Beating the Brain Attack: An Overview of Strokes

Some people call them “brain attacks.” Some refer to them as “cerebrovascular accidents.” No matter what you call it, strokes are serious business, and can be deadly. According to the American Stroke Association, nearly 800,000 Americans have a new or recurrent stroke each year, which amounts to one stroke every 40 seconds. The American Heart Association also notes that strokes are the fourth leading cause of death in America. If strokes run in your family, you may have some predispositions toward this frightening medical event. However, there are things you can do to discourage the onset of a stroke even if you have a condition that makes you more susceptible. Adapting to a healthy lifestyle and working closely with your doctor at the first warning sign, you may be able to beat the “brain attack” before it beats you.

What is a Stroke?

If a blood clot blocks an artery, a blood vessel breaks, or any other rupture occurs causing an interruption in oxygen-rich blood flow to the brain, a stroke happens. Brain cells quickly die without access to oxygen. Hemorrhaging in the brain can damage valuable brain cells. The actions that take place during a stroke reflect what happens to the parts of the body that are connected to the damaged brain cells. For example, the dead or damaged brain cells may cause paralysis, slurred speech, and poor eyesight. In the effect of a stroke, the damage may be irreversible, with the outcome of a long-term disability. Some don’t survive them, as strokes can also be fatal. There are two common types of strokes; ischemic strokes are when oxygen-rich arteries supplying blood to the brain become blocked, whereas hemorrhagic strokes are when an artery in the brain ruptures or leaks blood, causing a pressure that damages the brain cells. Ischemic strokes are more common. High blood pressure and aneurysms may be precursors for hemorrhagic strokes.

Ischemic strokes can be broken down further into either thrombotic strokes or embolic strokes. In a thrombotic stroke, a blood clot in an artery blocks blood supply to the brain. However, in an embolic stroke, a blood clot or other kind of substance that travels via bloodstream gains access to an artery in the brain. This could be a piece of plaque or fatty secretion, both of which would cause harm. Regardless of embolic or thrombotic, the main concern is the blocked blood flow, depriving the brain of oxygen. There are also two types of hemorrhagic strokes — intracerebral and subarachnoid. Intracerebral hemorrhaging is defined by a leaking or ruptured blood vessel in the brain, while subarachnoid hemorrhaging is when a blood vessel specifically on the surface of the brain leaks or ruptures, causing bleeding between the inner and middle membranes covering the brain. Either way, the leaking causes swelling, and the brain can only expand so much within the confines of the skull. The increased pressure causes cell damage.

There are also what are referred to as “mini strokes,” or transient ischemic attacks. Mini strokes occur when blood flow to the brain is only briefly blocked, resulting in damage, but not permanent or long-lasting damage. Both ischemic strokes and ischemic attacks are usually caused by blood clots. Having a mini-stroke may not be as serious as a full-on stroke, but they still require immediate emergency attention and one should always be cautious if they occur as they often lead to regular strokes. Thus, if you have a mini stroke, you should diligently work with your doctor to determine the cause and take the necessary steps towards stroke prevention. With any kind of stroke, mini or full blown, being treated as quickly as possible can minimize the lasting damage, so it should always be immediately tended to.

If you think you’re having a stroke, act quickly. The symptoms may develop over minutes, hours, or days depending on the circumstance, but you may experience partial paralysis, weakness, confusion, vision or respiratory problems, the inability to understand or communicate with speech, an abnormally severe headache, or even loss of consciousness. All of these symptoms should be cause for alarm in any scenario, especially if they occur seemingly out of nowhere.

Risk Factors and Stroke-Causing Conditions

Some of your natural-born traits may predispose you toward strokes. At other times, your lifestyle choices may be behind the development of a stroke. Smokers should be especially wary of strokes, because their habit can cause a myriad of problems over time culminating to a stroke. For example, continuous smoking causes a raise in blood pressure and damage to your blood vessels. Oxygen may not reach your tissue as effectively causing tissue death. Likewise, if you are overweight or otherwise eat an unhealthy diet, you are more susceptible to having a stroke. Alcohol and drug consumption can encourage a stroke, as can excessive stress or depression. Your risks for developing a stroke increase with age. Even your ethnicity can determine whether you are more likely to have a stroke; African American, Alaska Native, and American Indian adults tend to have more strokes than Caucasian, Hispanic, or Asian American adults, according to the American Heart Association.

There are also some conditions that commonly cause strokes, some of which you may have no control over. Atherosclerosis, a condition in which plaque grows on the inner walls of arteries, can be a precursor for a stroke. As the plaque builds up, it hardens, narrowing the arteries such that blood can’t get through adequately to tissues and organs within the body. It can also crack or break open, causing blood platelets to form at the site of the injured plaque, which can result in a blood clot. Blood clots, too, can block off an artery. The main arteries to be concerned about are the carotid arteries, which supply blood containing oxygen to the face, scalp, brain, and neck. Carotid artery disease is a disease specific to plaque build-up in these crucial arteries and is another disease that has a high propensity for causing ischemic strokes. In terms of embolic strokes, atrial fibrillation can be a common cause. Atrial fibrillation is a heart condition in which the heart contracts irregularly, causing a bit of blood to collect in the heart. As the blood gathers there, blood clots may form in the heart chambers. Diabetes points to an increased risk for strokes. A number of heart diseases, such as coronary heart disease, cardiomyopathy, heart failure, and atrial fibrillation can cause blood clots that can lead to a stroke.

