Stroke

How FINDcures Can Help

FINDcures specializes in providing help in areas that other foundations often miss or leave unaddressed.  When a family member is diagnosed with Stroke, a cascade of questions and concerns materialize that can easily overwhelm a family.  Most often the issues of on-going therapy and education on how family members can be effective caregivers when nessesary will be need to be addressed.

Beyond the issues of therapy and caregiver education there are other adjustments that need to be considered.  Specific concerns, that most often arise in a progression of unanswered questions, can have an overwhelming impact on a family’s sense of security and self-worth.  FINDcures has developed a service model (shown at right) called the “Perimeter of Hope” which is designed to provide solutions and answers to the myriad questions that arise when a neurological diagnosis occurs.

The most common questions that come up are these:

  1. Why is this happening?  What caused this?  How difficult is this going to be?  How is this going to impact my family?  Who can I turn to when I start to feel overwhelmed?  How do I deal with all of the emotions I’m feeling?  (Mental Health & Well-Being Services)
  2. How will I be able to provide for my family in the future?  (Financial Planning & Retirement Services)
  3. How can I protect my assets so that they will be available as a resource for my family when I am unable to do so?  (Legal Assistance & Estate Planning Services)
  4. If our family needs to relocate to receive better care or to reduce expenses who can I turn to for help?  (Housing, Relocation & Real Estate Services)
  5. Will I be able to help with my children’s education expenses in the future?  (Education Planning & Tuition Assistance)
  6. When will they find a cure?  What health steps can we take in the meantime?  (Medical Research & Information Services)

 

When an impacted individual or family is faced with making these decisions on their own and without help from qualified individuals familiar with the impact of neurological diseases, the task list can be overwhelming.  Why make things more difficult by going it alone when you can contact an experienced FINDcures representative and allow them to assist you?  Our services are free of charge.  The consultation costs you nothing and should you choose a service we offer, the cost, if any, is subsidized by the donations we receive.

Stroke – An Overview

Stroke is when there is an abnormal flow of blood to the brain – either too little or too much.  There are generally two types of strokes; clot or bleed strokes.  First, the most common type is an Ischemic (Clot) Stroke.  This occurs when there is a clot or obstruction within the blood vessel which prevents blood flow to the brain.  Within this category are also the transient ischemic attacks or TIAs.  These are often referred to as “mini strokes” since they only last for a short period of time.  Second, is the Hemorrhagic (Bleed) stroke which occurs when there is a rupture of a blood vessel.

Stroke is a medical emergency. Know the signs and symptoms of stroke (http://www.cdc.gov/stroke/signs_symptoms.htm), and call 9-1-1 right away if you think someone might be having a stroke. Getting fast treatment (http://www.cdc.gov/stroke/treatments.htm) is important to preventing death and disability from stroke. You may be able to prevent stroke (http://www.cdc.gov/stroke/prevention.htm) or reduce your risk through healthy lifestyle changes. In addition, medication can reduce stroke risk for some people.

Stroke is the fifth leading cause of death in the United States and is a major cause of adult disability.1,2 About 800,000 people in the United States have a stroke each year. One American dies from a stroke every 4 minutes, on average. Get more quick facts about stroke (http://www.cdc.gov/stroke/facts.htm).

During a stroke, every minute counts! Fast treatment (http://www.cdc.gov/stroke/treatments.htm) can reduce the brain damage that stroke can cause.

By knowing the signs and symptoms of stroke, you can be prepared to take quick action and perhaps save a life—maybe even your own.

Signs of Stroke in Men and Women

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

Call 9-1-1 immediately if you or someone else has any of these symptoms.

Acting F.A.S.T. Is Key for Stroke

Acting F.A.S.T. can help stroke patients get the  treatments(http://www.cdc.gov/stroke/treatments.htm) they desperately need. The most effective stroke treatments are only available if the stroke is recognized and diagnosed within 3 hours of the first symptoms. Stroke patients may not be eligible for the most effective treatments if they don’t arrive at the hospital in time.

