Topic Overview
What is a stroke?
A stroke occurs when a blood
vessel in the brain is
blocked or bursts. Without blood and the oxygen it carries, part of the brain
starts to die. The part of the body controlled by the damaged area of the brain
can't work properly.
Brain damage can begin within minutes, so it
is important to know the symptoms of stroke and act fast. Quick treatment can
help limit damage to the brain and increase the chance of a full
recovery.
What are the symptoms?
Symptoms of a stroke happen
quickly. A stroke may cause:
- Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
- Sudden vision changes.
- Sudden trouble speaking.
- Sudden confusion or trouble understanding simple statements.
- Sudden problems with walking or balance.
- A sudden, severe headache that is
different from past headaches.
If you have any of these symptoms, call 911 or other emergency services right away.
See your doctor if you have
symptoms that seem like a stroke, even if they go away quickly. You may have
had a
transient ischemic attack (TIA), sometimes called a
mini-stroke. A TIA is a warning that a stroke may happen soon. Getting early
treatment for a TIA can help prevent a stroke.
What causes a stroke?
There are two types of
stroke:
- An
ischemic stroke develops when a blood clot blocks a
blood vessel in the brain. The clot may form in the blood vessel or travel from
somewhere else in the blood system. About 8 out of 10 strokes are ischemic (say
“iss-KEE-mick”) strokes. They are the most common type of stroke in older
adults.
- A
hemorrhagic stroke develops when an artery in the
brain leaks or bursts. This causes bleeding inside the brain or near the
surface of the brain. Hemorrhagic (say “heh-muh-RAH-jick”) strokes are less
common but more deadly than ischemic strokes.
How is a stroke diagnosed?
You need to see a doctor right away. If a stroke is diagnosed quickly—right after symptoms start—doctors may be able to use medicines that can help you recover better.
The first thing the doctor needs to find out
is what kind of stroke it is: ischemic or hemorrhagic. This is important
because the medicine given to treat a stroke caused by a blood clot could be
deadly if used for a stroke caused by bleeding in the brain.
To
find out what kind of stroke it is, the doctor will do a type of X-ray called a
CT scan of the brain, which can show if there is
bleeding. The doctor may order other tests to find the location of the clot or
bleeding, check for the amount of brain damage, and check for other conditions
that can cause symptoms similar to a stroke.
How is it treated?
For an ischemic stroke, treatment focuses on restoring blood flow to
the brain. If you get to the hospital right away after symptoms begin, doctors
may use a medicine that dissolves blood clots. Research shows that this
medicine can improve recovery from a stroke, especially if given within 90
minutes of the first symptoms.1 Other medicines may be
given to prevent blood clots and control symptoms.
A
hemorrhagic stroke can be hard to treat. Doctors may do
surgery or other treatments to stop bleeding or reduce pressure on the brain.
Medicines may be used to control blood pressure, brain swelling, and other
problems.
After your condition is stable, treatment shifts to
preventing other problems and future strokes. You may need to take a number of
medicines to control conditions that put you at risk for stroke, such as high
blood pressure, high cholesterol, and diabetes. Some people need to have a
surgery to remove
plaque buildup from the blood vessels that supply the
brain (carotid arteries).
The best way to get
better after a stroke is to start
stroke rehab. The goal of stroke rehab is to help you
regain skills you lost or to make the most of your remaining abilities. Stroke
rehab can also help you take steps to prevent future strokes. You have the
greatest chance of regaining abilities during the first few months after a
stroke. So it is important to start rehab soon after a stroke and do a little
every day.
Can you prevent a stroke?
After you have had a
stroke, you are at risk for having another one. You can make some important
lifestyle changes that can reduce your risk of stroke and improve your overall
health.
Treat any health problems you have
- Manage high blood pressure or high cholesterol by working with your doctor.
- Manage diabetes. Keep your blood sugar levels within a target range.
- If your doctor recommends you take aspirin or a blood thinner, take it. This can help prevent having a stroke.
- Take your medicine exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
Adopt a healthy lifestyle
- Do not smoke or allow others to smoke around you.
- Limit alcohol to 2 drinks a day for men and 1 drink a day for women.
- Stay at a healthy weight. Being overweight makes it more likely you will develop high blood pressure, heart problems, and diabetes. These conditions make a stroke more likely.
