ISCHEMIC STROKE

GENERAL INFORMATION:

What is an ischemic stroke? An ischemic (is-KE-mik) stroke is a condition that affects the brain and the blood vessels supplying it. This happens when blood flow to a part of the brain suddenly decreases or stops. Blood carries oxygen and other nutrients to parts of the brain. When oxygen cannot get to the brain, brain cells may become damaged or even die. An ischemic stroke may begin suddenly and develop quickly. It can cause death of brain tissue within minutes to hours. Body functions, such as walking or talking, are controlled by certain areas of your brain. An ischemic stroke can cause body functions controlled by areas of the brain to be lost.

What causes an ischemic stroke? An ischemic stroke may be caused by any of the following:

• A piece of fatty plaque formed in a blood vessel may break away and go to the brain. When this plaque blocks an artery (blood vessel), it causes an embolic stroke.
  
• A thrombus (blood clot) formed in an artery that supplies blood to the brain may cause a thrombotic stroke.
  
• A lacunar stroke happens when small blood vessels deeper inside your brain get blocked.
  
• In some cases, the cause of an ischemic stroke is not known.

What puts me at a higher risk of having an ischemic stroke? The risk of having an ischemic stroke increases as you get older, and is higher in men than women. The following factors put you at a higher risk of having an ischemic stroke. These factors also make it more likely for the signs and symptoms of a stroke to get worse:

• Atherosclerosis (hardening of the arteries) or cholesterol (fat) deposits on artery walls.
  
• Cigarette smoking, drinking too much alcohol, or using street drugs such as cocaine, amphetamines, or heroin.
  
• Health conditions, such as high blood pressure, diabetes (high blood sugar), and high blood cholesterol levels.
  
• Heart disease, such as coronary artery disease.
  
• Women who are pregnant, or in menopause and using hormone therapy.
  
• Weighing more than what your caregiver suggests.
  
• You or a close family member has had a stroke in the past.

What are the signs and symptoms of an ischemic stroke? Signs and symptoms depend on the part of the brain affected and how much damage was done. These signs or symptoms may appear within minutes or hours after an ischemic stroke. You may have one or more of the following signs and symptoms:

• Blindness in one eye, or blurred or double vision.
  
• Numbness (loss of feeling), tingling, weakness, or being unable to move one side of your body.
  
• Trouble walking, swallowing, talking, or understanding.
  
• Severe (very bad) headache, dizziness, confusion, or passing out.

How is an ischemic stroke diagnosed? Your caregiver will ask you about your past medical conditions and drug use. He will ask about the medicines you use now. He will also do a physical exam on you. You may have any of the following tests:

• Arteriography: Arteriography is an x-ray test of the arteries. A special dye is given into an artery in your leg or arm. The dye helps the arteries show up better in the x-ray pictures. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be allergic to this dye. Tell your caregiver if you have any allergies.
  
• Carotid ultrasound: This test uses sound waves to show the blood flow in your carotid arteries. The carotid arteries are the blood vessels in your neck that carry blood to your brain. A carotid ultrasound will check for narrow or blocked carotid arteries.
  
• CT scan:
  • This is also called a CAT scan. A special x-ray machine uses a computer to take pictures of your brain. It may be used to look at bones, muscles, brain tissue, and blood vessels.
    
  • You may be given dye before the pictures are taken. The dye is usually given in your IV. The dye may help your caregiver see the pictures better. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell the caregiver if you are allergic to shellfish, or have other allergies or medical conditions.
    
• Echocardiogram: 
  
  • This test is also called an echo. It is a type of ultrasound, using sound waves to show pictures of the size and shape of your heart. An echo also looks at how your heart moves when it is beating. These pictures are seen on a TV-like screen.
    
  • This test is done while lying down on your back. Clear jelly will be squirted on your chest to help the ultrasound sensor slide easily. The sensor will be rubbed across your chest to see your heart from different angles. You may hear a whooshing noise, which is the sound of your blood flow. Caregivers may ask you to pedal a bike during the test (exercise echo) or you may get medicine before the test to increase blood flow to your heart muscle (stress echo). This test can tell how well your heart is pumping. An echo can also find problems, such as fluid around the heart or problems with your heart valves.
    
• MRI: This test is called magnetic resonance imaging. During the MRI, pictures are taken of your head. An MRI may be used to look at the brain, muscles, joints, bones, or blood vessels. You will need to lay still during a MRI. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. This can cause serious injury. Tell your caregiver if you have any metal implants in your body.

How is an ischemic stroke treated? Treatment of an ischemic stroke depends on its cause, and your signs and symptoms. You may be admitted to the Intensive Care Unit (ICU) so that caregivers can watch you closely.

• Medicines:
  
  
  • Anticoagulants: These medicines are also called blood thinners, and they keep clots from forming in the blood.
    
  • Antiplatelets: These medicines work against platelets to prevent blood clots from forming. Platelets are a type of blood cell that form blood clots.
    
  • Thrombolytics: These medicines are used when a stroke is caused by a clot in a blood vessel. Thrombolytics break apart clots and restore blood flow.
    
  • Other medicines: You may need medicine to treat diabetes or high blood cholesterol. You may need medicine to stop you from having seizures or decrease your blood pressure. Keeping your blood pressure low helps protect your brain from more damage. You may get diuretic medicine to help decrease swelling in your brain. This may help your brain get better blood flow.
    
