Stroke: Causes, Symptoms, Treatments and Helpful Resources

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The below provides a general overview on this topic and may not apply to everyone. Any treatment protocol should be discussed with a qualified healthcare practitioner ... Please refer to: Medical & Legal Disclaimer.

About 780,000 Americans suffer strokes each year, resulting in the death of about 160,000 stroke victims annually. Stroke is a leading cause of premature death and long-term disability in the Western world.

Starting treatment within minutes to several hours after a stroke is crucial in limiting brain damage and can often limit the disability caused by the stroke.

Thousans of people die UNNECESSARILY because the people around them don't recognize the symptoms of a stroke. A Neurologist stated that they can treat stroke patients - provided they receive treatment within 3 hours of a stroke.

One symptom of a stroke could be as ordinary as stumbling. For example, in one case, a woman stumbled, but said she was fine. Hours later she was dead. Her stumbling was actually caused by a stroke. Nobody realized that ...

Personal Experience

Only months after working on this page, a member of our family suffered a severe stroke. He was paralyzed on his right side and the initial prognosis was that he is going to be transferred to a Skilled Nursing Facility afterwards, if he was going to survive. The first week was critical.

Three months later he was able to move quite freely. His major handicap at that point continued to be his inability to communicate. He suffered both from aphasia (problems with word retrieval) and apraxia (paralysis of muscles involved in speech). However, over time spontaneous speech continued to improve (spontaneous speech involves words that don't require "retrieval" - such as yes, no, thank you, bye, etc.)

Rehabilitation can be expensive, but for speech specifically, there are some good software packages out there that help. We subscribed to Bungalow Speech Software: www.bungalowsoftware.com, which was helpful in rehabilitation and he continues to use that to this day. This software is a good alternative for those who can't afford professional speech rehabilitation with a language pathologist - which runs around $100 per 45 minutes section (rates may be less or more expensive depending on the area and the speech pathologist). Another care taker successfuly used Rosetta Stone language-learning software for his Spanish-speaking wife.

Nearly three YEARS later, he is able to move around quite freely. He rides his bike and drives (alone) around the town. This being said, before allowing a stroke patient to drive, he or she needs to be assessed by a driving instructor TRAINED in assessing individuals with brain damage (stroke, accident, disease). We worked with a company called "Advanced Driver Rehabilitation" in Aventura (northern Miami). In cases where communication is an issue, the instructor recommended putting a label on the back of the driver's license. The useful information on that label should be:

• Cause / extent of disability (such as "stroke patient with language disability"
• Contact name and telephone of care giver or doctor.
• If patient is on BLOOD THINNERS (or any other relevant IMPORTANT medical alert information) - please note that on there as well). A medical alert bracelet is recommended.

If you find yourself in this challenging situation of having to care for a stroke patient, please accept my best wishes for a quick recovery. The road ahead is no easy, but with the right resources can be managed. To this end, feel free to contact us via the contact page linked in the menu above, and I will be happy to point you to relevant resources. Talking about "resources" - online forums are often very helpful. Living with Stroke - either as a patient or a care giver - is TOUGH. It really helps to talk to others who are - or were - in the same situation.

There are some basic 4 methods to verify whether or not a person had a stroke ...

Ask the person to ...

• smile. If he or she had a stroke, they won't be able to.

• speak a complete sentence

• lift BOTH arms -- A stroke victim either wouldn't be able to, or only partially one arm

• stick out the tongue - if the tongue is uneven, doesn't look as one would usually expect -- that also could indicate a stroke.

Common Symptoms of a Stroke:

• Strokes are typically painless while in progress, except when the stroke is caused by a ruptured blood vessel, in which case the patient will experience a sudden excruciating headache

• Trouble with speech or having difficulty talking; trouble understanding what other people are saying

• Feeling weak or numb on one side of your body, especially if it strikes you suddenly. For example, you may not be able to move your face, one hand or one leg.

• Suddenly having trouble with coordination on one side of the body

• Seeing double or having trouble focusing on objects or people

Victims may experience

• Memory loss
• Tingling sensations on one half of the body
• Confusion
• Nausea
• Stumbling
• Not being able to talk
• Awareness of what is happening but not being able to do anything about it
• Headaches

The two major types of stroke are

• Ischemic Stroke: Accounts for more than 80% of strokes. Results from an interruption in blood flow through a specific artery supplying a specific area of the brain. When brain cells die as a result of this type of stroke, the resulting injury to the brain is called a cerebral infarction.

• Hemorrhagic Strokes: Accounts for slightly less than 20% of strokes. They are caused by a ruptured blood vessel either inside the skull, but outside the brain (known as an extracerebral hemorrhage), or inside the brain (intracerebral hemorrhage). Once a blood vessel ruptures, the resulting hemorrhage (heavy bleeding) damages the brain, resulting in a mass of accumulated blood known as a hematoma, which compresses nearby brain tissue and interferes with its blood supply. The initial arterial rupture has a specific pathological cause that must be determined before treatment can begin.

Ranking of Stroke Severity (Modified Ranking Scale)

0 = No symptoms at all; no limitations and no symptoms.