- Do activities that raise your heart rate. Get at least 30 minutes of exercise on most days of the week. Walking is a good choice. You also may want to do other activities, such as running, swimming, cycling, or playing tennis or team sports.
- Eat a balanced diet that is low in cholesterol, saturated fats, and salt. These foods can make hardening of the arteries worse. Eat more fruits and vegetables. Eat fish at least once a month.
Frequently Asked Questions
|
Learning about stroke:
|
|
|
Being diagnosed:
|
|
|
Getting treatment:
|
|
|
Ongoing concerns:
|
|
|
Living with stroke:
|
|
|
End-of-life issues:
|
|
Cause
Causes of ischemic stroke
An
ischemic stroke is caused by a blood clot that blocks blood flow to the brain. A
blood clot can develop in a narrowed artery that supplies the brain or can
travel from the heart (or elsewhere in the body) to an artery that supplies the
brain.
Blood clots are usually the result of other problems in
the body that affect the normal flow of blood, such as:
Low blood pressure (hypotension) may also cause an
ischemic stroke, although less commonly. Low blood pressure results in reduced
blood flow to the brain and may develop as a result of narrowed or diseased
arteries, a heart attack, a large loss of blood, or a severe infection.
Some surgeries (such as endarterectomy) or other procedures (such as
carotid artery stenting) that are used to treat narrowed carotid arteries may cause a blood
clot to break loose, resulting in a stroke.
Causes of hemorrhagic stroke
A
hemorrhagic stroke is caused by bleeding inside the
brain (called intracerebral hemorrhage) or bleeding in the space around the
brain (called subarachnoid hemorrhage). Bleeding inside the brain may be a
result of long-standing high blood pressure. Bleeding in the space around the
brain may be caused by a ruptured
aneurysm or uncontrolled high blood pressure.
Other causes of hemorrhagic stroke are less common but
include:
- Inflammation in the blood vessels, which may
develop from conditions such as
syphilis,
Lyme disease,
vasculitis, or
tuberculosis.
- Blood-clotting disorders,
such as
hemophilia.
- Head or neck injuries that
result in damage to blood vessels in the head or neck.
- Radiation
treatment for cancer in the neck or brain.
- Cerebral amyloid
angiopathy (a degenerative blood vessel disorder).
Symptoms
If you have symptoms of a stroke,
call 911 or other emergency services right away. General symptoms of a
stroke include:
- Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
- Sudden vision changes.
- Sudden trouble speaking.
- Sudden confusion or trouble understanding simple statements.
- Sudden problems with walking or balance.
- A sudden, severe headache that is
different from past headaches.
Symptoms can vary depending on whether the stroke is caused by
a blood clot (ischemic stroke) or bleeding (hemorrhagic stroke), where the stroke occurs in the brain, and how bad it is.
A stroke usually happens suddenly but may occur over hours. For example, you may have mild weakness at first. Over time, you may not be able to move the arm and leg on one side of your body.
If several smaller strokes occur over time, you may
have a more gradual change in walking, balance, thinking, or behavior (multi-infarct dementia).
It is not always easy for people to recognize symptoms of a
small stroke. They may mistakenly think the symptoms can be attributed to
aging, or the symptoms may be confused with those of other conditions that
cause similar symptoms.
What Happens
When you have an
ischemic stroke, the oxygen-rich blood supply to part of your brain is reduced.
With a
hemorrhagic stroke, there is bleeding in the
brain.
- After about 4 minutes without blood and oxygen,
brain cells become damaged and may die.
- The body tries to restore
blood and oxygen to the cells by enlarging other blood vessels (arteries) near
the area.
- If blood supply is not restored, permanent brain damage
usually occurs.
When brain cells are damaged or die, the body parts
controlled by those cells cannot function. The loss of function may be mild or
severe and temporary or permanent. This depends on where and how much of the
brain is damaged and how fast the blood supply can be returned to the affected
cells.
If you have
symptoms of a stroke, call 911 or other emergency services right away. Life-threatening complications may occur after a
stroke. Early treatment may decrease the amount of
permanent damage to brain cells, decreasing the amount of disability.
Stroke is the most common nervous-system–related cause of physical
disability. Of people who survive a stroke, half will
still have some disability 6 months after the stroke.
