Stroke Recovery And Rehabilitation
A stroke is a brain attack. It is a sudden interruption of continuous blood flow to the brain and a medical emergency. A stroke occurs when a blood vessel in the brain becomes blocked or narrowed, or when a blood vessel bursts and spills blood into the brain. Just like a heart attack, a stroke requires immediate medical attention.
Stroke Recovery and Rehabilitation
Strokes can be prevented and treated. Making lifestyle changes and getting regular medical and prenatal care can help prevent stroke and significantly reduce the risk for other disorders such as dementia, heart disease, and diabetes.
People who have a stroke may not realize what is happening to them or mistakenly choose to ignore the signs, thinking the problem will pass. Even when people know there's a problem, they may not be able to call for emergency help on their own. The people around them might not know what is happening either, but they may recognize that something is wrong.
The brain is nourished by one of the body's richest networks of blood vessels. A blockage or rupture in one of these blood vessels may occur in any area of the brain. Since each area is responsible for different functions, the effects of stroke may range from mild to severe disabilities depending on the type, severity, and location of the stroke. The symptoms may be temporary or permanent.
There are two main types of stroke. Ischemic stroke, the most common type in the U.S., accounts for approximately 80 percent of all strokes. The other kind, called a hemorrhagic stroke, accounts for the remaining 20 percent.
Acute ischemic damage can also provoke inflammation, swelling (edema), and other processes that can continue to cause damage for hours to days after the initial insult. In large ischemic strokes, the swelling can cause the pressure inside the skull to rise to dangerous levels.
When an artery in the brain bursts, blood gushes into or around the brain, damaging the surrounding tissue. This is called a hemorrhagic stroke. The blood that enters the brain increases the pressure inside the skull (intracranial pressure) that can cause significant tissue damage. The mass of blood compresses the adjacent brain tissue, and the toxic substances in the blood mass further injure the brain tissue.
Conditions such as chronic high blood pressure (hypertension) and cerebral amyloid angiopathy (a buildup of the protein amyloid on the inside wall of blood vessels) can cause blood vessels to burst. Irregularities in the brain's vascular system (the network of arteries, veins, and smaller blood vessels) can also cause hemorrhagic stroke.
Arteriovenous malformations (AVMs) also increase the risk of hemorrhagic stroke. An AVM is an abnormal, snarled tangle of defective blood vessels within the brain that cause multiple irregular connections between the arteries and veins. The irregular connections allow arterial blood to travel directly to veins instead of first passing through a fine web of tiny capillaries. The blood flow through AVMs is exceedingly high and can cause the vessels to rupture.
Each year nearly 800,000 Americans have a stroke, and about 600,000 are first strokes. Once a person suffers a first stroke, the risk of another stroke increases. The risk of a recurrent stroke is greatest right after a stroke and decreases with time. In fact, about 25 percent of people who recover from their first stroke will have another stroke within five years, and approximately three percent of individuals with stroke will have another stroke within 30 days of their first stroke. Overall, one-third of recurrent strokes take place within two years of the first stroke.
Some risk factors for stroke apply only to females. These include pregnancy, childbirth, and menopause. These factors are tied to hormonal changes that affect females at different stages of life. In females of childbearing age, stroke risk is relatively low (with an annual incidence of one in 10,000). However, studies have shown that pregnancy increases that risk three times.
Infants and children who have a stroke will experience symptoms that are similar to those in adults such as headache, hemiplegia (paralysis on one side of the body), and hemiparesis (weakness on one side of the body). However, children are more likely than adults to have other symptoms, including seizures, breathing problems, or loss of consciousness.
Risk factors for childhood stroke include congenital (present at birth) heart problems, head trauma, and blood-clotting disorders. An important risk factor for Black children is sickle cell anemia (a genetic blood disorder characterized by red blood cells that take on a sickle or crescent shape and block arteries). In addition to anemia, the disorder can cause joint pain, swollen spleen, frequent and severe infections, and narrowing of brain arteries.
The outcome of stroke in children is difficult to predict. A stroke during fetal development may lead to cerebral palsy. A stroke that occurs during infancy or childhood can also cause permanent disability. Generally, outcomes are worse in children under age one and in those who experience decreased consciousness or seizures.