If you think someone may be having a stroke, act F.A.S.T. and do the following simple test:

F—Face: Ask the person to smile. Does one side of the face droop?
A—Arms:
Ask the person to raise both arms. Does one arm drift downward?
S—Speech:
Ask the person to repeat a simple phrase. Is their speech slurred or strange?
T—Time:
If you observe any of these signs, call 9-1-1 immediately.

Note the time when any symptoms first appear. Some treatments for stroke only work if given in the first 3 hours after symptoms appear. Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room.

Treating a Hemorrhagic stroke

If you are experiencing a hemorrhagic stroke, you will have a severe headache.  Get medical attention immediately.

Treating a Transient Ischemic Attack

If your symptoms go away after a few minutes, you may have had a transient ischemic attack (TIA)(http://www.cdc.gov/stroke/types_of_stroke.htm). Although brief, a TIA is a sign of a serious condition that will not go away without medical help. Tell your health care team about your symptoms right away.

Unfortunately, because TIAs clear up, many people ignore them. Don’t be one of those people. Paying attention to a TIA can save your life.

Stroke in the United States and Throughout the World

  • Stroke kills almost 130,000 Americans each year—that’s 1 out of every 20 deaths.
  • On average, one American dies from stroke every 4 minutes.
  • Every year, more than 795,000 people in the United States have a stroke.
  • About 610,000 of these are first or new strokes.
  • About 185,00 strokes—nearly one of four—are in people who have had a previous stroke.2
  • About 87% of all strokes are ischemic strokes (http://www.cdc.gov/stroke/types_of_stroke.htm), when blood flow to the brain is blocked.2
  • Stroke costs the United States an estimated $34 billion each year. This total includes the cost of health care services, medications to treat stroke, and missed days of work.

Stroke was the second most frequent cause of death worldwide in 2011, accounting for 6.2 million deaths (~11% of the total). Approximately 17 million people had a stroke in 2010 and 33 million people have previously had a stroke and were still alive. Between 1990 and 2010 the number of strokes decreased by approximately 10% in the developed world and increased by 10% in the developing world. Overall, two-thirds of strokes occurred in those over 65 years old. South Asians are at particularly high risk of stroke, accounting for 40% of global stroke deaths.

It is ranked after heart disease and before cancer. In the United States stroke is a leading cause of disability, and recently declined from the third leading to the fourth leading cause of death.

The incidence of stroke increases exponentially from 30 years of age, and etiology varies by age. Advanced age is one of the most significant stroke risk factors. 95% of strokes occur in people age 45 and older, and two-thirds of strokes occur in those over the age of 65.  A person’s risk of dying if he or she does have a stroke also increases with age. However, stroke can occur at any age, including in childhood.

Family members may have a genetic tendency for stroke or share a lifestyle that contributes to stroke. Having had a stroke in the past greatly increases one’s risk of future strokes.

Men are 25% more likely to suffer strokes than women, yet 60% of deaths from stroke occur in women. Since women live longer, they are older on average when they have their strokes and thus more often killed. Some risk factors for stroke apply only to women. Primary among these are pregnancy, childbirth, menopause, and the treatment thereof (HRT).

The main types of stroke

  • Ischemic stroke.
  • Hemorrhagic stroke.
  • Transient ischemic attack (a warning or “mini-stroke”).

Ischemic Stroke

Most strokes (85%) are ischemic strokes. If you have an ischemic stroke, the artery that supplies oxygen-rich blood to the brain becomes blocked.

Blood clots often cause the blockages that lead to ischemic strokes. Read more about factors that increase risk for ischemic stroke(http://www.cdc.gov/stroke/risk_factors.htm.

Hemorrhagic Stroke

A hemorrhagic stroke occurs when an artery in the brain leaks blood or ruptures (breaks open). The leaked blood puts too much pressure on brain cells, which damages them.

High blood pressure(http://www.cdc.gov/bloodpressure/index.htm and aneurysms—balloon-like bulges in an artery that can stretch and burst—are examples of conditions that can cause a hemorrhagic stroke.

