Stroke affects about two million people or more every year in the United States and is the third leading cause of death. It affects women about twice as often as men and is a major cause of permanent disability in this country as well (Source: MacLean, 1993). It is important to note that particularly with a first stroke, race is a major underlying and unchangeable risk factor, with African Americans having a risk that is at least two times higher than that of Caucasians.
Other risk factors for stroke that cannot be changed include family history, especially if a father or brother had a stroke or heart attack before the age of 55. The risk increases if mother or sister had either before they reached 65. Age is another factor, with the risk increasing for men at the age of 45 and ten years later for women. It should be noted that anyone at any age can have a stroke. Finally, a risk factor that cannot be changed is your previous medical history – your risk is higher if you have already had a heart attack or stroke or have been having transient ischemic attacks (TIA), which are also referred to as mini-strokes.
There are risk factors that can and should be changed, including:
– Hypertension, also known as high blood pressure
– Smoking or living with a smoker (research is showing that you do not have to be around when the actual smoking is happening to be affected by secondhand smoke, as it lingers on the clothing and can be just as toxic)
– Carotid or other artery disease
– Abnormal heartbeat, most commonly, atrial fibrillation
– High blood cholesterol
– Sedentary lifestyle
– Obesity (defined as more than twenty pounds overweight)
– Excessive alcohol use (more than two drinks per day for a man and more than one drink per day for a woman.)
– Drug abuse of any kind
(Source: Stephens, 2009)
Losing even a little weight can help the body, reducing some of the other risk factors that are common for stroke; however, there are times when even a relatively healthy person is at risk for stroke, including times of serious hormonal change, which in women can include pregnancy and menopause.
It is estimated that up to 80% of those who have had a stroke had a prior history of TIAs and either did not recognize them as such or did not notice them at all. The major stroke then tends to be of sudden and acute onset and is a medical emergency. Warning signs of impending or ongoing stroke include:
– A sudden weakness, numbness or paralysis of an arm, leg or the face, particularly if it only affects one side of the body.
– Sudden dimness or loss of vision, again, if it affects one eye more acutely than the other.
– Loss of speech, trouble talking or the inability to understand language.
– Sudden and severe headache with no real or apparent cause.
– Unexplained dizziness, unsteadiness or a sudden fall.
(Source: Ammer 2005)
Behavioral Changes After a Stroke
Between 30 to 50% of stroke sufferers develop depression, possibly because of the biochemical changes in the brain or because of the ongoing difficulties that they have both physically and mentally. (Source: Stephens 2009) In addition to depression, other behavior changes may occur, including physical and verbal abuse against their caregivers, whether that caregiver is a stranger or a loved one.
The change in behavior will depend on the area of the brain that was affected by the stroke and the activities that the brain controls or regulates there. The brain is divided into the right and left hemisphere as well as into different lobes, each with different tasks and responsibilities. A stroke that affects the left hemisphere of the brain can leave the victim weak or paralyzed on the right side of the body, make it hard to speak (also called dysarthria), and they may be unable to understand speech (aphasia) and may not be able to learn or remember new information. On the right side, it is the left side of the body that will be affected. They may also have one-sided neglect, where one side of the body is completely forgotten about. They may also develop impulsive behavior that is atypical of their normal personality.
The way that a stroke is handled in the hospital may depend on the nature of the stroke itself. For instance, the stroke can cause similar symptoms, whether it is ischemic or hemorrhagic in nature. In an ischemic stroke, a medication tPA is given to dissolve a clot that is preventing blood flow to the brain. (Ischemia means lack of blood.) Medication can completely reverse the effects of the stroke. However, this same medication given to a person who is having a hemorrhagic stroke will worsen their condition, causing more bleeding to occur and can even lead to death (Source: Valeo)
A CT scan is typically one of the first tests that will be ordered for the patient to determine if the stroke is ischemic in nature or not. If there is not a definitive answer, tPA will not likely be considered.
The Scan Types
CT scans are the most commonly used scans; however, they do increase the amount of radiation that the patient is exposed to.
MRI (magnetic resonance imaging) creates a detailed image of the brain using magnetic fields instead of using radiation. These are better at determining the type of stroke and its location; however, not all areas have MRI scanners available and they can be expensive.
There are other scans that are being developed; however, many of them are still in the research/experimental stages and may be years away from being commonly available and/or acceptable.
Recovering from Stroke: A Case Study
Marilyn knew that she was at high risk for stroke before it ever happened. She was fifty pounds overweight, a heavy smoker and both her mother and father had serious heart disease before dying at relatively early ages. Her sister just had a heart attack that almost killed her and her brother had two strokes in the space of a single month. To top it off, Marilyn is African American, putting her in the very high risk category. Her blood pressure is 165/110 on a normal day and can be far higher when she is stressed. She rarely exercises and has been feeling a little weak and dizzy practically every day for the past week. On Friday morning, she wakes up, takes her pug out for his morning walk around the yard and collapses on the floor. Her daughter finds her there an hour later.
At the hospital, Marilyn is given several tests to gauge how far the weakness has progressed and how severely she is affected. After a CT scan, it is determined that she has had a stroke that has affected her cerebellum. After several days in the hospital, Marilyn is sent home with the orders to work with a physical and occupational therapist to deal with her difficulties. These include:
– Poor balance and muscle coordination which leaves her unable to walk without swaying
– Difficulty eating and grooming herself
– Loss of fine motor control (she cannot pick up items, especially if they are very small)
Marilyn is surrounded by loved ones who encourage her, so she does not develop serious depression. By working with the physical therapist and others, she has learned new ways to do the things she can do for herself safely and effectively and has learned to let go and accept help for the things that she cannot do. She is eating a much healthier diet now, mostly consisting of smaller meals and softer textured foods. She is also using a protein supplement, Profect, from Protica, to make sure that she gets enough protein in her diet. Because it is thicker, she can swallow it better than juices and other supplements and she is slowly regaining some of her strength.