Risk Factors

Left Brain/Right Brain: A Stroke's Impact

The impact of stroke depends on the location of the blocked artery, and how much brain tissue is affected. The left and right side of the brain control the opposite side of the body. So, if the stroke occurred on the left side of your brain, your right side would be primarily affected.

If A Stroke Occurs on the Right Side of the Brain*.

• Possible paralysis on left side of body
• Possible vision problems
• Possible inquisitive behavioral reactions
• Possible memory loss

If A Stroke Occurs on the Left Side of the Brain*

• Possible paralysis on the right side of the body
• Possible speech/language challenges
• Possible memory loss
• Possible slowness and caution in behavior

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"High blood pressure is the number one risk factor for stroke," says Jayne Ward D.O., McLaren Greater Lansing Primary Stroke Center Medical Director. "Blood pressure is the amount of force applied against artery walls as blood is pumped through the body. When your blood pressure is high, your arteries are under great stress. Over time, the arteries weaken and become a reservoir for cholesterol plaque and blood clots that can lead to heart attack and stroke.

"A person can feel perfectly fine, yet have a blood pressure reading that off the charts. That's why it's important to have your blood pressure checked regularly. A new category - prehypertension - describes blood pressure between 120/80 and 139/89.  If your blood pressure falls within this range, it's important to see your physician and start treatment to reduce your blood pressure.  Besides medication, there are a number of steps you can take to reduce high blood pressure --

• Reduce salt in your diet;
• Walk or do other exercise activities that get your heart rate up. Aerobic exercise strengthens your heart, and burns calories.
• Lose weight if needed.
• Eat a low-fat diet.
• Quit smoking, if that applies to you.
• In individuals over 50, the systolic presure is the most important. 
• If you're on medications for high cholesterol and high blood pressure, take them every day as prescribed."

The American Heart Association lists some common misconceptions about high blood pressure --

• If you have high cholesterol, you have high blood pressure.

• I took my high blood pressure medication for awhile, but I'm feeling much better now. I've cut back on the amount of medication I take.

• I don't have to worry about interaction of high blood pressure medication with over-the-counter drugs.

• High blood pressure is a man's disease. I'm a woman, so I don't have to worry.

• I don't use that much salt. I don't think it can affect my blood pressure.

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Causes

What can cause a cerebral aneurysm and how are they classified?

A cerebral aneurysm is a weak or thin spot on a blood vessel in the brain that balloons out and fills with blood. The bulging aneurysm can put pressure on a nerve or surrounding brain tissue. It may also leak or rupture, spilling blood into the surrounding tissue (called a hemorrhage). Cerebral aneurysms can be congenital, resulting from an inborn abnormality in an artery wall. They are also more common in people with certain genetic diseases, such as connective tissue disorders and polycystic kidney disease, and certain circulatory disorders, such as arteriovenous malformations (snarled tangles of arteries and veins in the brain that disrupt blood flow). Other causes include trauma or injury to the head, high blood pressure, infection, tumors, artherosclerosis (a blood vessel disease in which fats build up on the inside of artery walls) and other diseases of the vascular system, cigarette smoking, and drug abuse.

There are three types of cerebral aneurysm.

Saccular aneurysm-is a rounded or pouch-like sac of blood that is attached by a neck or stem to an artery or a branch of a blood vessel. This type is also known as a berry aneurysm because it resembles a berry hanging from a vine. This is the most common form of cerebral aneurysm and is typically found on arteries at the base of the brain. It is most common in adults.

Lateral aneurysm-appears as a bulge on one wall of the blood vessel.

Fusiform aneurysm-is formed by the widening along walls of the vessel.