Recovery
depends on the location and amount of brain damage caused by the stroke, the
ability of other healthy areas of the brain to take over functioning for the
damaged areas, and
rehabilitation. In general, the less damage there is
to the brain tissue, the less disability results and the greater the chances of
a successful recovery.
You have the greatest chance of regaining
your abilities during the first few months after a stroke. Regaining some
abilities, such as speech, comes slowly, if at all. About half of all people
who have a stroke will have some long-term problems with talking,
understanding, and decision-making. They also may have changes in behavior that
affect their relationships with family and friends.
Long-term
complications of a stroke, such as
depression and
pneumonia, may develop right away or months to years
after a stroke. Some long-term complications may be prevented with proper home
treatment and medical follow-up. For more information, see the Home Treatment
section of this topic.
What to expect after a stroke
In addition to the
more obvious physical problems you have after a stroke, you (or a caregiver)
may also notice:
If you have concerns, discuss them with your doctor. Your
doctor will provide support and may offer other suggestions for dealing with
these issues.
What Increases Your Risk
Risk factors for
stroke include those you can treat or change and those you
can't change.
Risk factors you can treat or change:
- High blood pressure (hypertension).
- Atrial fibrillation.
- Diabetes.
- Smoking.
- High cholesterol.
-
Heavy use of
alcohol
.
- Being overweight.
- Physical
inactivity.
Risk factors you cannot change
include:
- Age. The risk of stroke increases with age.
- Race. African Americans, Native Americans, and Alaskan Natives
have a higher risk than those of other races.
- Gender. Stroke is more common in
men than women until age 75, when more women than men have strokes. Because
women live longer than men, more women have strokes each year.
- Family history. The risk for stroke is greater if
a parent, brother, or sister has had a stroke or
transient ischemic attack (TIA).
- History
of stroke or TIA.
When To Call a Doctor
Call
911
or other emergency services immediately if you have signs of a stroke:
- Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
- Sudden vision changes.
- Sudden trouble speaking.
- Sudden confusion or trouble understanding simple statements.
- Sudden problems with walking or balance.
- A sudden, severe headache that is
different from past headaches.
Signs of a transient ischemic attack are similar to signs of a stroke. But TIA symptoms usually disappear after 10 to 20 minutes. There is no way to tell whether the symptoms are caused by a stroke or by TIA, so emergency medical care is needed for both conditions.
Call your doctor immediately if you
have:
- Had recent symptoms of a TIA or stroke, even if
the symptoms have disappeared.
- Had a TIA or stroke and are taking
aspirin or other medicines that prevent blood clotting and you notice any
signs of bleeding.
- Had a stroke and have a
choking episode from food going down your windpipe.
- Had a stroke
and have signs of a blood clot in a
deep blood vessel, which include redness, warmth, and
pain in a specific area of your arm or leg.
Call your doctor for an appointment if you:
- Think you have had a TIA in the past and have
not talked with your doctor about it.
- Have had a stroke and have a
pressure sore.
- Have had a stroke and notice that your affected arm or
leg is becoming increasingly stiff or you are not able to straighten it
(spasticity).
- Have had a stroke and notice signs of a urinary tract
infection. Signs may include fever, pain with urination, blood in urine, and
low back (flank) pain.
- Have had a stroke and you are having trouble keeping
your balance.
Watchful Waiting
Watchful waiting is not appropriate if you have
signs of a stroke. Emergency medical care is needed to prevent or treat any
complications that may be life-threatening. Prompt treatment may prevent
extensive damage to the brain, reducing permanent
disabilities from the stroke.
If the
stroke is caused by a blood clot, early care by a doctor in the emergency room
or hospital is critical. If you seek help right away, you can sometimes
receive a medicine (tissue plasminogen activator, or t-PA) that dissolves
clots. This medicine works best when it is given right after
symptoms begin. Not everyone can safely receive this medicine.
Who To See
Doctors who can diagnose and treat stroke
include:
If you need surgery or have other health problems, other
specialists may be consulted, such as a:
Some hospitals have a stroke team made up of many
different health professionals, such as a physical therapist, an occupational
therapist, a speech therapist, a rehabilitation doctor (physiatrist), a nurse,
and a social worker.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
Time is critical when diagnosing a
stroke. A quick diagnosis—the sooner, the better—may
enable your doctor to use medicines that can lead to a better recovery.
