What is a stroke?  

A stroke is a really serious situation that happens when a part of your brain doesn't get enough blood. Think of it like a blockage or a burst pipe in the roads that carry blood to your brain. This can be caused by something stopping the blood flow, like a roadblock, or if there's bleeding inside your brain. When the brain doesn't receive enough blood, the cells in that area start to die because they're not getting the oxygen they need.

IMPORTANT: A stroke is a bit like a big emergency, and time is super important. If you or someone you're with starts showing signs of a stroke, don't waste any time – call 911 (or your local emergency number) right away. Acting quickly increases the chances of recovering well without lasting problems.

To figure out if someone might be having a stroke, remember the acronym BE FAST:

- B:Notice if they suddenly can't stand or walk properly, like they're losing their balance.

- E: Keep an eye out if they suddenly can't see well in one or both eyes, or if things look blurry.

- F: Ask them to show their smile. If one side of their face droops or looks strange, it might mean a muscle problem.

- A: Check if they can lift both arms. If one arm can't go up or feels weak, it might be a sign of weakness on one side of their body.

- S: Listen to how they speak. If their words are jumbled or they're having trouble talking, that's a red flag.

- T: Time is super important, so don't waste any. If you can, remember when the symptoms began. Sharing this with the doctors helps them figure out the best way to help.

Remember, a stroke is a big emergency – if you notice any of these signs in yourself or someone else, don't wait, get help right away. 

Who's at risk of having a stroke?

Well, it's not just grown-ups, even kids can have one, but some folks have a bigger chance of getting it. Strokes can happen when you're older too, with about two-thirds occurring in people who are 65 or older.

Certain health issues also make the chances of having a stroke higher. These include things like high blood pressure (hypertension), high cholesterol (hyperlipidemia), Type 2 diabetes, and if you've had a stroke before, a heart attack, or heart problems like atrial fibrillation.

Now, how often do strokes happen? They're actually pretty common. All around the world, strokes are the second most common reason why people pass away. In the United States, they're fifth on the list of causes of death. Strokes also play a big role in causing disability worldwide. 

Think of a stroke like a heart attack, but for your brain. When a stroke happens, a part of your brain loses its blood supply. This means that the brain area doesn't get enough oxygen, and without oxygen, the brain cells in that area can't work properly.

If brain cells go without oxygen for too long, they die. If a lot of brain cells in one spot die, it can cause permanent damage, and you might lose certain abilities that part of the brain controlled. But, if blood flow is restored quickly, it can prevent or limit this kind of damage. This is why time is really important when dealing with a stroke.

Two main types of strokes: ischemia and hemorrhage.

Ischemic Stroke

This is when cells don't get enough blood flow, and therefore not enough oxygen. It often happens because something blocks the blood vessels in your brain. About 80% of strokes are of this type. Ischemic strokes can occur in a few ways:

- A clot forms right in your brain (thrombosis).

- A clot from somewhere else in your body travels to your brain and gets stuck there (embolism).

- Small blood vessels in your brain get blocked due to untreated high blood pressure, high cholesterol, or high blood sugar.

- Sometimes, we don't know the exact reason for these strokes (cryptogenic strokes).

Hemorrhagic strokes

Which you pronounce as "hem-or-aj-ick," are strokes that cause bleeding either in or around your brain. There are two ways this can happen:

1.Bleeding Inside the Brain (Intracerebral): Imagine a blood vessel inside your brain tearing or breaking open. This leads to bleeding that adds pressure on the brain tissue around it. It's like a leak that's causing the brain area to get squished.

2.Bleeding into the Subarachnoid Space: This is the space between your brain and its outer covering. Think of the outer covering as a thin layer with a pattern like a spiderweb. Sometimes, blood vessels passing through this covering can get damaged, causing bleeding that goes into the space below it. This puts pressure on the brain tissue underneath, creating what's called a subarachnoid hemorrhage.

In both cases, the bleeding creates pressure and can harm the brain tissue. Hemorrhagic strokes are serious and require immediate medical attention. 

The symptoms of a stroke depend on which part of your brain is affected because different parts of your brain control different things. For instance, if the stroke affects a part called Broca's area, which manages how you use your face and mouth muscles to speak, you might start slurring words or having difficulty talking.