1 = No significant disability; symptoms present but not other limitations.

Question: Does the person have difficulty reading or writing, difficulty speaking or finding the right word, problems with balance or coordination, visual problems, numbness (face, arms, legs, hands, feet), loss of movement (face, arms, legs, hands, feet), difficulty with swallowing, or other symptom resulting from stroke?

2 = Slight disability; limitations in participation in usual social roles, but independent for ADL.

Questions: Has there been a change in the person's ability to work or look after others if these were roles before stroke? Has there been a change in the person's ability to participate in previous social and leisure activities? Has the person had problems with relationships or become isolated?

3 = Moderate disability; need for assistance with some instrumental ADL but not basic ADL.

Question: Is assistance essential for preparing a simple meal, doing household chores, looking after money, shopping, or traveling locally?

4 = moderately severe disability; need for assistance with some basic ADL, but not requiring constant care.

Question: Is assistance essential for eating, using the toilet, daily hygiene, or walking?

5 = Severe disability; someone needs to be available at all times; care may be provided by either a trained or an untrained caregiver.

Question: Does the person require constant care?

Wilson, L. J. T., Harendran, A., Grant, M., Baird, T., Schultz, U. G. R., Muir, K. W., & Bone, I. (2002). Improving the assessment of outcomes in stroke: Use of a structured interview to assign grades on the Modified Rankin Scale. Stroke, 33, 2243-2246.

Stroke outcome scenarios based on Rankin Scale (Slot & Berge. 2009)

Mild stroke (Modified Rankin Score 1)

• You have a slightly numb feeling in your non-dominant arm as a result of the stroke, but no significant loss of muscle strength.
• You have residual lower facial weakness on one side.
• You are fully independent of others in daily living after this stroke and can walk normally.
• You can think, read, and speak clearly
• You are not incontinent.

Moderately severe stroke (Modified Rankin Score 3)

• Your non-dominant arm is paralyzed and you have reduced muscle strength in one leg.
• You can walk without assistance, but have a slight limp.
• You are independent in daily living, but require some assistance of others in cooking, shopping, and dressing.
• Your speech is slow and unclear, but understandable.
• You can think and read clearly.
• You are not incontinent.

Severe stroke (Modified Rankin Score 5)

• The right side of your body (arm and leg) is completely paralyzed.
• You cannot walk without assistance and need to use a wheelchair.
• You are bedridden most of the time.
• You need help in washing, dressing, and feeding.
• Your speech is slow and unclear, but understandable.
• You can think and read clearly.
• You are incontinent.

Slot, K. B., & Berge, E. (2009). Thrombolytic treatment for stroke: Patient preferences for treatment, information, and involvement. Journal of Stroke and Cerebrovascular Diseases, 18(1), 17-22.

Causes:

Heart disease - including high blood pressure, high cholesterol and diabetes increase your risk of suffering a stroke. Irregular heart beat can cause clots to form in the heart; if the patient experiences atrial fibrillation, clots can break off and release into the blood stream, causing a stroke.

High Blood Cholesterol: When the human blood cholesterol level is higher than that which can be used by the human body, the surplus cholesterol may eventually cause strokes, and or cardiovascular distress. Medications, such as statins prescribed to lower the blood cholesterol, are themselves known to affect our bodies negatively in the long term.

Smoking

Arteriosclerosis / atherosclerosis

Diabetes: Diabetics are 2-4 times more likely to die of a heart attack or suffer a stroke. In a 2002 study, analysis of a group of over 500 patients showed that 40% of patients suffering their first stroke had high glucose levels. Additional mortality in this group was increased. As well, patients with high glucose levels were more likely to have complications after a stroke, and were likely to have much longer hospital stays following a stroke. The study indicates that reducing high glucose levels may also reduce chance of stroke.

Chronic Kidney Disease - like high blood pressure, diabetes and elevated cholesterol levels - leads to an increased risk for heart disease and stroke.

Prehypertension puts you at high risk for developing hypertension (high blood pressure), which in turn increases the risk of a heart attack or stroke.

Magnesium Deficiency: According to the National Academy of Sciences, most Americans are magnesium deficient, which the academy says helps to account for high rates of heart disease, stroke, osteoporosis, arthritis and joint pain, digestive maladies, stress-related illnesses, chronic fatigue and a number of other ailments - Please click on this link for more information.

Certain Drugs / Medications:

• Tamoxifen: The leading breast cancer drug Tamoxifen can indeed reduce breast cancer occurrence in certain high-risk women, but it also hikes your risk for blood clots, stroke and uterine cancer. In a recent British study, breast cancer patients who switched from tamoxifen to an aromatase inhibitor (AI) had a much lower death risk -- and were less likely to have the cancer spread. In fact, indications are that aromatase inhibitors are up to 44% more effective for many women over 40.




• Menopause Drugs: Standard HRT drugs make estrogen dominance worse, as they provide estrogen - but contain NO natural progesterone. Instead, they use a synthetic form called progestin, which does not protect women from breast and other cancers. In fact, it puts women at increased risk for stroke, epilepsy and asthma.

