Download Ischemic strokes

Stroke:
Ischemic strokes:
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Stroke Risk Factors:
What Patients and Families Should Know
Evaluating the risk for stroke is based on heredity, natural process and lifestyle. Many risk factors for stroke can be
changed or managed, while others that relate to hereditary or natural processes cannot be changed.
Risk factors that you and your health care provider can change, treat or control:
High blood pressure – The most important controllable risk factor for stroke is controlling high blood pressure. In an
adult, high blood pressure is defined as a systolic pressure of 140mm Hg or higher and /or a diastolic pressure of 90
mm Hg or higher for an extended time. Goal blood pressure is 120/80mm Hg.
High blood cholesterol and lipids – High blood cholesterol and lipids increase the risk
for stroke. Diet: diets high in salt can increase blood pressure. Excess calories lead to obesity. Fruits and veggies can
decrease risk of stroke. A poor diet has lots of saturated fats and/or trans fats.
Diabetes mellitus – Diabetes is treatable, but having it increases the risk for stroke.
Atrial fibrillation – This heart rhythm disorder raises the risk for stroke because the heart’s upper chambers quiver
instead of beating effectively. This lets the blood pool and clot. If a clot breaks off, enters the blood stream and
lodges in an artery leading to the brain, a stroke results.
Carotid and other artery disease – The carotid arteries in the neck supply blood to the brain. When the carotid
arteries are narrowed by atherosclerosis (plaque in artery walls), they may become blocked by a blood clot. People
with peripheral artery disease (narrowed blood vessels in legs/arms) have a higher risk of carotid artery disease,
which raises their risk of strokes.
Other heart disease – People with coronary heart disease or heart failure have a higher risk of stroke as those with
hearts that work normally. Dilated cardiomyopathy (an enlarged heart), heart valve disease and some types of
congenital heart defects may also increase the chance of stroke.
Certain blood disorders – A moderate increase in the number of red blood cells thickens the blood and makes clots
more likely, thus increasing the risk of stroke. Sickle cell anemia increases risk of stroke because the “sickled” cells
tend to stick to vessel walls, which can block arteries to the brain, causing a stroke.
Physical inactivity and obesity – Being inactive and/or obese can increase your risk of high blood pressure, high blood
cholesterol, diabetes, heart disease and stroke.
Cigarette smoking – Smoking is the number one preventable risk factor for stroke. The nicotine and carbon
monoxide in tobacco smoke reduce the amount of oxygen in your blood. They also damage the walls of blood
vessels, making clots more likely to form. Using some kinds of birth control pills combined with smoking cigarettes
greatly increases stroke risk.
Excessive alcohol use – More than two drinks per day in men, or more than 1 drink/day in women is considered
excessive. This can raise blood pressure, and binge drinking can lead to stroke.
Illegal drug abuse – Intravenous drug abuse carries a high risk of stroke. Cocaine, amphetamine, and heroin use have
been linked to strokes and heart attacks. Some have been fatal even in first-time users.
IT IS VERY important that you follow up with your Primary Care Physician soon after your discharge from the
hospital to continue addressing your controlable risk factors for stroke.
Risk factors for stroke that cannot be changed:
Age – Stroke happens to people of all ages, including children. But the older you are, the greater your risk for stroke.
Sex (gender) – Stroke is more common in men than women. However, more women than men die of strokes. Use of
birth control pills and pregnancy pose special risks for women.
Heredity (family history) and race – The chance of stroke is greater for someone whose parent, grandparent, sister or
brother has had a stroke. African Americans have a much higher risk of death and disability from a stroke than
Caucasians do, in part because the African American population has a greater incidence of high blood pressure.
Prior stroke, TIA, or MI increases risk of another stroke. A TIA is a “warning stroke” that does not cause long-term
damage but is a strong predictor of future stroke. Recognizing and treating TIAs can reduce the risk of a major
stroke. It is very important to recognize the warning signs of a TIA or stroke. Call 9-1-1 to get medical help
immediately if they occur! Do not take these lightly!