Diagnosis

Angiography is a dye test used to analyze the arteries or veins. This test can detect the degree of narrowing or obstruction of an artery or blood vessel in the brain, head or neck and can identify changes in an artery or vein such as a weak spot like an aneurysm. It is used to diagnose stroke and to precisely determine the location, size, and shape of a brain tumor, aneurysm, or blood vessel that has bled. Following the injection of a local anesthetic, a flexible catheter is inserted into an artery and threaded throught the body to the affected artery. A small amount of contrast dye (one that is highlighted on x-rays) is released into the bloodstream and allowed to travel into the head and neck. A series of x-rays is taken and changes, if present, are noted.

Computed tomography (CT) of the head is a fast, painless, noninvasive diagnostic tool that can reveal the presence of a cerebral aneurysm and determine, for those aneurysms that have burst, if blood has leaked into the brain. X-rays of the head are processed by a computer as two-dimensional cross-sectional images, or "slices," of the brain and skull. Sometimes a contrast dye is injected into the bloodstream prior to scanning. This process, called CT angiography, produces sharper, more detailed images of blood flow in the rain arteries.

Magnetic resonance imaging (MRI) used computer-generated radio waves and a powerful magnetic field to produce detailed images of the brain and other body structures. Magnetic resonance angiography (MRA) produces more detailed images of blood vessels. The images may be seen as either three-dimensional pictures or two-dimensional cross-slices of the brain and vessels. Both procedures can show the size and shape of an unruptured aneurysm and can detect bleeding in the brain.

Cerebrospinal fluid analysis may be conducted if a ruptured aneurysm is suspected. Following application of a local anesthetic, a small amount of this fluid (which protects the brain and spinal cord) is removed from the subarachnoid space located between the spinal cord and the membranes that surround it, by surgical needle and tested to detect any bleeding or brain hemorrhage.

Symptoms

Most cerebral aneurysms do not show symptoms until they either become very larger or burst. Small, unchanging aneurysms generally will not produce symptoms, whereas a larger aneurysm that is steadily growing may press on tissues and nerves. Symptoms may include pain above and behind the eye; numbness, weakness, or paralysis on one side of the face; dilated pupils; and vision changes. When an aneurysm hemorrhages, an individual may experience a sudden, severe headache, double vision, nausea, vomiting, stiff neck, and/or loss of consciousness.

Treatment

Microvascular clipping-this involves cutting off the flow of blood to the aneurysm. Under anesthesia, a section of the skull is removed and the aneurysm is located. The neurosurgeon uses a microscope to isolate the blood vessel that feeds the aneurysm and places a small, metal, clothespin-like clip on the aneurysm's neck, halting its blood supply. The clip remains in the person and prevents the risk of future bleeding. The piece of the skull is then replaced and the scalp is closed. Clipping has been shown to be highly effective, depending on the location, shape, and size of the aneurysm.

Occlusion-this involves the surgeon clamping off (occluding) the entire artery that leads to the aneurysm. This procedure is often performed when the aneurysm has damaged the artery. It is also sometimes accompanied by a bypass, in which a small blood vessel is surgically grafted to the brain artery, rerouting the flow of blood away from the section of the damaged artery.

Endovascular embolization-is a minimally invasive procedure that accesses the treatment area from within the blood vessel. During the procedure the patient is under anesthesia. A hollow plastic tube (catheter) is inserted into an artery (usually in the groin) and threaded through the vascular system to the site of the aneurysm in the brain using angiography (a procedure performed to view blood vessels in real time, after injecting them with a radioopaque dye that outlines them on x-ray). Using a guide wire, detachable coils (spirals of platinum wire) or small latex balloons are passed through the catheter and released into the aneurysm. The coils or balloons fill the aneurysm, block it from circulation, and cause the blood to clot, which effectively destroys the aneurysm. The coils are made of platinum so they can be visible via x-ray and be flexible enough to conform to the aneurysm shape. The procedure may need to be performed more than once during the person's lifetime.

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If you've had early warning signs of stroke, or had a stroke, certain tests may be ordered to diagnosis the type of stroke and the most efficient treatment. Some common tests for stroke are:

Tests Viewing the Brain, Skull or Spinal Cord

• CT Scan -- Computerized Axial Tomography uses x-rays to produce a three-dimensional image of your head. Can be used to diagnose ischemic or bleeding strokes.