Hemorrhagic strokes are most commonly caused by conditions such as high blood pressure, arteriovenous malformations, and aneurysms. Your blood pressure is considered to be within a dangerous range if it consistently sits around 140/90 mmHg or higher. Both arteriovenous malformations and aneurysms are defined by faulty arteries. In an aneurysm, arteries can burst from bulges within. Arteriovenous malformations occur when your arteries are tangled, allowing for them to rupture inside the brain.

Treatment Options

Different kinds of strokes require different treatment methods, given their varying causes. Thrombolytics are drugs that help promote blood flow to the brain by dispelling the clots. They work most effectively if they are given shortly after the stroke has occurred. A common brand name of a thrombolytic drug is Activase. The patient may also need tissue plasminogen activators, or tPAs, natural enzymes that convert or stimulate plasminogen into another enzyme such that it may dissolve the blood clot. Doctors may use tPA in an IV, sometimes in combination with a thrombolytic drug. Yet again, time is of the essence with this treatment, and patients are only eligible to receive tPA if they have caught the stroke quickly. If the patient is not eligible for tPA or thrombolytic drugs, the Merci Retriever may be implemented. The Merci Retriever is a device that captures, retrieves, and subsequently removes blood clots. Most physicians in America use the Merci Retriever system as treatment because there is no special window for usage. Even if the stroke occurred many hours prior, it is an effective form of treatment and will not cause the patient harm, whereas Activase can cause hemorrhaging and must be used as quickly as possible after the stroke has occurred.

The newest treatment option for stroke patients is the Penumbra System, which became available in 2004. It works to re-vascularize blood vessels for patients undergoing an ischemic stroke, removing occlusions where necessary. The process is somewhat daunting. The device is inserted through the patient’s groin and then a miniscule catheter is threaded into a blood vessel. The catheter weaves all the way to the neck, where an even smaller catheter is released, which snakes its way up to the brain. It is then able to vacuum out the offending blood clots. Specialists of the Penumbra System undergo years of training to be able to administer such a delicate procedure. Yet, it has a much more marginalized risk for bleeding than tPA drugs and can be used outside of the three-hour window required by tPA treatment.

Stents may also be an effective treatment option. Dr. Tudor Jovin, co-director of UPMC’s Center for Endovascular Therapy, conducted a recent study which found that stenting procedures were successful in opening internal carotid arteries deep within the neck in 23 of 25 participants. Stents have been used to remove plaque from carotid arteries for some time, as they re-enable the plaque to move readily through the artery and prevent blockages.

After a stroke, getting adequate exercise and proper nutrition can go a long way on the road toward recovery and the prevention of another stroke down the line. Whether you’ve suffered a stroke or not, you should maintain a healthy diet and weight range, keep your cholesterol levels, blood pressure, and blood sugar in check, and be sure to get a little physical activity in every day. While there are many causes for a stroke that you can’t prevent, there are also many that you can prevent by simply being healthy, and that is also an important part of maintaining a stroke-free existence after you’ve already had one.

New Age Treatment

There have been some recent developments on what is referred to as the “new age” medical front towards a treatment called infrared laser therapy, which is specifically targeted towards ischemic strokes. The NeuroThera Laser System uses an infrared laser technology backed by photobiostimulation, both in vitro and vivo. The wavelengths used in the therapy do not have the same risks that UV light wavelengths have, and the infrared wavelengths are able to penetrate the body and into the brain. From there, photobiostimulation occurs, which drives the formation of ATP and effectively results in “improved energy metabolism, enhanced cell viability, and may also involve prevention of apoptosis in the ischemic penumbra and enhancement of neurorecovery mechanisms,” according to the article, Infrared Laser Therapy for Ischemic Stroke: A New Treatment Strategy.

Many will also vouch for stroke rehabilitation acupuncture therapy, which is acupuncture targeted towards stroke victims. Also called “Xing Nao Kai Qiao” therapy, stroke patient acupuncture was created in the 1970s by a team at the Tianjin University of Traditional Chinese Medicine in China, and their studies showed that it made a huge difference in stroke patient recovery time. The acupuncture is so effective, according to Huffington Post blogger and licensed acupuncturist Atsuki Maeda, because it “loosens up affected muscle groups,” enabling patients to undergo rehabilitation after a stroke much faster. Many patients suffer muscle contractions leading to restricted joint movement known as spasticity, and the acupuncture reverses this process so they can be on the road to recovery more rapidly.