Prevention:

Exercise: Dr. Steven Hooker of the University of South Carolina's Prevention Research Center lead a study that found that men who did the most cardiovascular exercise had a 40 percent lower risk of a stroke than those who did the least. For women, there was a 43-percent lower risk. To lower your risk, the recommendation is to get at least 30 minutes of moderate-intensity physical actvity on all or most days.

Blood Sugar Control / Diabetes Studies show that control of high blood sugar can significantly help decrease chances of several very serious conditions, including strokes. It is recommended that people, particularly over the age of 40, have yearly blood glucose tests to rule out diabetes, and the development of greater risk factors for stroke, cancer and cognitive impairment. Screening is especially important for people at high risk of developing diabetes, such as those with a family history of diabetes, those who are overweight, and those who are more than 40 to 45 years old.

• Click here for information on blood glucose levels.

Supportive Nutrition:

• Vitamin E: This well-known antioxidant significantly slows the progression of Alzheimer's and stroke-related dementia. However, research shows that overdoing it with too much vitamin E does more harm than good. (Recommended dosages are usually between 30 mg to 400 mg per day - discuss with your doctor). (Vitamin E also has application in Cancer Treatments)

• Flaxseeds have the highest ALA and lowest LA, thus can help improve the imbalance in essential fatty acids. ALA has many benefits, one of them is to protect the heart in two ways – through improvements in abnormal heart rhythms and a reduction of blood platelet stickiness. ALA also reduces LDL or “bad” cholesterol and lipoprotein levels for the prevention of heart attacks and stroke.

• Bananas are high in potassium yet low in salt, making it perfect to beat blood pressure. So much so, the US Food and Drug Administration has just allowed the banana industry to make official claims for the fruit's ability to reduce the risk of blood pressure and stroke. According to research in The New England Journal of Medicine, eating bananas as part of a regular diet can cut the risk of death by strokes by as much as 40%!

• Ginkgo biloba improves the blood supply and circulation to the brain as it does to other parts of the body, which can only have a positive effect on the memory and other cognitive functions of the organ. Moreover, improved circulation along with ginkgo biloba’s anti-oxidant properties play a major role in protecting against the circulatory problems which can lead to stroke.

• Organic Raw Chocolate: Another study compared how blood platelets responded to a flavonol-rich cocoa drink with 25 grams of semi-sweet chocolate pieces and a blood-thinning, 81-milligram aspirin dose. The research found similar reactions to the two from a group of 20- to 40-year-olds: both the drink and the aspirin prevented platelets from sticking together or clotting, which can impede blood flow. In conclusion, flavonol-rich cocoa and chocolate act similarly to low-dose aspirin in promoting healthy blood flow. Reducing the blood's ability to clot also reduces the risk of stroke and heart attacks.

• Omega-3 and Omega-6 Fatty Acids: Evidence is accumulating that diseases, such as Obesity, hypertension, insulin resistance, and stroke, are the result of high levels of omega-6 fatty acids and low levels of omega-3 fatty acids along with deficiencies of fat-soluble vitamins.
  • In 1998, data from the Physicians’ Health Study showed that eating fish once a week versus less than once monthly halved the likelihood of dying suddenly from a heart attack. Total heart attack rates were not affected by fish consumption or the amount of omega-3 fatty acids ingested. One year later, a report in Lancet described a randomized trial in which men who’d had a heart attack received either a fish oil supplement, 300 mg of vitamin E, both, or neither. The groups who received the fish oil supplement had significantly lower rates of heart attack, stroke, and death during the next three and a half years. Rates of sudden death dropped by 45%.
  • Report on nearly 80,000 women in the Nurses’ Health Study: Published in 2001 in the Journal of the American Medical Association, this 14-year study found that eating fish at least twice a week versus less than once a month cut in half the risk of strokes caused by clots blocking an artery to the brain. The Nurses’ Health Study also found that eating one to three servings of fish per month cut the risk of heart disease by 20%, while eating at least five servings a week lowered risk by 40%.
    

• Kiwifruit help lower triglyceride levels, and they reduce platelet clumping. The platelet effect could be particularly good for your ticker: Although platelets aid in blood clotting, when these cells stick together too much, it could set the stage for a heart attack or stroke.

• Bell Peppers contain vitamin B6 and folic acid, which are important for reducing high levels of homocysteine, a substance produced during the methylation cycle. High homocysteine levels have been shown to cause damage to blood vessels and are associated with a greatly increased risk of heart attack and stroke. In addition to providing the vitamins that convert homocysteine into other beneficial molecules, bell peppers also provide fiber that can help lower high cholesterol levels, another risk factor for heart attack and stroke.

• Vinpocetine is derived from common periwinkle leaves and used as a stroke treatment in Eastern Europe and Japan. It improves the flexibility of red blood cells, which allows them to flow more freely through the brain's smaller vessels, providing damaged neurons with the benefits of enhanced circulation. Vinpocetine is not recommended for dementia not caused b vascular issues. (5 mg to 10 mg daily may be recommended by health practitioners - discuss with your health practitioner).

• Peas are full of folate, a powerful B vitamin known to lower blood levels of a stroke-promoting compound.

• Cranberries ... Grapes ... Peanuts

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