• MRI Scan -- Magnetic Resonance Imaging uses magnetic fields to produce a three-dimensional image of your head. Shows the brain and spinal cord in more detail than a CT scan. An MRI can be used to diagnose ischemic and bleeding strokes.

• CT Angiogram: Special CT scan that visualizes blood vessels in the brain and neck.

Tests Viewing Blood Vessels that Supply the Brain

• Carotid Doppler -- Ultrasound waves used to take a picture of the carotid arteries in your neck. Shows blood flowing to brain, and if an artery is narrowed by plaque deposits.

• Transcranial Doppler -- Ultrasound waves used to measure blood flow in certain arteries of your brain.

• MRA -- Magnetic Resonance Angiogram is a special type of MRI scan to see blood vessels in the neck or brain.

• Cerebral Arteriogram -- A catheter is inserted in an arm or leg artery. A special dye is injected into the blood vessels leading to the brain. X-ray images show any blood vessel abnormalities, including narrowing or blockages, including aneurysms. This is a more difficult test than the carotid doppler or MRA, but provides the most accurate results.

Tests Viewing Heart by Checking Its Function

• Electrocardiogram (EKG, or ECG) -- Standard test to show electrical activity pattern in your heart. Electrical leads are attached to your chest, arms and legs connected to a telemetry monitor. If the test is given over time, you will wear a portable recorder (Holter monitor).

• Echocardiogram -- Ultrasound waves used to take a picture of your heart and circulating blood. Ultrasound probe may be placed on your chest or in your throat.

Routine Screening Tests

• Chest X-ray -- X-ray of lung and heart is standard for patients with acute cardiac or respiratory problems.

• Urinalysis -- Sample screens for bladder infections, or kidney problems.

• Pulse Oximetry -- A small probe with a red light is attached to one finger to see if your blood is receiving enough oxygen from the lungs.

Neurologic Tests

• Electroencephalogram (EEG) -- Measures brain waves through electrical leads attached to your head. Not usually used to diagnose stroke, but is used to confirm seizure.

• Lumbar Puncture -- Needle is inserted in lower back to obtain cerebrospinal fluid, which surrounds your brain and spinal cord. Most often used to diagnose bleeding from a cerebral aneurysm, or a nervous system infection.

• Electromylogram -- Records electrical activity of the nerves and muscles. Used if there seems to be a problem with nerves in your arms or legs.

• Brain Biopsy -- Surgical procedure in which a small piece of the brain is removed for microscopic examination. Rarely used for stroke, but is used to diagnose tumors.

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Common stroke symptoms seen in both men and women: 

• Sudden numbness or weakness of face, arm or leg -- especially on one side of the body
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause

Women may report unique stroke symptoms:

• Sudden face and limb pain
• Sudden hiccups
• Sudden nausea
• Sudden general weakness
• Sudden chest pain
• Sudden shortness of breath
• Sudden palpitations

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After a stroke and during your rehabilitation you will need medicines to help prevent another stroke. You may need medicine to thin your blood and prevent clots from forming and medicines to lower blood pressure and cholesterol.

Medicines you may take after a stroke include:

Antiplatelets to prevent blood clots.
Aspirin is an antiplatelet medicine that decreases blood clot formation by preventing the smallest blood cells, or platelets, from sticking together and forming blood clots. Aspirin is the most commonly used medicine to prevent stroke. It reduces the risk of stroke in people who have already had a transient ischemic attack (TIA) or ischemic stroke, also known as a "mini-stroke." This type of stroke is caused by a temporary clot in the brain.

Aspirin or other antiplatelet drugs may reduce the risk of stroke in people who cannot have surgery to reopen a blocked carotid artery. Aspirin with extended-release dipyridamole is used to reduce the risk of additional strokes or TIAs in people who had a stroke or TIA while taking aspirin.

