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 What are the warning signs of stroke?
Know that not everyone gets all of the following warning signs. And, sometimes these signs can go away and return. Treatments are most effective if given within one hour of when the attack begins. If you have any of these symptoms, call 911 right away!
- Sudden numbness or weakness of face, arm, or leg, especially on one side of the body.
- Sudden confusion or trouble speaking or understanding speech.
- Sudden trouble walking, dizziness, or loss of balance or coordination.
- Sudden severe headache with no known cause.
- Blurred or double vision, drowsiness, and nausea or vomiting.
What is a stroke?
A stroke is the sudden loss of brain function caused by the interuption of blood flow to the brain or when a blood vessel in the brain bursts. This interuption of blood flow or the rupture of blood vessels causes the brain cells in the affected area to die. Your brain needs the oxygen and nutrients supplied by the blood to keep your body and systems functioning properly.
 What is a "mini-stroke" or TIA?
A "mini-stroke" refers to a transient ischemic attack (TIA). In a TIA, there is a short-term reduction in blood flow to the brain. This causes temporary stroke symptoms (often just for a few minutes) such as weakness or tingling in an arm or leg.
TIAs don't cause brain damage, but they are important warning signs that a person is at risk of having a stroke. If you have a TIA, you should seek medical care right away to prevent a full stroke.
In a healthy, functioning brain, neurons do not come into direct contact with blood. The vital oxygen and nutrients the neurons need from the blood come to the neurons across the thin walls of the cerebral capillaries. The glia (nervous system cells that support and protect neurons) form a blood-brain barrier, an elaborate meshwork that surrounds blood vessels and capillaries and regulates which elements of the blood can pass through to the neurons.
When an artery in the brain bursts, blood spews out into the surrounding tissue and upsets not only the blood supply but the delicate chemical balance neurons require to function. This is called a hemorrhagic stroke. Such strokes account for approximately 20 percent of all strokes.
Hemorrhage can occur in several ways. One common cause is a bleeding aneurysm, a weak or thin spot on an artery wall. Over time, these weak spots stretch or balloon out under high arterial pressure. The thin walls of these ballooning aneurysms can rupture and spill blood into the space surrounding brain cells.
Hemorrhage also occurs when arterial walls break open. Plaque-encrusted artery walls eventually lose their elasticity and become brittle and thin, prone to cracking. Hypertension, or high blood pressure, increases the risk that a brittle artery wall will give way and release blood into the surrounding brain tissue.
A person with an arteriovenous malformation (AVM) also has an increased risk of hemorrhagic stroke. AVMs are a tangle of defective blood vessels and capillaries within the brain that have thin walls and can therefore rupture.
Bleeding from ruptured brain arteries can either go into the substance of the brain or into the various spaces surrounding the brain. Intracerebral hemorrhage occurs when a vessel within the brain leaks blood into the brain itself. Subarachnoid hemorrhage is bleeding under the meninges, or outer membranes, of the brain into the thin fluid-filled space that surrounds the brain.
The subarachnoid space separates the arachnoid membrane from the underlying pia mater membrane. It contains a clear fluid (cerebrospinal fluid or CSF) as well as the small blood vessels that supply the outer surface of the brain. In a subarachnoid hemorrhage, one of the small arteries within the subarachnoid space bursts, flooding the area with blood and contaminating the cerebrospinal fluid. Since the CSF flows throughout the cranium, within the spaces of the brain, subarachnoid hemorrhage can lead to extensive damage throughout the brain. In fact, subarachnoid hemorrhage is the most deadly of all strokes.
 Healthy steps to prevent a stroke
The more stroke risk factors you have, the greater the chance that you will have a stroke. You can't control some risk factors, such as aging, family health history, race and gender. But you can change or treat most other risk factors to lower your risk.
Here are some healthy ways to prevent stroke:
What are the effects of stroke?
A person who has a stroke may suffer little or no brain damage and disability, especially if the stroke is treated promptly. But stroke can lead to severe brain damage and disability, or even death.
The type of disability caused by a stroke depends on the extent of brain damage and what part of the brain is damaged.
Stroke may cause paralysis or weakness of one side of the body, memory problems, mood changes, trouble speaking or understanding speech, problems with eating and swallowing, pain, depression, and other problems. Rehabilitation and medical treatment can help a person recover from the effects of stroke and prevent another stroke from occurring.
Where can stroke occur in the brain and how does that affect the body?
The brain is a complex organ. Each area of the brain is responsible for a particular function or ability. The brain is divided into four main parts: the right hemisphere (or half), the left hemisphere, the cerebellum and the brain stem.
A stroke in the right hemisphere of the brain often causes paralysis in the left side of the body. This is known as left hemiplegia. In addition, a stroke in this part of the brain may cause:
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Problems with spatial and perceptual abilities. For example, the stroke survivor may misjudge distances and fall, or be unable to guide her hands to pick up an object.
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Impaired judgment and behavior. For example, she may try to do things that she should not attempt to do, such as trying to drive a car.
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Problems with short-term memory. Although she may be able to recount events from 30 years ago, she may be unable to remember what she ate for breakfast that morning.