There are two types of hemorrhagic strokes:

  • Intracerebral hemorrhage is the most common type of hemorrhagic stroke. It occurs when an artery in the brain bursts, flooding the surrounding tissue with blood.
  • Cerebral hemorrhage (also known as intracerebral hemorrhage), which is basically bleeding within the brain itself (when an artery in the brain bursts, flooding the surrounding tissue with blood), due to either intraparenchymal hemorrhage (bleeding within the brain tissue) or intraventricular hemorrhage (bleeding within the brain’s ventricular system).
  • Subarachnoid hemorrhage is a less common type of hemorrhagic stroke. It refers to bleeding in the area between the brain and the thin tissues that cover it.
  • Subarachnoid hemorrhage, which is basically bleeding that occurs outside of the brain tissue but still within the skull, and precisely between the arachnoid mater and pia mater (the delicate innermost layer of the three layers of the meninges that surround the brain).

Transient Ischemic Attack (TIA)

A transient ischemic attack (TIA) is sometimes called a “mini-stroke.” It is different from the major types of stroke because blood flow to the brain is blocked for only a short time—usually no more than 5 minutes.

It is important to know that

  • A TIA is a warning sign of a future stroke.
  • A TIA is a medical emergency, just like a major stroke.
  • Strokes and TIAs require emergency care. Call 9-1-1 right away if you feel signs of a stroke or see symptoms in someone around you.
  • There is no way to know in the beginning whether symptoms are from a TIA or from a major type of stroke.
  • Like ischemic strokes, blood clots often cause TIAs.
  • More than a third of people who have a TIA end up having a major stroke within 1 year if they don’t receive treatment, and 10%-15% will have a major stroke within 3 months of a TIA.

Recognizing and treating TIAs can reduce the risk of a major stroke. If you have a TIA, your health care team can find the cause and take steps to prevent a major stroke.

Factors That Can Increase Risk Of Stroke

High Blood Pressure

High blood pressure(http://www.cdc.gov/bloodpressure/index.htm) is a major risk factor for stroke. It occurs when the pressure of the blood in your arteries and other blood vessels is too high.

There are often no symptoms to signal high blood pressure. Lowering blood pressure by changes in lifestyle or by medication can reduce your risk for stroke.

High Cholesterol

Cholesterol(http://www.cdc.gov/cholesterol/index.htm) is a waxy, fat-like substance made by the liver or found in certain foods. Your liver makes enough for your body’s needs, but we often get more cholesterol from the foods we eat. If we take in more cholesterol than the body can use, the extra cholesterol can build up in the arteries, including those of the brain. This can lead to narrowing of the arteries, stroke, and other problems.

A blood test can detect of the amount of cholesterol and triglycerides (a related kind of fat) in your blood.

Heart Disease

Common heart disorders(http://www.cdc.gov/heartdisease/index.htm) can increase your risk for stroke. For example, coronary artery disease(http://www.cdc.gov/heartdisease/coronary_ad.htm) increases your risk for stroke because plaque builds up in the arteries and blocks the flow of oxygen-rich blood to the brain. Other heart conditions, such as heart valve defects, irregular heartbeat (including atrial fibrillation), and enlarged heart chambers, can cause blood clots that may break loose and cause a stroke.

Diabetes

Diabetes mellitus also increases the risk for stroke. Your body needs glucose (sugar) for energy. Insulin is a hormone made in the pancreas that helps move glucose from the food you eat to your body’s cells. If you have diabetes, your body doesn’t make enough insulin, can’t use its own insulin as well as it should, or both.

Diabetes causes sugars to build up in the blood. Talk to your doctor about ways to manage diabetes and control other risk factors.

Sickle Cell Disease

Sickle cell disease is a blood disorder associated with ischemic stroke(http://www.cdc.gov/stroke/types_of_stroke.htm) that mainly affects black and Hispanic children. The disease causes some red blood cells to form an abnormal sickle shape. A stroke can happen if sickle cells get stuck in a blood vessel and block the flow of blood to the brain.

Prognosis

Disability affects 75% of stroke survivors enough to decrease their employability. Stroke can affect people physically, mentally, emotionally, or a combination of the three. The results of stroke vary widely depending on size and location of the lesion.  Dysfunctions correspond to areas in the brain that have been damaged.

Some of the physical disabilities that can result from stroke include muscle weakness, numbness, pressure sores, pneumonia, incontinence, apraxia (inability to perform learned movements), difficulties carrying out daily activities, appetite loss, speech loss, vision loss and pain. If the stroke is severe enough, or in a certain location such as parts of the brainstem, coma or death can result.

