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Stroke care

About strokes

About strokes

What is a stroke?

A stroke happens when a blood vessel in the brain is blocked or starts leaking blood. Other names for a stoke are "brain attack" or "cerebral-vascular accident (CVA)." 

Brain cells need a constant supply of oxygen. When brain cells don't get the blood supply and oxygen they need, they stop working right. If the problem goes on for too long (sometimes just a few minutes), the brain cells start to die. These dead brain cells never grow back. This area of dead brain cells shows up on CT scans, and means the patient had a stroke.

A stroke can involve a large section of the brain, or a relatively small area. However, a small stroke in one part of the brain can be more dangerous than a larger stroke somewhere else in the brain.

What does a stroke look like?

How a stroke looks depends on where in the brain the blockage or bleeding happens. However, there is usually a sudden change that shows part of the brain isn't working right. An easy way to tell if someone might be having a stroke is BE FAST:

  • BALANCE: Sudden loss of balance
  • EYES: Sudden trouble seeing out of one or both eyes
  • FACE: Sudden weakness on one side of the face
  • ARM: Sudden weakness in one arm or leg
  • SPEECH: Sudden loss of speech
  • TIME: TIME TO CALL 911 RIGHT AWAY!

Many strokes can be identified using BE FAST. Some other stroke symptoms are:

  • Problems walking or with coordination. The person seems clumsy or has trouble keeping themselves upright.
  • Decrease or loss of consciousness. The patient may be really sleepy, or may just "pass out."

These signs and symptoms don't always mean someone is having a stroke. Many other problems can look like a stroke. However, it is very important to get the person help right away, just to be sure.

What if the stroke symptoms go away?

Sometimes stroke symptoms "go away" and the person can seem to be normal. This is called a "transient ischemic attack," "TIA," or "mini-stroke." TIAs look just like a stroke, but the symptoms go away. This can happen over hours or even minutes. Even if the patient feels better and looks normal, he still may have had a stroke.

TIAs are still very dangerous. They are not "strokes that didn't happen," they are "strokes that haven't happened yet." A doctor needs to see the patient and help him keep the stroke from happening.

What should I do if I think someone is having a stroke?

Brain cells start dying very soon after they stop getting enough oxygen, so it is important that the person having a stroke gets medical help right away. 

  • CALL 911. Tell the operator you think the person is having a stroke. Please do not drive the patient to the hospital yourself! The ambulance paramedics can start treating the stroke as soon as they arrive, tell the hospital they are bringing in a stroke patient, and help the patient if she gets worse on the way to the hospital. You can't do any of these things.
  • Do not wait to see if the symptoms "go away." The symptoms may go away, but the person still needs to go to the hospital right away. She still may have had a stroke, even if she feels better. If she hasn't had a stroke, she can still have one very soon.
  • Help the person lie down. This helps in two important ways. First, when someone is having a stroke, lying down helps blood flow to the brain tissue. Since the problem is that the brain isn't getting enough blood supply, this can help keep brain tissue from dying. Second, if the person is having problems with balance or coordination, he might fall and hurt himself. Don't take him to a bedroom. The couch (or even the floor) is just fine.
  • Don't give the person anything to eat or drink, including medicine (even aspirin). Someone having a stroke may have trouble swallowing, too. She can suck what she tries to eat or drink into her lungs ("aspiration"), which can cause pneumonia. Aspirin can help patients having a heart attack, but can make a "bleeding stroke" worse.
  • Gather up all the person's medicines. If possible, get all the patient's medicines and send them to the hospital with the paramedics. Be sure to look in the medicine cabinet, nightstand and even the refrigerator.
  • Tell the paramedics everything you know about what happened. The most important thing you can tell the paramedics is when the person last seemed to be normal.

Where should someone go for stroke treatment?

If the paramedics think a patient is having a stroke, they will take the patient to a Primary Stroke Center. Primary Stroke Centers are hospitals certified by The Joint Commission, and these centers must show they are experts in taking care of stroke patients.

How are strokes treated?

If a patient comes to the hospital quickly (within a few hours), blood flow can be restored to the parts of the brain that were blocked off. It can be done a couple of ways:

  • Thrombolytic drugs ("clot-busters"). A medicine is given through an intravenous (IV) line. This medicine dissolves the clot which is blocking blood flow to the area of brain tissue. The patient needs to receive this medicine soon after the stroke starts (within 3 hours for most patients, but there are exceptions). The medicine is very expensive, and many people can't take the medicine safely. People who had recent surgery, injury or blood clotting problems can't take thrombolytics. All Primary Stroke Centers can quickly figure out which patients should have patient thrombolytic medicine.
  • Interventional radiology. Using a special X-ray, a doctor can guide a special tube up to the clot in the patient's brain. The doctor can inject thrombolytic ("clot-buster") medicine directly into the clot, or "snag" the clot and pull it out. This service is available at Legacy Emanuel Medical Center and Legacy Meridian Park Medical Center.