Someone who has had a left hemisphere stroke may have right hemiplegia, paralysis of the right side of the body. She may also have:
- Aphasia - speech and language problems.
- Slow and cautious behavior, in contrast to the behavior of a right-hemisphere stroke survivor. She may need a lot of help to complete tasks.
- Memory problems similar to those of right-hemisphere stroke survivors. For example, she may have trouble learning new information and have poor short-term memory.
A stroke that takes place in the cerebellum can cause:
- Abnormal reflexes of the head and torso
- Coordination and balance problems
- Dizziness, nausea and vomiting.
Strokes that occur in the brain stem are especially devastating. The brain stem is the area of the brain that controls all of our involuntary "life-support" functions, such as breathing rate, blood pressure and heartbeat. The brain stem also controls abilities such as eye movements, hearing, speech and swallowing.
Since impulses generated in the brain's hemispheres must travel through the brain stem on their way to the arms and legs, patients with a brain stem stroke may also develop paralysis in one or both sides of the body.
 Who is at risk for stroke?
Stroke risks are higher in people who have a family or personal history of stroke and for African Americans. African American women have a higher risk of disability and death from stroke than Caucasian women do.This is partly because more African American women have high blood pressure, a major stroke risk factor.
Age is also a factor: the chance of having a stroke more than doubles for each decade of life after age 55. Women who smoke or who have high blood pressure, heart disease, or diabetes are at greater risk of having a stroke. Hormonal changes with pregnancy, childbirth, and menopause are also linked to an increased risk of stroke.
 Are Children at Risk For Stroke?
The young have several risk factors unique to them. Young people seem to suffer from hemorrhagic strokes more than ischemic strokes, a significant difference from older age groups where ischemic strokes make up the majority of stroke cases. Hemorrhagic strokes represent 20 percent of all strokes in the United States and young people account for many of these.
Clinicians often separate youth into two categories: those younger than 15 years of age, and those 15 to 44 years of age. People 15 to 44 years of age are generally considered young adults and have many of the risk factors mentioned above, such as drug use, alcohol abuse, pregnancy, head and neck injuries, heart disease or heart malformations, and infections. Some other causes of stroke in the young are linked to genetic diseases.
Medical complications that can lead to stroke in children include intracranial infection, brain injury, vascular malformations such as moyamoya syndrome, occlusive vascular disease, and genetic disorders such as sickle cell anemia, tuberous sclerosis, and Marfan's syndrome.
The symptoms of stroke in children are different from those in adults and young adults. A child experiencing a stroke may have seizures, a sudden loss of speech, a loss of expressive language (including body language and gestures), hemiparesis (weakness on one side of the body), hemiplegia (paralysis on one side of the body), dysarthria (impairment of speech), convulsions, headache, or fever. It is a medical emergency when a child shows any of these symptoms.
In children with stroke the underlying conditions that led to the stroke should be determined and managed to prevent future strokes. For example, a recent clinical study sponsored by the National Heart, Lung, and Blood Institute found that giving blood transfusions to young children with sickle cell anemia greatly reduces the risk of stroke. The Institute even suggests attempting to prevent stroke in high-risk children by giving them blood transfusions before they experience a stroke.
Most children who experience a stroke will do better than most adults after treatment and rehabilitation. This is due in part to the immature brain's great plasticity, the ability to adapt to deficits and injury. Children who experience seizures along with stroke do not recover as well as children who do not have seizures. Some children may experience residual hemiplegia, though most will eventually learn how to walk.
 How is stroke diagnosed?
Before a stroke can be treated, diagnostic tests must be performed. Health care providers must find out what kind of stroke it is to treat it correctly. A person thought to be having a stroke may have a neurological exam, blood tests and an electrocardiogram.
Other kinds of tests used in diagnosing stroke include:
How is stroke treated?
Strokes caused by blood clots can be treated with clot-busting drugs such as TPA (tissue plasminogen activator). TPA must be given within 3 hours of the start of a stroke to be effective, and tests must be done first. This is why it is so important for a person having a stroke to get to a hospital fast.
Other medicines are used to treat and to prevent stroke. Anticoagulants such as warfarin and antiplatelet agents such as aspirin interfere with the blood's ability to clot and can play an important role in preventing stroke.
Surgery is sometimes used to treat or prevent stroke. For example, carotid endarterectomy is the surgical removal of fatty deposits clogging the carotid artery in the neck that could lead to a stroke. For hemorrhagic stroke, surgical treatment may include placing a metal clip at the base of an aneurysm or removing abnormal blood vessels.
What about stroke rehabilitation?
Rehabilitation is a very important part of recovery for many stroke survivors. The effects of stroke may mean that you must change, relearn or redefine how you live. Stroke rehabilitation is designed to help you return to independent living.
Rehabilitation doesn't reverse the effects of a stroke. Its goals are to build your strength, capability and confidence so you can continue your daily activities despite the effects of your stroke. Rehabilitation services may include:
The information in this FAQ was adapted from the Office on Women's Health in the Department of Health and Human Services.
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