The first priority will be to determine whether you are having an
ischemic or hemorrhagic stroke. This distinction is critical because the medicine
given for an ischemic stroke (caused by a blood clot) could be life-threatening
if the stroke is hemorrhagic (caused by bleeding). Your doctor will also want
to rule out other conditions that have symptoms similar to a stroke and to
check for complications.
The first test after a stroke is
typically a
computed tomography (CT) scan of the brain, which is a
series of X-rays of your brain that can show whether there is bleeding. This
test will help your doctor diagnose whether the stroke is ischemic or
hemorrhagic.
Magnetic resonance imaging (MRI) may also be done to
find out the amount of damage to the brain and help predict recovery.
Other initial tests recommended for ischemic stroke include:
If your doctor suspects or if other tests show narrowing of
a
carotid artery, he or she may want you to have a
carotid ultrasound/Doppler scan to evaluate blood flow
through the artery. Your doctor may also request
magnetic resonance angiogram (MRA), CT angiogram, or
carotid angiogram.
If your doctor
believes the stroke may have been caused by a problem with your heart, an
echocardiogram or
Holter monitoring or telemetry test may be done.
Guidelines recommend that risk factors for heart disease also be
assessed after a stroke to prevent disability or death from a future heart
problem. This is because many people who have had a stroke also have
coronary artery disease.
Treatment Overview
Initial treatment for a stroke happens in the hospital. The sooner you get treatment, the better. The worst damage from a stroke often
occurs within the first few hours. The faster you receive treatment, the less
damage will occur.
In the hospital
Your treatment will depend on whether the stroke is caused by a blood clot (ischemic) or
by bleeding in the brain (hemorrhagic). Treatment
focuses on restoring blood flow for an ischemic stroke or controlling bleeding
for a hemorrhagic stroke.
Before starting treatment, your doctor
will use a
computed tomography (CT) scan or
magnetic resonance imaging (MRI) of your head to diagnose the type
of stroke you've had. For more information about these and other tests, see Exams and Tests.
Ischemic stroke
Emergency treatment for an ischemic stroke depends on the location and
cause of the clot. Measures will be taken to stabilize your vital signs,
including giving you medicines.
- If your stroke is diagnosed soon enough after
the start of symptoms, you may be given a clot-dissolving medicine called
tissue plasminogen activator (t-PA), which can
increase your chances of survival and recovery.
- You may also receive
aspirin or
another antiplatelet medicine.
Hemorrhagic stroke
Treatment for hemorrhagic stroke includes efforts
to control bleeding, reduce pressure in the brain, and stabilize vital signs,
especially blood pressure.
- You will be
closely monitored for signs of increased pressure on the brain, such as
restlessness, confusion, difficulty following commands, and headache. Other
measures will be taken to keep you from straining from excessive coughing,
vomiting, or lifting, or straining to pass stool or change
position.
- If the bleeding is due to a ruptured
brain aneurysm, surgery to repair the aneurysm may be
done. Repair may include:
- Using a metal clip to clamp off the
aneurysm to prevent renewed bleeding.
- Inserting a small coil into the
aneurysm to block it off (endovascular coil embolization).
- In some cases, medicines may be given to control blood
pressure, brain swelling, blood sugar levels, fever, and seizures.
- If a large amount of bleeding
has occurred and the person is rapidly getting worse, surgery may be needed to
remove the blood that has built up inside the brain and to lower pressure
inside the head.
Preventing another stroke
After emergency treatment for
stroke, and when your condition has stabilized, treatment focuses on
preventing another stroke. It will be important to control
your risk factors for stroke, such as
high blood pressure,
atrial fibrillation,
high cholesterol, and diabetes. Your doctor will probably want you to take one or more medicines to prevent another stroke. For more information on the medicines you may have to take after a stroke, see Medications.
Changes in
lifestyle will also be an important part of your treatment to reduce
your risk of having another stroke:
- Do not smoke or allow others to smoke around you.
- Limit alcohol to 2 drinks a day for men and 1 drink a day for women.
- Stay at a healthy weight.
- Do activities that raise your heart rate. Get at least 30 minutes of exercise on most days of the week. Walking is a good choice.