Anticoagulants to keep clots from growing and to prevent new clots.
Although anticoagulants are often called blood thinners, they do not really thin blood. Warfarin prevents the production of certain proteins that are necessary for blood to clot. Heparin and newer low-molecular-weight heparins interfere with the complex process of blood clot formation. Heparin and warfarin prevent new clots from forming and may prevent existing clots from getting larger. They do not break up clots.

Treatment with heparin followed by warfarin is often recommended for people whose TIA or stroke was likely caused by a clot formed in the heart. Heparin often is used first because it can be given quickly into a vein and it has an immediate effect on clotting. Warfarin is used long-term after heparin use is ended.

Statins to lower cholesterol.
Statins block an enzyme the body needs to produce cholesterol. As a result, LDL ("bad") cholesterol levels in the blood go down, thereby lowering total blood cholesterol levels.

Statins may be taken alone or taken with other cholesterol medicines such as fibric acid derivatives, bile acid sequestrants, or nicotinic acid. Statins may also be combined with other types of medicines into one drug. For example, Vytorin is a combination medicine that lowers cholesterol in two ways: with a statin, which blocks the production of cholesterol in the body; and with ezetimibe, which reduces the amount of cholesterol absorbed by the intestines. Examples of statins include Lipitor, Crestor and Zocor.

Angiotensin-converting enzyme (ACE) inhibitors to lower blood pressure.
Angiotensin-converting enzyme (ACE) inhibitors block an enzyme needed to form a substance that narrows blood vessels. As a result, blood vessels relax and widen, making it easier for blood to flow through the vessels, which reduces blood pressure. These medicines also increase the release of water and sodium to the urine, which also lowers blood pressure. ACE inhibitors can be used alone or in combination with a diuretic or other agents.These medicines are used alone for high blood pressure or they are used with other medicines such as a diuretic or beta-blocker.

Angiotensin II receptor blockers (ARBs) to lower blood pressure.
These medicines block the action of a hormone that causes blood vessels to narrow. As a result, blood vessels may relax and open up. This makes it easier for blood to flow through the vessels, which reduces blood pressure. Also, these drugs increase the release of sodium and water into the urine, which also lowers blood pressure.

Angiotensin II receptor blockers (ARBs) may be used alone or combined with other medicine-often a diuretic-to treat high blood pressure. ARBs may be used by people who cannot take ACE inhibitor medicines. ACE inhibitors can cause an annoying cough. This cough may be hard for some people to live with. So doctors may prescribe an ARB instead. ARBs are less likely to cause a cough.

Beta-blockers to lower blood pressure.
Beta-blockers lower the heart rate, the amount of blood the heart pumps out, and the force of the heart beat, all of which lower blood pressure.

For high blood pressure, most beta-blockers are taken once or twice a day. They may be combined with a diuretic in the same pill.
Beta-blockers are widely used for high blood pressure, either alone or combined with other medicines including diuretics, ACE inhibitors, or calcium channel blockers. These medicines may be especially useful in people who also have angina or who have had a heart attack, small aortic aneurysms, migraine headaches, or an anxiety disorder.

Diuretics to lower blood pressure.
Diuretics cause the kidneys to remove more sodium and water from the body which helps to relax the blood vessel walls, thereby lowering blood pressure. Diuretics often are combined with other high blood pressure medicines. Using both a diuretic and another medicine often works well because diuretics can enhance the effect of the other medicines and sometimes prevent the fluid retention that can occur.

Diuretics are recommended as the first line of treatment for high blood pressure. They are usually recommended as one of at least two medicines to control high blood pressure.

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Who Is at Risk for a Stroke? 

Anyone can have a stroke no matter your age, race or gender. But, the chances of having a stroke increase if a person has certain risk factors, or criteria that can cause a stroke. The good news is that up to 80 percent of strokes can be prevented, and the best way to protect yourself and loved ones from stroke is to understand personal risk and how to manage it. 