Stroke symptoms can involve one or more of the following:

- Weakness or paralysis on just one side of your body.

- Trouble speaking or finding the right words (aphasia).

- Speaking in a slurred or unclear way (dysarthria).

- Loss of control over muscles on one side of your face.

- Suddenly losing some or all of your senses like vision, hearing, smell, taste, or touch.

- Seeing things as blurry or double (diplopia).

- Losing coordination or being clumsy (ataxia).

- Feeling dizzy or like things are spinning (vertigo).

- Nausea and throwing up.

- Stiffness in your neck.

- Going through emotional ups and downs, or having personality changes.

- Feeling confused or agitated.

- Having a seizure.

- Losing memory or forgetting things (amnesia).

- Having severe, sudden headaches.

- Passing out or fainting.

- Falling into a coma.

Remember, if you or someone else shows these symptoms, it could be a stroke – seek medical help immediately. 

Both kinds of strokes, ischemic and hemorrhagic, can be caused by different things. Ischemic strokes are often tied to blood clots that form for various reasons, such as:

- Atherosclerosis, where arteries get narrower and harder.

- Conditions that make your blood clot more easily.

- A heart condition called atrial fibrillation, especially when connected to sleep apnea.

- Abnormal heart structures, like atrial or ventricular septal defects.

- A condition called microvascular ischemic disease that affects the small blood vessels in your brain.

Hemorrhagic strokes also have various triggers, including:

- Having high blood pressure for a long time or at very high levels.

- Burst brain aneurysms that cause bleeding.

- Brain tumors, even cancerous ones.

- Diseases that weaken or cause strange changes in blood vessels in the brain, like moyamoya disease.

Knowing what can cause these strokes helps doctors decide on the best treatments and ways to prevent them. 

Other factors and conditions can also increase the chances of having a stroke. These include:

- Struggling with alcohol use.

- High blood pressure, which isn't only a concern for hemorrhagic strokes—it can damage blood vessels, boosting the risk of any stroke.

- High cholesterol (hyperlipidemia).

- Experiencing migraine headaches, which can sometimes look like stroke symptoms. People with migraines, especially those with auras, have a higher risk of stroke at some point in their life.

- Dealing with Type 2 diabetes.

- Smoking and using tobacco in various forms (like vaping or smokeless tobacco).

- Misusing drugs, whether prescription or over-the-counter.

Treatment 

How strokes are treated can vary because of different factors, but the biggest factor is the type of stroke someone has.

Ischemic Stroke: For ischemic strokes, the main goal is to get blood flowing back to the parts of the brain that were affected. Doing this quickly might prevent permanent damage or at least make the stroke less severe. This usually involves a special medication called thrombolytics. Sometimes, a procedure with a catheter might also be used to bring back regular blood flow.

Hemorrhagic Stroke: Treating hemorrhagic strokes depends on where and how much bleeding is going on. A key step is often to lower blood pressure. This helps in reducing the bleeding and prevents it from getting worse. Another way is to help the blood clot, which can stop the bleeding. In certain cases, surgery might be needed to ease the pressure on the brain caused by the built-up blood. 

Stroke Rehabilitation 

Is a big part of helping someone recover after a stroke. This is especially true when it comes to getting back abilities they had before the stroke. The goal is to aid them in adapting to the changes in their brain and getting back to their normal life.

Rehabilitation comes in different forms, including:

Speech Therapy:This helps people regain their language and speaking skills. It also works on improving the control of muscles needed for activities like breathing, eating, drinking, and swallowing.

Physical Therapy: This focuses on getting back or enhancing the use of hands, arms, feet, and legs. It's also useful for dealing with balance problems and muscle weakness.

Occupational Therapy: This helps retrain the brain for everyday activities. It's great for refining precise hand movements and muscle control.

Cognitive Therapy: If there are memory issues or trouble focusing after a stroke, this therapy can be really helpful.

There are other therapies too, depending on the individual situation. Your healthcare provider will be the best person to guide you about what treatments can help you recover effectively. Remember, rehabilitation plays a significant role in getting back to your usual self after a stroke. 

By Andrew Anongu, DailyHealth