- Eat a balanced diet that is low in cholesterol, saturated fats, and salt. What kind of diet you use(What is a PDF document?) depends on your individual risks, your doctor's recommendation, and your preference. Here are some options:
Your doctor may also recommend surgery to remove plaque buildup in the carotid arteries. A procedure called carotid artery stenting (CAS) is another option for some people who have blocked carotid arteries. For more information on surgery to prevent a stroke, see Surgery. For more information on CAS, see Other Treatment.
For more information on preventing a stroke, see Prevention.
Rehabilitation
Starting a
rehabilitation (rehab) program as soon as possible after a
stroke increases your chances of recovering some of the abilities you
lost.
It is not
possible to predict precisely how much physical ability you will regain. The
more ability you retain immediately after a stroke, the more independent you
are likely to be when you are discharged from the hospital. After a
stroke:
- People usually show the greatest progress in
being able to walk during the first 6 weeks. Most recovery occurs within the
first 3 months. But you may continue to improve slowly over the next few
years.
- Speech, balance, and skills needed for day-to-day living
return more slowly and may continue to improve for up to a
year.
- About half of the people who suffer a stroke have problems
with coordination, communication, judgment, or behavior that affect their work
and personal relationships.
Your
rehab will be based on the physical abilities that were lost, your
general health before the stroke, and your ability to participate.
Rehab begins with helping you resume activities of daily living, such
as eating, bathing, and dressing. For more information, see the topic
Stroke Rehabilitation.
What To Think About
After a person has had a stroke, family members can learn
ways to provide support and encouragement to their
loved one.
If you get
worse, your loved one may need to move you to a care facility
that can meet your needs, especially if your caregiver has his or her own
health problems that make it difficult to properly care for you. It is common
for caregivers to neglect their own health when they are caring for a loved one
who has had a stroke. If your caregiver's health declines, the risk of injury
to you and your caregiver may increase. For more information, see:
-
Stroke: Should I Move My Loved One Into Long-Term Care?
Prevention
You can help prevent a stroke if you
control risk factors and treat other medical conditions that can lead to a
stroke.
And if you have already had a stroke or a
transient ischemic attack (TIA), you can prevent
another stroke in the same way, by controlling risk factors and treating
medical conditions that can lead to stroke.
Know your stroke risk
These are some of the common risk factors for stroke:
Treat any health problems you have
- Manage high blood pressure or high cholesterol by working with your doctor.
- Manage diabetes. Keep your blood sugar levels within a target range.
- If your doctor recommends you take aspirin or a blood thinner, take it. This can help prevent having a stroke.
- Take your medicine exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
Adopt a healthy lifestyle
- Do not smoke or allow others to smoke around you. For more information, see the topic Quitting Smoking.
-
Limit alcohol to 2 drinks a day for men and 1 drink a day for women.
- Stay at a healthy weight. Being overweight makes it more likely you will develop high blood pressure, heart problems, and diabetes. These conditions make a stroke more likely.
- Do activities that raise your heart rate. Get at least 30 minutes of exercise on most days of the week. Walking is a good choice. You also may want to do other activities, such as running, swimming, cycling, or playing tennis or team sports.
- Eat a balanced diet that is low in cholesterol, saturated fats, and salt. What kind of diet you use(What is a PDF document?) depends on your individual risks, your doctor's recommendation, and your preference. Here are some options:
Home Treatment
After a
stroke, home treatment will be an important part of
your rehabilitation.
You may need to use assistive devices to help
you:
-
Eat. Large-handled silverware can be easier to grab
and use if you have a weak hand. If you have trouble swallowing, you may need
to change your diet or your doctor may provide you with a feeding tube to use
at home.
-
Get dressed. Devices called reachers can help you
put on socks or stockings if you have weakness in one arm or hand.
-
Walk. Canes and walkers can be used to help prevent
falls.
Tips for a successful recovery
-
Be as involved as possible in your care. Although you may feel like letting a caregiver take charge, the
more you can participate, the better. Ask for help in dealing with any
disabilities you may have, and try to make people understand your
limitations.
-
Recognize and deal with depression.
Depression is common in people who have had a stroke,
and it can be treated. You may need
medicines for depression and pain to help you
cope.
- Participate in a
stroke rehabilitation program as soon as possible.