There are two types of risk factors for stroke: controllable and uncontrollable. Controllable risk factors generally fall into two categories: lifestyle risk factors or medical risk factors. Lifestyle risk factors can often be changed, while medical risk factors can usually be treated. Both types can be managed best by working with a doctor, who can prescribe medications and advise on how to adopt a healthy lifestyle. Uncontrollable risk factors include being over age 55, being male, being African American, Hispanic or Asian/Pacific Islander, or having a family history of stroke or transient ischemic attack (TIA).

Controllable Risk Factors:
Controllable Medical Risk Factors

• High Blood Pressure
• Atrial Fibrillation
• High Cholesterol
• Diabetes

Controllable Lifestyle Risk Factors

• Tobacco Use and Smoking
• Alcohol Use
• Physical Inactivity
• Obesity

Uncontrollable Risk Factors:

• Age
• Gender
• Race
• Family History
• Previous Stroke or TIA (Transient Ischemic Attack)
• Fibromuscular Dysplasia
• Patent Foramen Ovale (PFO or Hole in the Heart)

To become more familiar with your personal risk for stroke, the National Stroke Association developed an easy-to-use tool called a Stroke Risk Scorecard. The Scorecard provides an idea of a person's stroke risk. Once the scorecard is completed, discuss the results with a doctor, who will help assess the risk factors and help manage and/or treat any controllable risk factors. Remember: It is important to always take medications as a doctor prescribes to stay on top of stroke prevention. 

African Americans and Stroke

One half of all African American women will die from stroke or heart disease.

African Americans are twice as likely to die from stroke as Caucasians. The rate of first strokes in African Americans is almost double that of Caucasians, and strokes tend to occur earlier in life for African Americans than Caucasians. Additionally, African American stroke survivors are more likely to become disabled and experience difficulties with daily living and activities.

The statistics are staggering -- in fact, African Americans are more impacted by stroke than any other racial groups within the American population.

Why?
Not all of the reasons are clear why African Americans have an increased risk of stroke. Some risk factors play a major role. African Americans have a higher rate of:

High blood pressure: The number one risk factor for stroke, and 1 in 3 African Americans suffer from high blood pressure.
Diabetes: People with diabetes have a higher stroke risk.
Sickle cell anemia: The most common genetic disorder amongst African Americans. If sickle-shaped cells block a blood vessel to the brain, a stroke can result.
Smoking: Risk for stroke doubles when you smoke. If you stop smoking today, your stroke risk will immediately begin to decrease.
Obesity: Adopting a lower-sodium (salt), lower-fat diet and becoming more physically active may help lower blood pressure and risk for stroke.

If a person has one or more of these risk factors, it's even more important to learn about stroke symptoms and response and the lifestyle and medical changes that can be made to prevent a stroke. 

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Often, it is believed that stroke is a disease of old age. You may be surprised to learn that stroke can strike anyone, at any time, regardless of age, gender or ethnicity. Stroke is a disease that affects the arteries leading to and within the brain. It is a leading cause of long-term disability and the No. 4 cause of death in the United States. In many cases, stroke may be prevented.

The American Stroke Association recommends learning about stroke and taking the necessary steps as early as possible to help prevent it.Click here to take their quiz.

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"Time is Brain" when it comes to stroke

WHAT IS ACUTE STROKE?

A stroke means brain tissue damage is occurring because of loss of blood and oxygen. The person will notice a sudden onset of symptoms. One minute the person is fine, and suddenly, the person notices an inability to move one side of the body, and may have difficulty speaking. If the person is alone, call 9-1-1 immediately. If someone is with the individual, have him or her call 9-1-1. A stroke is a medical emergency.

Immediate therapy in the Emergency Department is critical. Once there, a brain scan is done to see whether it's a bleeding stroke or an ischemic stroke. Close to 85% of strokes are ischemic strokes. Two to three percent of patients may be candidates for a clot-busting drug to reduce stroke damage and improve stroke outcome. The time window for the effectiveness of clot-busting drugs is under three hours. Regardless of the type of stroke, TIME IS BRAIN. Early warning signs of stroke require immediate medical attention.