Emotional problems following a stroke can be due to direct damage to emotional centers in the brain or from frustration and difficulty adapting to new limitations. Post-stroke emotional difficulties include anxiety, panic attacks, flat affect (failure to express emotions), mania, apathy and psychosis. Other difficulties may include a decreased ability to communicate emotions through facial expression, body language and voice.

Disruption in self-identity, relationships with others, and emotional well-being can lead to social consequences after stroke due to the lack of ability to communicate. Many people who experience communication impairments after a stroke find it more difficult to cope with the social issues rather than physical impairments. Broader aspects of care must address the emotional impact speech impairment has on those who experience difficulties with speech after a stroke. Those who experience a stroke are at risk of paralysis which could result in a self disturbed body image which may also lead to other social issues.

30 to 50% of stroke survivors suffer post-stroke depression, which is characterized by lethargy, irritability, sleep disturbances, lowered self-esteem and withdrawal. Depression can reduce motivation and worsen outcome, but can be treated with antidepressants.

Emotional lability, another consequence of stroke, causes the person to switch quickly between emotional highs and lows and to express emotions inappropriately, for instance with an excess of laughing or crying with little or no provocation. While these expressions of emotion usually correspond to the person’s actual emotions, a more severe form of emotional lability causes the affected person to laugh and cry pathologically, without regard to context or emotion. Some people show the opposite of what they feel, for example crying when they are happy.  Emotional lability occurs in about 20% of those who have had a stroke.

Up to 10% of people following a stroke develop seizures, most commonly in the week subsequent to the event; the severity of the stroke increases the likelihood of a seizure.

Rehabilitation

Stroke rehabilitation is the process by which those with disabling strokes undergo treatment to help them return to normal life as much as possible by regaining and relearning the skills of everyday living. It also aims to help the survivor understand and adapt to difficulties, prevent secondary complications and educate family members to play a supporting role.

For most people with stroke, physical therapy (PT), occupational therapy (OT) and speech-language pathology (SLP) are the cornerstones of the rehabilitation process. Often, assistive technology such as wheelchairs, walkers and canes may be beneficial. Many mobility problems can be improved by the use of ankle foot orthoses.  PT and OT have overlapping areas of expertise, however PT focuses on joint range of motion and strength by performing exercises and re-learning functional tasks such as bed mobility, transferring, walking and other gross motor functions. Physiotherapists can also work with patients to improve awareness and use of the hemiplegic side. Rehabilitation involves working on the ability to produce strong movements or the ability to perform tasks using normal patterns. Emphasis is often concentrated on functional tasks and patient’s goals. One example physiotherapists employ to promote motor learning involves constraint-induced movement therapy. Through continuous practice the patient relearns to use and adapt the hemiplegic limb during functional activities to create lasting permanent changes.  OT is involved in training to help relearn everyday activities known as the Activities of daily living (ADLs) such as eating, drinking, dressing, bathing, cooking, reading and writing, and toileting.  Speech and language therapy is appropriate for people with the speech production disorders and/or problems with swallowing.

Stroke rehabilitation should be started as quickly as possible and can last anywhere from a few days to over a year. Most return of function is seen in the first few months, and then improvement falls off with the “window” considered officially by U.S. state rehabilitation units and others to be closed after six months, with little chance of further improvement. However, patients have been known to continue to improve for years, regaining and strengthening abilities like writing, walking, running, and talking. Daily rehabilitation exercises should continue to be part of the stroke patient’s routine. Complete recovery is unusual but not impossible and most patients will improve to some extent: proper diet and exercise are known to help the brain to recover.

References:

Wikipedia under Stroke

CDC website under stroke

Disclaimer

The information contained in the FINDcures website is provided for informational and educational purposes only, and should not be construed to be a diagnosis, treatment, regimen, or any other health-care advice or instruction.  The reader should seek his or her own medical or other professional advice, which the information contained in the FINDcures website is not intended to replace or supplement.  FINDcures disclaims any responsibility and liability of any kind in connection with the reader’s use of the information contained herein.