Most patients come to the hospital too late for thrombolytic medicines or interventional radiology to work. Other patients can't have thrombolytic medicine or interventional radiology because it is more likely to make them worse. However, there are many other things that will help save brain cells and prevent complications. This helps the patient have as little disability as possible.

The care the patient receives will depend on whether the stroke is from a blocked artery ("ischemic stroke") or a leaking artery ("hemorrhagic stroke"), where in brain the stroke happened, and how much brain tissue is involved. Legacy Primary Stroke Centers bring together the latest research and close teamwork between neurologists, nurses, therapists, pharmacists and case managers so every stroke patient gets the best possible care. 

  

Effects of stroke

What are the effects of stroke?

The effects of stroke vary from person to person based on the type, severity, location, and number of strokes. The brain is very complex. Each area of the brain is responsible for a special function or ability. When an area of the brain is damaged from a stroke, the loss of normal function of part of the body may occur. This may result in a disability.

The brain is divided into 3 main areas:

  • Cerebrum (consisting of the right and left sides or hemispheres)
  • Cerebellum
  • Brainstem

Depending on which of these regions of the brain the stroke occurs, the effects may be very different. Know how to "BE-FAST" about strokes

What effects can be seen with a stroke in the cerebrum?

The cerebrum is the part of the brain that occupies the top and front portions of the skull. It controls movement and sensation, speech, thinking, reasoning, memory, vision, and emotions. The cerebrum is divided into the right and left sides, or hemispheres.

Depending on the area and side of the cerebrum affected by the stroke, any, or all, of these functions may be impaired:

  • Movement and sensation

  • Speech and language

  • Eating and swallowing

  • Vision

  • Cognitive (thinking, reasoning, judgment, and memory) ability

  • Perception and orientation to surroundings

  • Self-care ability

  • Bowel and bladder control

  • Emotional control

  • Sexual ability

In addition to these general effects, some specific impairments may occur when a particular area of the cerebrum is damaged.

Effects of a right hemisphere stroke in the cerebrum

The effects of a right hemisphere stroke may include:

  • Left-sided weakness or paralysis and sensory impairment

  • Denial of paralysis or impairment and reduced insight into the problems created by the stroke (this is called "left neglect")

  • Visual problems, including an inability to see the left visual field of each eye

  • Spatial problems with depth perception or directions, such as up or down and front or back

  • Inability to localize or recognize body parts

  • Inability to understand maps and find objects, such as clothing or toiletry items

  • Memory problems

  • Behavioral changes, such as lack of concern about situations, impulsivity, inappropriateness, and depression

Effects of a left hemisphere stroke in the cerebrum

The effects of a left hemisphere stroke may include:

  • Right-sided weakness or paralysis and sensory impairment

  • Problems with speech and understanding language (aphasia)

  • Visual problems, including the inability to see the right visual field of each eye

  • Impaired ability to do math or to organize, reason, and analyze items

  • Behavioral changes, such as depression, cautiousness, and hesitancy

  • Impaired ability to read, write, and learn new information

  • Memory problems

What effects can be seen with a stroke in the cerebellum?

The cerebellum is located beneath and behind the cerebrum towards the back of the skull. It receives sensory information from the body through the spinal cord. It helps coordinate muscle action and control, fine movement, coordination and balance.

Although strokes are less common in the cerebellum area, the effects can be severe. Four common effects of strokes in the cerebellum include:

  • Inability to walk and problems with coordination and balance (ataxia)

  • Dizziness

  • Headache

  • Nausea and vomiting

What effects can be seen with a stroke in the brainstem?

The brainstem is located at the base of the brain right above the spinal cord. Many of the body's vital "life-support" functions such as heartbeat, blood pressure, and breathing are controlled by the brainstem. It also helps control the main nerves involved with eye movement, hearing, speech, chewing, and swallowing. Some common effects of a stroke in the brainstem include problems with:

  • Breathing and heart functions

  • Body temperature control

  • Balance and coordination

  • Weakness or paralysis 

  • Chewing, swallowing, and speaking

  • Vision

  • Coma

Unfortunately, death is possible with brainstem strokes.

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