Using a multidisciplinary stroke team approach, most strokes can be treated in a Primary Stroke Center.

WHAT IS AN ISCHEMIC STROKE?

Eighty-five percent of strokes are "ischemic" strokes.  This occurs because a clot in one of the intracranial arteries prevents the brain from receiving an adequate blood supply.

WHAT IS A BLEEDING STROKE?

Only 15% of strokes are "hemorrhagic", or bleeding strokes.  This means bleeding is occurring on the brain..

WHAT IS A TRANSIENT ISCHEMIC ATTACK (TIA)?

TIAs are 'warning strokes'. They produce stroke-like symptoms, but no lasting damage. If you experience stroke-like symptoms that go away, call 9-1-1 immediately. 'Warning strokes' are just that -- you are at significant risk for stroke. Get treatment right away.

WHAT RISK FACTORS FOR STROKE CAN BE CONTROLLED OR TREATED?

• High Blood Pressure -- If your blood pressure is consistently 140/90, see your physician and get on high blood pressure medication, and a diet and exercise regimen to lower your blood pressure. Even if you feel well, take your blood pressure medication as prescripted.  Everyone should have his or her blood pressure checked regularly in a medical setting. Don't rely on blood pressures at stores that have areas for "cuff checks."  You may not get an accurate reading.

• Smoking -- This is a major, preventable risk factor. The nicotine and carbon monoxide in tobacco reduce blood oxygen levels. The also damage blood vessel walls, making it easier for clots to form. If you smoke, and use birth control pills, you double your risk for stroke.

• Diabetes Mellitus -- Having diabetes increase a person's risk for stroke. These individuals often have high blood pressure, high blood cholesterol, and are overweight. Make sure your blood sugar levels are controlled. Lose weight if needed. Get regular blood pressure and fasting cholesterol checks.

• Carotid or other artery disease -- The carotid arteries in your neck supply blood to the brain. A carotid artery narrowed by plaque build-ups could become blocked by a blood clot. If you have heart disease in your family, or have had a heart attack, make sure your doctor or surgeon checks your carotid arteries on a regular basis.

• Peripheral Artery Disease -- This means blood vessels carrying blood to leg and arm muscles have narrowed. If you feel aching or tingling in your arm or leg muscles, go to your doctor for a check-up.

• Atrial Fibrillation -- The heart's upper chambers quiver, instead of beating rhythmically. This lets blood pool and clot. If you feel your heart rhythm isn't right, go to your doctor for a check-up. Unchecked, a clot could break away, enter the bloodstream, and lodge in a carotid artery.

• Use of excessive alcohol -- One drink for women and two drinks for men per day are all that's recommended if you indulge. More alcohol can raise high blood pressure.

• High Blood Cholesterol -- Total blood cholesterol that is 240 mg/dl is a major factor for heart disease that raises your stroke risk. LDL (bad) blood cholesterol -- greater than 100 mg/dl --and triglycerides, or blood fats -- greater than 150 mg/dl may substantially raise your risk for heart disease and stroke. Low levels of HDL (good) blood cholesterol may also increase stroke risk.

• Physical Inactivity and/or Obesity -- Being inactive and/or obese increases your risk for stroke. Your blood vessels, like any muscle, need strength to work "for" you. The recommendation is 30 minutes of brisk activity, like walking, every day.

• Certain blood disorders -- A high red blood cell count thickens the blood and makes clots more likely. Doctors can treat this condition by prescription blood thinners.

• Sickle Cell Disease -- This genetic disorder primarily affects African-Americans. "Sickled" red blood cells are less able to carry oxygen throughout the body. The cells tend to stick to blood vessel walls, which can block arteries.

• Illegal Drug Use -- Intravenous drug use is a major risk factor for stroke. Cocaine use has been linked to heart disease and strokes.