After a stroke, a combination of physical, speech, and occupational therapies
can help you manage the basics of daily living, such as bathing, dressing, and
eating. A team that includes a doctor, a variety of therapists, and nurses will
work with you to overcome disabilities, learn new ways to do tasks, and
strengthen parts of your body impaired by the stroke. For more information, see
the topic
Stroke Rehabilitation.
Tips for dealing with the effects of a stroke
-
Managing getting dressed. Getting
dressed may be easier if you use stocking/sock spreaders, rings or strings
attached to zipper pulls, and buttonhooks. Talk with an
occupational therapist about assistive devices that
can help you get dressed.
-
Managing vision problems. After a stroke, some people have problems seeing to one side.
For example, people with right-sided paralysis may have difficulty seeing to
the right.
- Managing eating problems. You may not be able to feel
food on one or both sides of your mouth. This increases your risk for choking.
You may need further tests or an evaluation by a speech therapist.
Stroke Recovery: Coping With Eating Problems
-
Managing bowel and bladder problems.
Some people who have a stroke suffer loss of bladder control (urinary
incontinence) after the stroke. But this is usually temporary, and it can have
many causes, including infection, constipation, and the effects of
medicines.
Tips for family members and caregivers
-
Family adjustment and support will be important to
your loved one's recovery. Strong support from the family can greatly enhance
recovery.
- Help
manage speech and language problems with some simple
tips. These problems may involve any or all aspects of language use, such as
speaking, reading, writing, and understanding the spoken word. Speaking slowly
and directly and listening carefully can help.
For more information on rehabilitation (rehab) at home, see
the topic
Stroke Rehabilitation.
Although stroke
rehab is increasingly successful at prolonging life, a stroke can be a
disabling or fatal condition. People who have had a stroke may consider
discussing health care and other legal issues that may arise near the end of
life. Many people find it helpful and comforting to state their health care
choices in writing with a
living will or other
advance directive while they are still able to make
and communicate these decisions. For more information, see the topic
Care at the End of Life.
Medications
Your doctor will probably prescribe several medicines after you have had a stroke. Medicines to prevent blood clots are typically used, because blood clots can cause TIAs and strokes.
The types of medicines that prevent clotting are:
- Antiplatelet medicines.
- Anticoagulant medicines.
Cholesterol-lowering and blood-pressure–lowering medicines are also used to prevent TIAs and strokes.
Antiplatelet medicines
Antiplatelet medicines keep
platelets in the blood from sticking together.
- Aspirin (for example, Bayer) is most often used to prevent TIAs
and strokes.
- Aspirin combined with dipyridamole (Aggrenox)
is a safe and effective alternative to aspirin.
- Clopidogrel (Plavix) may be used
for people who cannot take aspirin.
Anticoagulants
Anticoagulants
prevent blood clots from forming and keep existing blood clots from getting bigger. If you have atrial fibrillation, you will probably take an anticoagulant such as warfarin (for example, Coumadin). For more information, see the topic Atrial Fibrillation.
Statins
Statins lower cholesterol and can greatly reduce the risk of stroke in people who have had a TIA. Statins even protect against stroke in people who do not have heart disease or high cholesterol.2
Blood pressure medicines
If you have high blood pressure, your doctor may want you to take medicines to lower it. Blood pressure medicines include:
Other medicines
Medicines used to treat depression and pain may also be
prescribed after a stroke.
Surgery
When surgery is being considered after a
stroke, your age, prior overall health, and current
condition are major factors in the decision.
Surgery for ischemic stroke
If you have significant blockage in the carotid arteries in your neck, you may need a carotid endarterectomy. During this surgery, a surgeon removes plaque buildup in the carotid arteries to reduce the risk of transient ischemic attack (TIA) or stroke. The benefits and risks of this surgery must be carefully weighed, because the surgery itself may cause a stroke. Your need to have carotid endarterectomy depends on whether you have had a TIA or stroke and how much your carotid arteries have narrowed.
-
Stroke: Should I Have Carotid Endarterectomy?
Surgery for hemorrhagic stroke
Surgeries for hemorrhagic stroke include:
- Surgery to drain or remove blood in or around the brain that was
caused by a bleeding blood vessel.