Virginians live in part of the “stroke belt”; strokes are more common in the Southeastern United States than in any
other part of the country.
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STROKE TESTS: What patients and families should know
Advances in technology now make it possible to examine how the brain looks, functions and get its blood
supply. These tests can outline the affected part of the brain and help define the problem created by stroke.
WHAT IMAGING TESTS MAY BE DONE?
Computerized Tomography (CT or CAT scan) is a test that uses a combination of x-rays and computer technology to
produce pictures of the brain and neck. For a CT Scan, the patient is placed flat on the x-ray table with their head
placed inside the scanner. The patient is asked to remain very still. Sometimes, a CT Angiogram (CTA) is done to look
at the blood vessels of the brain and neck. To do this an IV line will be placed and contrast dye will be injected as the
pictures are taken. The time required to do the CT scan varies, but is usually about 15 minutes. Additional time is
required for the patient to travel to and from the radiology department.
Magnetic Resonance Imaging (MRI/MRA, DWI) is a diagnostic procedure that uses a combination of large magnets,
radiofrequencies, and a computer to produce detailed images of the brain and other parts of the body. During a MRI
the patient will be asked to lie flat and still on a narrow table inside the round opening of a large magnet. During the
exam, humming and clicking sounds will be heard as the images are taken. Because the MRI uses a magnet to
produce pictures, a worksheet is completed by the patient or family to screen for metal prior to the MRI. The opening
to the MRI scanner is small and makes some people feel claustrophobic, so medications may be given to help the
patient relax during the MRI. The length of time needed for the MRI varies a lot depending on the type of pictures
needed.
Carotid Doppler ultrasound test uses high-frequency sound waves to detect blockages in the carotid arteries that
feed blood to the brain. A probe is placed on the patient’s neck and ultrasound images are taken. This test may be
done at the patient’s bedside or in a special room in the radiology department.
Cerebral Angiography (A-gram) is a test that injects dye into the cerebral arteries, providing information about the
blood vessels of the brain. A thin tube (catheter) is placed in the large artery of the leg and fed up to the neck and
head. Dye is injected to outline the blood vessels. Several injections are required. After each injection of dye, x-rays
are taken to look at the circulation of the blood in the brain. After the test, the catheter is removed from the leg and
pressure is applied to the insertion site. The patient must lie still for several hours after the test is completed.
Echocardiogram (ECHO) is a test that uses ultrasound (high-frequency sound waves) to produce moving images of the
heart beating on a video screen, evaluating the heart size and valves. One cause of stroke is a clot forming in the heart
and then traveling to the brain, so an echo is often ordered on patients after a stroke.
APHASIA: What Patients and Families Should Know
What is aphasia?
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Aphasia is defined as a language disorder that usually results from damage to the left side or hemisphere of
the brain. Depending on what area of the brain has been damaged, there may be differences in the type of
aphasia. Aphasia usually occurs suddenly, with a stroke or brain injury, but can occur slowly, in the case of a
brain tumor.
Some people with aphasia have difficulty with expression of language (expressive aphasia), some have
difficulties understanding language (receptive aphasia) and others have difficulties with both areas (global
aphasia). Aphasia can also cause difficulties with reading and writing.
It is estimated that about 1 million people in the United States have aphasia.
Not all strokes cause aphasia, but about 20% of people who have strokes suffer a serious loss of speech and
language. Some people recover quickly, while others will have permanent difficulties. A speech-language
pathologist (SLP) works with patients to help rehabilitate speech and language function.
How can I help communicate with an aphasic person?
Remember that the patient’s intelligence has not decreased. Always keep in mind that the aphasia is probably very
frustrating for the patient too, and s/he is trying to communicate effectively.
General Guidelines:
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Try to communicate in a quiet environment with no distractions (turn off the TV, radio, and limit the number
of people talking at one time).
Do not use baby talk, talk to the person in a normal tone, loudness, and intonation.
Use shorter, simple statements and questions, rephrase if the person does not understand.
You can pause often when talking, giving the person time to understand and respond.
