Stroke: Prevention and Treatment

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Thanks to new tests that help predict stroke, treatments that help control
high blood pressure, and good health habits that many Americans are
practicing, the death rate from stroke is down as much as 50 percent since
1970. Still, stroke is the third leading cause of death in the United States
and the leading cause of disability among adults.

*What Is a Stroke?*

A stroke is a sudden partial loss of brain function usually caused by a clot
that stops the flow of blood to an area of the brain. Without oxygen and
important nutrients, the affected brain cells are either damaged or die
within a few minutes.

While cell damage can be repaired and the lost function regained, the death
of brain cells is permanent. Most strokes are caused by a blood clot or
narrowing of a blood vessel (artery) leading to the brain. Other strokes are
caused by a hemorrhage (bleeding) from an artery. There are three major
types of strokes: Thrombotic strokes are caused by fatty deposits (plaques)
that have built up in the arteries carrying blood to the brain. This slows
the blood flow until a blood clot completely blocks the artery and the flow
of oxygen and nutrients to the brain.

An embolic stroke is caused by a blood clot formed in another part of the
body that breaks loose, travels through the bloodstream, and blocks an
artery carrying oxygen and nutrients to the brain. When traveling through
the body the blood clot is called an embolus.

A hemorrhagic stroke is caused when an artery supplying blood bleeds into
the brain. The broken blood vessel prevents needed oxygen and nutrients from
reaching the brain cells. One type of hemorrhagic stroke is caused when an
artery that has weakened over time bulges (called an aneurysm) and suddenly
breaks.

*Diagnosis and Treatment*

A stroke requires immediate medical care. Research shows that treatment
during the first hours after symptoms appear can be important for the best
possible recovery. An emergency doctor or neurologist (a doctor who
diagnoses and treats disorders of the brain and nervous system) will provide
emergency treatment. Then a family doctor, internist, or geriatrician can
step in and provide longer term care.

Doctors make an early diagnosis by looking at symptoms, reviewing the
patient's medical history, and performing tests such as a computerized
tomography scan--a 3-dimensional x-ray technique to take pictures of the
brain.

*What You Can Do to Prevent a Stroke*

A stroke was once viewed as a single damaging attack, but we now know it
develops over many years. The risk factors or conditions that may lead to
stroke include high blood pressure, smoking, heart disease, and diabetes.
The risk of stroke increases with age and is higher in African Americans and
Hispanics than in whites.

You can reduce your stroke risk by taking the following steps:

Control your blood pressure. Have your blood pressure checked often, and, if
it is high, follow your doctor's advice on how to lower it. Treating high
blood pressure reduces the risk for both stroke and heart disease.

Stop smoking. Cigarette smoking is linked to increased risk for stroke.
Research shows that the risk of stroke for people who have quit smoking for
2-5 years is lower than for smokers.

Exercise regularly. Researchers think that exercise may make the heart
stronger and improve circulation. It also helps control weight. Being
overweight increases the chance of high blood pressure, atherosclerosis,
heart disease, and adult-onset (type II) diabetes.

Physical activities like brisk walking, cycling, swimming, and yard work
lower the risk of both stroke and heart disease. Talk with your doctor
before starting an exercise program.

Eat a healthy diet. Choose, prepare, and eat foods low in fats, saturated
fatty acids, and cholesterol. Eat a variety of fruits and vegetables.

Control diabetes. If untreated, diabetes can damage the blood vessels
throughout the body and lead to atherosclerosis.

Promptly report warning signs or symptoms to your doctor. The warning signs
for stroke are a sudden, unexplained tingling and/or numbness on one side of
the body, a sudden severe headache, blurred vision, difficulty talking,
stumbling and/or sudden clumsiness. Sometimes a mini-stroke, lasting only a
few moments and called a transient ischemic attack (TIA), comes before a
stroke.

*Rehabilitation for Stroke*

Rehabilitation should begin as soon as possible after the patient is stable.
It often continues after the patient has gone home. Stroke rehabilitation
includes many kinds of therapies: physical therapy to strengthen muscles and
improve balance and coordination; speech and language therapy; and
occupational therapy to improve eye-hand coordination and skills needed for
tasks such as bathing and cooking. A team of health care experts
(physicians, physical and occupational therapists, nurses, social workers,
and speech and language specialists) coordinates activities for the patient
and family.

Rehabilitation progress varies from person to person. For some, recovery is
completed within weeks following a stroke; for others, it may take many
months or years.



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