- A
procedure (endovascular coil embolization) to
repair a brain aneurysm that is the cause of a hemorrhagic stroke. A
small coil is inserted into the aneurysm to block it off and stop or prevent bleeding.
- Surgery (craniotomy) to repair the aneurysm that caused the hemorrhagic stroke. A small metal clip is placed around the base of the aneurysm to block it off. This stops the bleeding in the brain.
Whether this surgery can be done depends on the location of the aneurysm, its size, and your general health.
- Surgery to remove or
block off abnormally formed blood vessels (arteriovenous malformation) that
have caused bleeding in the brain.
Other Treatment
Stroke rehabilitation (rehab) is a
critical part of a successful recovery. Early
rehab, begun as soon as possible after the
stroke, helps to reduce dependence on others. Most
recovery occurs during the first 3 months after a stroke but may continue
slowly over the next few years. For more information, see the topic
Stroke Rehabilitation.
Carotid artery stenting (also called carotid angioplasty and stenting) is now being done as an alternative to surgery for preventing transient ischemic attack (TIA) or stroke. In this procedure, a doctor threads a thin tube called a catheter through an artery in the groin and up to the carotid arteries in your neck. The doctor then uses a tiny balloon to enlarge the narrowed portion of the artery and places a wire mesh stent to keep the artery open. Carotid artery stenting is not as common as carotid endarterectomy.
Other Places To Get Help
Organizations
|
National Institute of Neurological Disorders and
Stroke
|
| NIH Neurological Institute |
| P.O. Box 5801 |
| Bethesda, MD 20824 |
| Phone: |
1-800-352-9424 |
| Phone: |
(301) 496-5751 |
| TDD: |
(301) 468-5981 |
| Web Address: |
www.ninds.nih.gov |
| |
|
The National Institute of Neurological Disorders and
Stroke (NINDS), a part of the National Institutes of Health, is the leading
U.S. federal government agency supporting research on brain and nervous system
disorders. It provides the public with educational materials and information
about these disorders.
|
|
|
American Stroke Association
|
| 7272 Greenville Avenue |
| Dallas, TX 75231 |
| Phone: |
1-888-4-STROKE (1-888-478-7653) |
| Web Address: |
www.strokeassociation.org |
| |
|
This association provides information and referrals to
local self-help groups for people who have had a stroke and for their families.
Pamphlets and other information can be obtained by calling the Dallas office (toll-free).
|
|
|
Centers for Medicare and Medicaid Services
|
| 7500 Security Boulevard |
| Baltimore, MD 21244-1850 |
| Phone: |
1-877-267-2323 toll-free |
| Phone: |
(410) 786-3000 |
| TDD: |
(410) 786-0727 |
| Web Address: |
www.medicare.gov/NHCompare/home.asp |
| |
|
Nursing Home Compare is a website with information about every Medicare- and Medicaid-certified nursing home in the country. The site allows you to search for nursing homes by name, city, county, state, or ZIP code. It also allows you to compare the quality of nursing homes using a five-star rating. The site also has information on alternatives to nursing homes, such as home care or assisted living.
The Centers for Medicare and Medicaid Services (CMS) is a
federal agency within the U.S. Department of Health and Human Services. CMS
administers Medicare, Medicaid, and the Children's Health Insurance Program
(CHIP). CMS also has other responsibilities, such as overseeing the health
insurance portability standards, which include the Health Insurance Portability
and Accountability Act of 1996 (HIPAA), and ensuring quality care standards in
long-term care facilities and clinical laboratories.
|
|
|
Family Caregiver Alliance
|
| 180 Montgomery Street |
| Suite 1100 |
| San Francisco, CA 94104 |
| Phone: |
1-800-445-8106
(415) 434-3388 |
| Email: |
info@caregiver.org |
| Web Address: |
www.caregiver.org |
| |
|
This organization supports and assists people who are
providing long-term care at home. It also provides education, research,
services, and advocacy.
|
|
|
National Stroke Association
|
| 9707 East Easter Lane, Building B |
| Centennial, CO 80112 |
| Phone: |
1-800-STROKES (1-800-787-6537) |
| Fax: |
(303) 649-1328 |
| Email: |
info@stroke.org |
| Web Address: |
www.stroke.org |
| |
|
This association provides education, information,
referrals, and research on stroke. Information specific to survivors,
caregivers, family, women, and children is included.
|
|
References
Citations
-
Adams HP Jr, et al. (2007). Guidelines for the early
management of adults with ischemic stroke: A guideline from the American Heart
Association/American Stroke Association Stroke Council, Clinical Cardiology
Council, Cardiovascular Radiology and Intervention Council, and the
Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in
Research Interdisciplinary Working Groups: The American Academy of Neurology
affirms the value of this guideline as an educational tool for neurologists.