    
• IV lines: An intravenous (IV) line is a tube or catheter placed in a vein (blood vessel) in your arm. It is used to give you medicine or liquids. A central line is a tube placed into a large vein near your collarbone, in your neck, or in your groin. The groin is the area where your abdomen meets your upper leg. Certain central lines may also be used to collect blood samples.
  
• IV pressure monitoring: You may need an arterial line, which is a tube placed into a large artery in your wrist or groin. An arterial line may be used for measuring your blood pressure or for taking blood. A CVP line is a type of central line that is hooked up to a monitor. This is done to take internal blood and heart pressure readings. The CVP line may be used to give medicines or IV fluids, or to take blood samples. This information helps caregivers check your heart.
  
• Fever treatment: If you have a fever, you may need special devices to cool your body. You may also need medicine to decrease your body temperature.
  
• ICP monitor: ICP stands for intracranial pressure. An ICP monitor is a small tube that is put through the skull and into the head. The tubing is connected to a TV-type screen. Caregivers use the ICP monitor to keep an ongoing measurement of the pressure inside your skull (the bones of your head).
  
• Surgery: Blocked carotid arteries cause poor blood flow to your brain. If your carotid arteries are blocked, a type of surgery called carotid endarterectomy may be done. Ask your caregiver for more information about this type of surgery.
  
• Ventilator: A ventilator is a special machine that can breathe for you if you cannot breathe well on your own. You may have an endotracheal tube (ET tube) in your mouth or nose. A tube called a trach may go into an incision (cut) in the front of your neck. The ET tube or trach is hooked to the ventilator. The ventilator can also give oxygen to you.

How can an ischemic stroke be prevented? 

• Do not smoke or drink too much alcohol. Smoking may harden blood vessels and cause conditions leading to ischemic stroke. Alcohol is found in beer, wine, liquor, like vodka or whiskey, and other adult drinks. Drinking too much too often can increase your risk of a stroke.
  
• Exercise regularly, and stay at a healthy weight.
  
• If you have atrial fibrillation (an irregular or fast heartbeat), take antithrombotic medicine as ordered by your caregiver. You may also need this medicine if you had a heart attack.
  
• Keep your blood cholesterol level in a normal range. Eat foods low in fat to help prevent plaque from growing in your blood vessels. If you have high blood cholesterol levels, talk to your caregiver about ways to lower it.
  
• Manage your blood sugar level if you have diabetes. You may be told to change the way you eat to control your blood sugar. Ask your caregiver what your blood sugar levels should stay at.
  
• Take your blood pressure medicine as ordered, and check your blood pressure often. Ask your caregiver for more information about checking your blood pressure.

When should I call my caregiver? Call your caregiver if:

• Your blood pressure is higher than you caregiver has told you it should be.
  
• You are having trouble with your therapy or exercises.
  
• You have a pressure sore on your skin.
  
• You cannot make it to your next appointment.
  
• You have questions or concerns about your stroke, or your medicine or care.

When should I get immediate help? The following are signs of an emergency. Call 911 or 0 (operator) for an ambulance to get to the nearest hospital if you have any of these signs. Do not drive yourself!

• Blurred vision or fainting.
  
• Chest pain that spreads to your arms, jaw, or back.
  
• Trouble breathing.
  
• You have one or more of the following signs or symptoms of a stroke:
  
  
  • A very bad headache. This may feel like the worst headache of your life.
    
  • Confusion and problems speaking or understanding things.
    
  • Not able to see out of one or both of your eyes.
    
  • Too dizzy to stand, trouble walking, or loss of balance.
    
  • Weakness or numbness of your face, arm, or leg, especially on one side of your body.

How can I tell if someone is having a stroke? Use the quick and easy-to-remember F.A.S.T. test to check for signs that someone is having a stroke:

• F = Face: Ask the person to smile. Drooping on one side of the mouth or face is a sign of a stroke.
  
• A = Arms: Ask the person to raise both arms. One arm that slowly comes back down or cannot be raised is a sign of a stroke.
  
• S = Speech: Ask the person to repeat a simple sentence that you say first. Speech that is slurred or strange sounding is a sign of a stroke.
  
• T = Time: If you see that the person has any of these signs, this is an emergency. Call 911 or 0 (operator) to activate the EMS (emergency medical service). Ask for an ambulance to take the person to the nearest hospital.

Where can I find support and more information? Ischemic stroke is a life-changing event for you and your family. Accepting that you have had an ischemic stroke is hard. You and those close to you may feel angry, sad, or scared. These feelings are normal. Talk to your caregivers, family, or friends about your feelings. You may also want to join a support group. This is a group of people who also had a stroke. Contact the following for more information:

• National Institute of Neurological Disorders and Stroke
  P.O. Box 5801
  Bethesda, MD20824
  Phone: 1-800-352-9424
  Web Address: http://www.ninds.nih.gov
  
• National Stroke Association
  9707 E. Easter Lane
  Englewood, CO80112
  Phone: 1-303-649-9299
  Phone: 1-800-787-6537
  Web Address: http://www.stroke.org

© 1974-2009  Thomson Reuters. All rights reserved.