Stroke

Stroke occurs when blood flow to the brain is disrupted. This disruption happens when a blood clot blocks one of the vital blood vessels in the brain (ischemic stroke) or when a vessel in the brain bursts, spilling blood into surrounding tissues (hemorrhagic stroke).

The brain needs a constant supply of blood, oxygen, and nutrients to function. Brain cells begin to die after just a few minutes without blood or oxygen.

Brain cell death causes loss of brain function, which may impair movement, speech, thinking and memory, bowel and bladder, eating, emotional control, and other functions. Recovery from stroke depends on the size and location of the stroke. A small stroke may result in problems such as weakness in an arm or leg. Larger strokes may cause paralysis, loss of speech, or even death.

Stroke is an emergency. The greatest chance for recovery from stroke occurs when treatment starts immediately.

Types of Stroke

Strokes can be classified into two main categories: ischemic strokes (caused by a blocked artery) and hemorrhagic strokes (caused by bleeding).

Ischemic Stroke

An ischemic stroke occurs when a blood vessel that supplies the brain becomes blocked and impairs blood flow to part of the brain. The brain cells and tissues begin to die within minutes from lack of oxygen and nutrients. The area of tissue death is called an infarct.

Ischemic strokes are further divided into two groups:

• Thrombotic strokes: Thrombotic strokes are caused by a thrombus (blood clot) in the arteries supplying blood to the brain. This type of stroke is usually seen in older persons, especially those with high cholesterol levels and atherosclerosis. Symptoms of a thrombotic stroke can occur suddenly (often during sleep or in the early morning) or gradually (over hours or days). Thrombotic strokes may be preceded by "mini-strokes," called transient ischemic attacks (TIAs). They may last minutes to days and are often a warning sign that a stroke may occur.
  Another type of stroke that occurs in the small blood vessels in the brain is called a lacunar infarct. Lacunar infarctions are often found in people who have diabetes or high blood pressure.
• Embolic strokes: Embolic strokes are usually caused by an embolus (a blood clot that forms elsewhere in the body and travels through the bloodstream to the brain). Embolic strokes often result from heart disease or heart surgery and occur rapidly and without warning. About 15 percent of embolic strokes occur in people with atrial fibrillation, a type of abnormal heart rhythm in which the upper chambers of the heart do not beat effectively.  

Hemorrhagic Stroke

Hemorrhagic strokes occur when a blood vessel that supplies the brain ruptures and bleeds. When an artery bleeds into the brain, brain cells and tissues do not receive oxygen and nutrients. In addition, pressure builds up in surrounding tissues, and irritation and swelling occur. About 13 percent of strokes are caused by hemorrhage.

Hemorrhagic strokes are further divided into two main categories:

• Intracerebral hemorrhage: Intracerebral hemorrhage is usually caused by hypertension (high blood pressure), and bleeding occurs suddenly and rapidly. There are usually no warning signs, and bleeding can be severe enough to cause coma or death.
• Subarachnoid hemorrhage: Subarachnoid hemorrhage results when bleeding occurs between the brain and the meninges (the membrane that covers the brain) in the subarachnoid space. This type of hemorrhage is often due to an aneurysm or an arteriovenous malformation (AVM). An aneurysm is a weakened, ballooned area on an artery wall that may rupture. Aneurysms may be congenital (present at birth) or may develop later in life due to such factors as hypertension or atherosclerosis. An AVM is a congenital disorder that consists of a tangled web of arteries and veins.

Symptoms of Stroke

While each person may experience a stroke differently, common symptoms include the following. 

If any of these symptoms occur, call 911 right away. Treatment is most effective when started immediately. Do not ignore any of these symptoms, even if they go away. 

• Weakness or numbness of the face, arm, or leg, especially on one side of the body
• Confusion or difficulty speaking or understanding
• Problems with vision, such as dimness or loss of vision in one or both eyes
• Dizziness or problems with balance or coordination
• Problems with movement or walking
• Severe headaches with no other known cause
• Loss of consciousness or seizure

Other, less common, symptoms of stroke may include the following:

• Sudden nausea, vomiting, or fever not caused by a viral illness
• Brief loss or change of consciousness, such as fainting, confusion, seizures, or coma
• Transient ischemic attack (TIA) or "mini-stroke": Even though TIA symptoms may only last minutes to 24 hours, they may be a warning sign that a stroke will occur, so get immediate medical help.

Risk Factors for Stroke

Risk factors for stroke vary between men and women and include the following:

Stroke risk factors in women and men

• Being inactive
• Older age
• Previous heart and blood vessel (cardiovascular) disease
• Being overweight
• Unhealthy diet (for example, high in fat, cholesterol, and sugar)
• Smoking

Women-only stroke risk factors

• Pregnancy
• Preeclampsia (a condition with high blood pressure when you are pregnant)
• Taking birth control pills
• Taking hormone replacement after menopause

Stroke risk factors in women and men that are more likely to increase risk in women

• Migraine headache with aura
• Atrial fibrillation (a fast, irregular heartbeat)
• Diabetes mellitus
• High blood pressure
• Depression
• Stress

Treatment and Rehabilitation for Stroke

The outlook for stroke patients today is more hopeful than ever due to advances in stroke treatment and rehabilitation. Stroke rehabilitation works best when the patient, family, and rehabilitation staff work together as a team. Family members must learn about impairments and disabilities caused by the stroke and how to help the patient regain optimal function.

The goal of stroke rehabilitation is to help the patient return to the highest possible level of function and independence, while improving daily life physically, emotionally, and socially. Rehabilitation is designed to meet each person's specific needs; therefore, each program is different.

Stroke can cause several disabilities, including paralysis or problems controlling movement, such as walking or swallowing; difficulty feeling touch or temperature; difficulty using or understanding language; thinking and memory problems; and emotional disturbances. Stroke rehabilitation can help you recover from these effects and learn new ways to perform tasks.
Rehab depends on many variables, including the type and severity of the stroke, the degree of disability, the patient’s overall health, and family support.

Specific areas covered in a stroke rehabilitation program may include:

• Self-care skills, such as feeding, grooming, bathing, and dressing
• Mobility, such as walking, transfers, and self-propelling in a wheelchair
• Communication skills, such as speech, writing, and alternative methods of communication
• Cognitive skills, such as memory, concentration, judgement, problem-solving, and organization
• Socialization skills
• Vocational training
• Pain management, including medication and alternative methods of managing pain
• Psychological testing, such as identifying problems and solutions with thinking, behavioral, and emotional issues
• Family support, such as assistance with lifestyle changes and financial concerns
• Education, such as training about home care and adaptive techniques
• Spasticity management, including oral medications, botulinum toxin and other injections, and intrathecal baclofen pumps

There are a variety of stroke treatment programs, including the following:

• Acute rehabilitation programs
• Subacute rehabilitation programs
• Long-term care rehabilitation programs
• Home health rehabilitation programs

Why Choose Columbia for Stroke Care and Rehabilitation

Our expert team is highly skilled in partnering with patients and families to help individuals who have experienced a stroke achieve their best possible outcomes. Combining clinical expertise and personalized attention, our rehabilitation specialists have extensive experience improving function, providing adaptive tools, modifying the patient’s environment, and teaching the patient and their family how to adjust to lifestyle changes.