Children who have a stroke generally recover better than adults after treatment and rehabilitation. This is due in part to the brain's plasticity, or its ability to reorganize, change, and adapt to deficits and injury, and to rewire itself to carry on necessary functions.
Some people are at a higher risk for stroke than others. Understanding the risk factors and working on them may help prevent a stroke. Generally, stroke risk factors fall into two categories: unmodifiable or modifiable.
Modifiable risk factors are those that can be changed or controlled to prevent or reduce the risk of stroke. The most important modifiable risk factors for stroke are high blood pressure, heart disease, diabetes, and smoking. Others include heavy alcohol use and high cholesterol. Stroke is preventable and treatable. A better understanding of the causes of stroke has helped people make lifestyle changes that have cut the stroke death rate nearly in half in the last two decades.
Making lifestyle changes can reduce a person's risk of stroke. It is important for individuals to not stop taking their medications without first speaking with and getting approval from their healthcare provider. Stroke can be caused by people stopping their medications without medical guidance. The following are considered modifiable risk factors in preventing stroke:
Doctors use several tools to help diagnose stroke quickly and accurately. The first step is a neurological examination, which is an observational evaluation of the nervous system. When a person suspected of having a stroke arrives at a hospital, a healthcare professional, usually a doctor or nurse, will carry out a detailed assessment of the person's signs and symptoms. They also will ask when the symptoms began. Because of the importance of early treatment, assessment might even begin in the ambulance.
One test that helps doctors judge the severity of a stroke is the standardized NIH Stroke Scale, developed through research supported by the National Institute of Neurological Disorders and Stroke (NINDS). Healthcare professionals use the NIH Stroke Scale to measure neurological function and deficits by asking the person to answer questions and perform several physical and mental tests. This checklist of questions and tasks scores a person's level of alertness and ability to communicate and perform simple movements. Other scales that may be used include the Glasgow Coma Scale, the Modified Rankin Scale, and the Barthel Index. These scales can sensitively measure disabilities that result from stroke.
Healthcare professionals also use a variety of brain imaging techniques to assess stroke risk, diagnose stroke, determine stroke type (and the extent and exact location of damage, and evaluate individuals for clinical studies and best treatment, including:
Although MRI and CT are equally accurate in determining when hemorrhage (bleeding) is present, MRI provides a more accurate and earlier diagnosis of ischemic stroke, especially for smaller strokes and transient ischemic attacks, or TIAs. Also, MRI can be more sensitive than CT for detecting other types of neurological disorders that mimic the symptoms of stroke. However, MRI cannot be performed in people with certain types of metallic or electronic implants, such as pacemakers.
Treatment for ischemic stroke or a transient ischemic attack may include medicines and medical procedures. Treatment for hemorrhagic stroke involves finding and controlling the cause of bleeding. Remarkable progress has been made in acute stroke therapy, especially with stenting and devices for clot removal to restore blood flow in brain arteries.
The body produces thrombolytic proteins, and some of these have been engineered into drugs. Decades ago, NINDS-funded research found that a thrombolytic drug known as t-PA (tissue plasminogen activator) can be effective if a person receives it intravenously (through a vein) within three hours after stroke symptoms have started. Study results showed that individuals who were given intravenous t-PA were 30 percent more likely to have minimal or no disability three months after treatment. This led to the first treatment approved by the U.S. Food and Drug Administration (FDA) for acute ischemic stroke. Since thrombolytic drugs can increase bleeding, t-PA should only be used after the doctor is certain that the person has suffered an ischemic, and not a hemorrhagic, stroke. In more recent studies, scientists have identified conditions in which individuals may benefit from t-PA beyond the three-hour window after stroke symptoms begin. Most clinicians now treat within a five hour window.
Two other NINDS-sponsored trials compared the effectiveness of daily warfarin and aspirin in people who did not have atrial fibrillation but who had experienced a prior stroke, and thus were at risk for another stroke. Both trials concluded that aspirin is equal to warfarin for reducing stroke risk in people without atrial fibrillation. A trial is now in progress to determine if anticoagulation with a direct thrombin inhibitor is more effective than antiplatelet therapy to prevent recurrent stroke in persons suspected of having atrial dysfunction. 041b061a72
