Care has skilled case managers who set up and verify home health services so that when you return home you do so safely and with confidence.

Assisted Living

Assisted living facilities come in many forms. These facilities are focused on assisting patients with daily needs in life as opposed to their specific healthcare needs. These facilities may assist with groceries shopping, cleaning, cooking, personal hygiene, and social outings. Just as with home health programs Sierra Care’s case managers will ensure that you have your choice of the best assisted living programs at your time of discharge if you need these services to live your life to the fullest.

Sierra Care Offers Skilled Subacute Care

In this article we have discussed the most common types of strokes, their treatment, and many of the facilities that you or your loved ones may need to choose between for the treatment of a stroke.

If you or a loved one feel that you could benefit from Sierra Care’s services, click here to have us contact you for more information. If you wish to speak to one of our staff members regarding our facilities and services, click here for our contact information. Finally, for more information on what to expect during your stay click here for more general information about our facility and services.