WHAT RISK FACTORS FOR STROKE CAN YOU NOT CONTROL?

• Heredity -- Stroke risk is greater if a parent, grandparent, sister or brother has had a stroke. African-Americans have a higher risk of stroke than Caucasians, in part because of their tendency toward high blood pressure, diabetes and obesity.

• Sex -- Men are more prone to stroke than women. Women, though, count for more than half of stroke deaths. Women who are pregnant or who are taking birth control pills are at greater risk for stroke.

• Age -- The older you are, the more vulnerable you are to stroke.

• Prior stroke or heart attack -- Your heart or brain has already had damage. The risks increase if an individual does not modify their behavior by taking prescribed medications, getting regular physical activity, losing weight, eating heart-health foods, and reducing sodium in their diet.

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Ischemic stroke
Some 90 percent of all strokes are caused by blockages of the blood vessels in the brain. They are called ischemic strokes. Ischemic strokes are also divided into two categories, according to the American Heart Association (AHA). They are:

• Thrombotic - these are the result of two things, the slow narrowing of the arteries as fatty deposits build up and the formation of a clot that then lodges in this narrowed opening. (Read about "Arteriosclerosis & Atherosclerosis") AHA says uncontrolled high cholesterol is a risk factor for this type of stroke. (Read about "Cholesterol")
• Embolic - these happen when a clot forms somewhere else in the body, breaks free and eventually lodges in the brain. For example, a type of arrhythmia called atrial fibrillation affects the heart's ability to pump blood, so it may pool and clot. The clot can travel to the brain. In fact, AHA says about 15 percent of strokes occur in people with atrial fibrillation. (Read about "Arrhythmia")

Thrombolysis is the term used for the breaking up of a clot with drug therapy. Ischemic strokes can be treated with a drug called tPA, according to National Institute of Neurological Disorders and Stroke (NINDS). It dissolves blood clots obstructing blood flow to the brain. The window of opportunity to start treating stroke patients is three hours. To be evaluated and receive treatment however, patients need to get to the hospital within 60 minutes. Potential dangers from the drug include internal bleeding in the brain. Some patients, who are not candidates for tPA, may be helped by a newer procedure that involves the use of a tiny corkscrew-shaped device that can remove the blood clot or clots that are blocking the artery.

After an ischemic stroke, blood thinners, antiplatelet drugs or anticoagulants may be prescribed. If a doctor determines that a stroke has been caused by a blockage of a blood vessel leading to the brain, surgery may be needed too. (Read about "Carotid artery surgery - Endarterctomy") In a procedure called carotid endarterectomy, surgeons open up the carotid artery in the neck and scrape out plaque. Surgeons also may open up a clogged carotid artery with a small balloon and insert a small tube called a stent to keep the artery open. (Read about "Angioplasty") Following surgery, drugs that prevent more clots from forming may be prescribed. For some patients, who are considered at high risk of having a stroke, carotid artery surgery may be recommended as a prophylactic measure, to prevent a stroke from occurring. Depending on the severity of the stroke, and on the area of the brain impacted, physical rehabilitation may be necessary. (Read about "Rehabilitation") Again, since treatment and rehabilitation should begin as soon after a stroke as possible, it's essential for everyone to recognize the symptoms of a stroke and get help right away.

Hemorrhagic stroke
According to the American Stroke Association, 20 percent of strokes are hemorrhagic strokes. They happen when a weakened vessel ruptures and bleeds into the surrounding brain. This type of stroke can be caused by a head injury (Read about "Head Injury"), for example, or if an aneurysm (a blood-filled pouch that forms on weak spots in the artery wall) bursts. (Read about "Aneurysms") This type of stroke can also be caused by an arteriovenous malformation (AVM), a congenitally malformed mass of thin-walled blood vessels. (Read about "Vascular Lesions of the Central Nervous System") Subarachnoid hemorrhage refers to bleeding in the space between the surface of the brain and the skull. Intracerebral hemorrhage refers to bleeding that occurs within the brain tissue. A hemorrhagic stroke is very dangerous because the accumulated blood from the burst artery may put pressure on surrounding brain tissue and interfere with how the brain functions.