Use other forms of communication to reinforce your words (i.e. gestures, facial expressions, pointing, written
words, and pictures).
Accept any form of communication from the person with aphasia.
When asking a question to the person you can use YES and NO questions, give them choices, or use pictures
to reinforce your words.
If the person is having trouble speaking (expressive aphasia):
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phrase questions in such a way that s/he can answer yes or no
avoid pressuring him/her; give additional time for responses
encourage gesturing/pointing
do not interrupt the patient when s/he is trying to speak; avoid the temptation to talk for him/her if s/he is
trying to get his/her words out
if you are not sure exactly what s/he said, ask if your interpretation is correct
if you do not understand a message, begin by asking broad yes/no questions, and then narrow the topic with
more specific yes/no questions (for example, “Does something hurt?” “Is it your leg?,” “Is it your stomach?,”
“Is it your head?”)
if the patient can write or draw what s/he can not say, provide him/her with a pad and pencil
remember that s/he can probably understand what is being said; do not talk about the patient as if s/he is
not present
If the person is having trouble understanding (receptive aphasia):
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use short statements and questions; keep explanations short and simple
speak slowly and give him/her additional time to process what you say
look directly at the patient when speaking
if the patient fails to understand you, try repeating or rewording what you have said
only one person should speak to the patient at a time; turn off TV and radio
accompany your words with gestures, objects or pictures if possible
keep the topics you discuss with the patient relevant and familiar so that s/he can relate to what you say
NEGLECT: What Patients and Families Should Know
What is neglect?
Neglect frequently occurs when someone has a stroke in the right side of their brain. Generally speaking, neglect is
just that – inattention of their body, things or people on the left side. (Some people neglect their right side but this is
less common; if this is the case with your family member, switch right with left in the information written
below.) Problems that result from neglect can range from mild to severe. The more fortunate individuals are aware
of it and can make conscious efforts to compensate for it. Some, however, are completely unaware they have this
deficit.
What are the symptoms of neglect?
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Paying less attention to their left side
Difficulty finding things on the left
Unable to look or turn to the left
Unable to recognize one’s left arm or leg as their own
Ignoring (though not on purpose) anything or anyone to their left
Only eating things on the right side of their plate
Difficulty or fear of moving about in crowded areas
Startled by moving objects or people
Forgetting to dress the left side of the body
Bumping into doorways or objects on the left
Missing words on the left side of a page when reading or frequently losing one’s place
Below is a clock that was drawn by someone with left neglect
How is neglect treated?
Like other symptoms associated with a stroke, neglect can improve. Unfortunately, there is no medicine or simple
cure for neglect. Symptoms can improve over time; to what extent depends on the amount of damage in the
brain. Those who are aware that they have neglect do best.
What can I do to help someone with neglect?
The affected person should be encouraged to attend to the left side of their body and the environment. Approach
them from the left whenever possible, and encourage them to look at you when you are speaking. Provide as much
stimulation to the affected side as he or she can tolerate! Other tips:
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Constantly remind the person to turn their head and “look to the left” for lost objects, this is especially
important when walking or eating
Help them complete the exercises given to them by their physical therapist (PT) or occupational therapist
(OT).
Place items that the person finds motivating (pictures, TV, drinks/snacks) on the left.
Encourage the person to attend to their neglected side by positioning their arm/leg when turning in bed,
sitting in chair, and when performing self- care activities-ask nursing or OT/PT if you need guidance.
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People who have neglect should not drive!
Please remember that neglect can have serious safety
implications, especially if the person is unaware of their
deficits.
What’s the take-home message?
If you need to have an important conversation with a person who has left neglect speak with them on their right side
to ensure they are attending to you. They will be more likely to remember it. However, for general conversation with
someone who has neglect, spend at least part of your time on their left side. Place items that are important to the
person on the left to encourage them to look and reach to the left.
Educating the individual with neglect is important!
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Stroke Websites and support groups:
http://www.healthsystem.virginia.edu/docs/per/stroke-websites-and-supportgroups/at_download/perdocument