Stroke, 38(5): 1655–1711.
-
Adams RJ (2008). AHA/ASA science advisory: Update to
the AHA/ASA recommendations for the prevention of stroke in patients with
stroke and transient ischemic attack. Stroke, 39(5):
1647–1652.
Other Works Consulted
- Abbott AL (2009). Medical (nonsurgical) intervention alone is now best for prevention of stroke associated with asymptomatic severe carotid stenosis. Stroke, 40(10): e573–e583.
- Adams RJ, et al. (2003). Coronary risk evaluation in
patients with transient ischemic attack and ischemic stroke: A scientific
statement for healthcare professionals from the Stroke Council and the Council
on Clinical Cardiology of the American Heart Association/American Stroke
Association. Circulation, 108(10): 1278–1290.
- Albers GW, et al. (2008). Antithrombotic and
thrombolytic therapy for ischemic stroke: American College of Chest Physicians
evidence-based practice guidelines (8th ed.). Chest,
133(6, Suppl): 630S–669S.
- Bederson JB, et al. (2009). Guidelines for the management of aneurysmal subarachnoid hemorrhage. Stroke, 40(3): 994–1025.
- Brott TG, et al. (2010). Stenting versus endarterectomy for treatment of carotid-artery stenosis. New England Journal of Medicine, 363(1): 11–23.
- Ederle J, et al. (2009). Randomized controlled trials comparing endarterectomy and endovascular treatment for carotid artery stenosis: A Cochrane systematic review. Stroke, 40(4): 1373–1380.
- Goldstein LB, et al. (2010). Guidelines for the primary prevention of stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. Published online December 2, 2010 (doi: 10.1161/STR.0b013e3181fcb238).
- Hirsch J, et al. (2008). Executive summary: American
College of Chest Physicians evidence-based clinical practice guidelines (8th
ed.). Chest, 133(6): 71S–109S.
- International Carotid Stenting Study investigators (2010). Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): An interim analysis of a randomized controlled trial. Lancet, 375(9719): 985–997.
- Latchaw RE, et al. (2003). Guidelines and
recommendations for perfusion imaging in cerebral ischemia. Stroke, 34(4): 1084–1104.
- Morgenstern LB, et al. (2010). Guidelines for the management of spontaneous intracerebral hemorrhage. Stroke, 41(9): 2108–2129.
- Skinner JS, Cooper A (2009). Secondary prevention of ischaemic cardiac events, search date October 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
- Smith SC, et al. (2006). AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: Endorsed by the National Heart, Lung, and Blood Institute.
Circulation, 113(19): 2363–2372. [Erratum in
Circulation, 113(22): 847.]
- Spence JD, et al. (2010). Effects of intensive medical therapy on microemboli and cardiovascular risk in asymptomatic carotid stenosis. Archives of Neurology, 67(2): 180–186.
- U.S. Department of Health and Human Services (2008).
2008 Physical Activity Guidelines for Americans (ODPHP
Publication No. U0036). Washington, DC: U.S. Government Printing Office.
Available online:
http://www.health.gov/paguidelines/pdf/paguide.pdf.
-
U.S. Preventive Services Task Force (2007). Screening for carotid artery stenosis. Available online: http://www.ahrq.gov/clinic/uspstf/uspsacas.htm.
- Wahlgren N, et al. (2008). Thrombolysis with alteplase
3-4.5 h after acute ischemic stroke (SITS-ISTR): An observational study.
Lancet. Published online September 15, 2008
(doi:10.1016/S0140-6736(08)61339-2).
Credits
|
By
|
Healthwise Staff |
|
Primary Medical Reviewer
|
E. Gregory Thompson, MD - Internal Medicine |
|
Specialist Medical Reviewer
|
Richard D. Zorowitz, MD - Physical Medicine and Rehabilitation |
|
Last Revised
|
January 7, 2011 |