Treatment for hemorrhagic stroke depends on the cause of the hemorrhage and how much damage was done to the brain. With hemorrhagic stroke, doctors want to clot the blood and stop the bleeding. Medication can be used to do this. FDA says hemorrhagic stroke can also be treated with surgery that removes abnormal blood vessels or places a clip at the base of an aneurysm. Aneurysms may also be treated by using catheters. Surgery can also be used to remove the AVM, if this is the cause of the stroke. If high blood pressure caused the hemorrhagic stroke, medication may be used to bring blood pressure down. Depending on the severity of the stroke, and on the area of the brain impacted, physical rehabilitation may be necessary. Again, since treatment and rehabilitation should begin as soon after a stroke as possible, it's essential for everyone to recognize the symptoms of a stroke and get help right away.

TIA's and "silent" strokes
AANS says many people are unaware of the warning signs of a stroke. This is particularly true in the case of a transient ischemic attack (TIA). A TIA is a temporary situation in which you suddenly experience the symptoms of a stroke, but then the symptoms go away after a few minutes. People often ignore a TIA, thinking the problem has disappeared. This can be a fatal mistake because a TIA is serious warning. In fact, according to AANS, approximately 10 to 15 percent of patients who have TIA's will suffer a stroke within one year of the first attack.

In addition, there is also a "silent stroke." The American Heart Association (AHA) says silent strokes are far more common than once thought. Basically, silent strokes occur when small blood vessels in the brain become blocked or rupture. A silent stroke is not accompanied by the classic warning signs of stroke; in fact, someone experiencing silent strokes may not even be aware of it. But eventually, as blood and oxygen supply to the brain diminishes, cells die. This can lead to problems with memory or concentration. It can also create mood changes and lead to depression. (Read about "Transient ischemis attacks TIA")

Because of this, the American Stroke Association says seniors should be monitored more carefully for depression since depression may indicate that a silent stroke has already occurred. (Read about "Depression and Seniors")

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A person having a stroke needs immediate medical attention. Learn and recognize these symptoms of a stroke:

• Sudden numbness or weakness of the leg, arm or face
• Sudden confusion or trouble understanding 
• Sudden trouble seeing in one or both eyes 
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause

If you think you or someone you know is experiencing stroke these symptoms call 911 immediately. The sooner medical help is received, the better the chance for recovery. While waiting for emergency medical service to arrive.

• Stay with the person so they don't try to get up. Staying calm and quiet is important. 
• Have the person experiencing the stroke lie or sit down, if standing.
• Do not give the person anything to eat or drink. 
• If they are on the floor, don't move them.

What You Need to Know About a Stroke

• Review the warning signs of stroke. Even if you experience the signs of a Transient Ischemic Attack (TIA), call 9-1-1 for emergency treatment. Don't wait for a full-blown stroke. About 10% of people who have TIAs will have a stroke within 90 days. Another 3% will have a stroke within 30 days.
• The biggest risk factor for stroke is high blood pressure. Eighty-five percent of all strokes are "ischemic" strokes. This occurs because a clot in one of the intracranial arteries prevents the brain from receiving an adequate blood supply. 
• Only 15% of strokes are "hemorrhagic", or bleeding strokes. This means bleeding is occurring on the brain.
• High blood pressure weakens blood vessel walls, and is a major risk factor for all strokes.
• "The majority of strokes do not require treatment in a Neurological Intensive Care Unit. Most strokes can be treated in a dedicated Primary Stroke Center. As soon as a stroke patient is stable, we get patients moving to increase optimal patient outcomes. Appropriate medications are ordered, and the team puts together a rehabilitation plan based on the patient's stroke deficits.

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