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What is a Stroke? | Types of Stroke | Stroke Warning Signs | Stroke Risk Factors
African Americans & Stroke | Women & Stroke | How Do I Protect Myself?
Stroke is serious. It happens fast. And because of how stroke impacts a person's health, it is essential that people get help right away.
All three Columbia St. Mary’s Hospitals have received Primary Stroke Center Certification by the Joint Commission on Accreditation for Hospital Organization, a regulating organization dedicated to improving healthcare safety and quality of care. That means we have in place the staff and protocols to recognize stroke patients when they enter our emergency department and provide a fast response for treating stroke.
"Having primary stroke centers for all Columbia St. Mary's hospitals ensures that patients undergoing a stroke in Milwaukee or Ozaukee counties will be able to receive stroke care close to home," said Dr. Jacqueline Carter, the Stroke Center's Medical Director.
"At Columbia St. Mary's, we pride ourselves on having a 'Passion for Patient Care,' and the new national certification will elevate the quality of care we can provide for our stroke patients."
Stroke is a type of cardiovascular disease. It affects the arteries leading to and within the brain. A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts. When that happens, part of the brain cannot get the blood (and oxygen) it needs, so it starts to die.
- Clots that block an artery cause ischemic strokes. This is the most common type of stroke. Ischemic strokes account for about 80.8% of all strokes.
- Ruptured blood vessels cause hemorrhagic or bleeding strokes.
- When part of the brain dies from lack of blood flow, the part of the body it controls is affected. Strokes can cause paralysis, affect language and vision, and cause other problems.
Ischemic Stroke
In everyday life, blood clotting is beneficial. When you are bleeding from a wound, blood clots work to slow and eventually stop the bleeding. In the case of stroke, however, blood clots are dangerous because they can block arteries and cut off blood flow, a process called ischemia. An ischemic stroke can occur in two ways: embolic and thrombotic strokes.
Embolic Stroke
In an embolic stroke, a blood clot forms somewhere in the body (usually the heart) and travels through the bloodstream to your brain. Once in your brain, the clot eventually travels to a blood vessel small enough to block its passage. The clot lodges there, blocking the blood vessel and causing a stroke. The medical word for this type of blood clot is embolus.
Thrombotic Stroke
In the second type of blood-clot stroke, blood flow is impaired because of a blockage to one or more of the arteries supplying blood to the brain. The process leading to this blockage is known as thrombosis. Strokes caused in this way are called thrombotic strokes. That's because the medical word for a clot that forms on a blood-vessel deposit is thrombus.
Blood-clot strokes can also happen as the result of unhealthy blood vessels clogged with a buildup of fatty deposits and cholesterol. Your body regards these buildups as multiple, tiny and repeated injuries to the blood vessel wall. So your body reacts to these injuries just as it would if you were bleeding from a wound; it responds by forming clots. Two types of thrombosis can cause stroke: large vessel thrombosis and small vessel disease (or lacunar infarction).
Large Vessel Thrombosis
Thrombotic stroke occurs most often in the large arteries, so large vessel thrombosis is the most common and best understood type of thrombotic stroke. Most large vessel thrombosis is caused by a combination of long-term atherosclerosis followed by rapid blood clot formation. Thrombotic stroke patients are also likely to have coronary artery disease, and heart attack is a frequent cause of death in patients who have suffered this type of brain attack.
Small Vessel Disease/Lacunar Infarction
Small vessel disease, or lacunar infarction, occurs when blood flow is blocked to a very small arterial vessel. The term's origin is from the Latin word lacuna which means hole, and describes the small cavity remaining after the products of deep infarct have been removed by other cells in the body. Little is known about the causes of small vessel disease, but it is closely linked to hypertension (high blood pressure).
While many people will survive a stroke, they are often left with significantly compromised skills for daily living. Columbia St. Mary's Provides intense stroke rehabilitation services, including the Sacred Heart Rehabilitation Institute, located at Columbia St. Mary's Hospital Columbia. Individualized therapy for stroke rehabilitation brings together many different specialists: physical and occupational therapy, speech and language pathologists, recreational and music therapy, animal-assisted therapy, case managers, and social workers.
Know the warning signs of stroke!
- Sudden numbness or weakness of the face, arm or leg, especially on one side of the body.
- Sudden confusion, trouble speaking or understanding.
- Sudden trouble seeing in one or both eyes.
- Sudden trouble walking, dizziness, loss of balance or coordination.
- Sudden severe headache with no known cause.
- Do not wait! Call 911 immediately if you have any symptoms.
- Uncomfortable pressure, squeezing, fullness or pain in the center of the chest that lasts more than a few minutes or goes away and comes back.
- Pain or discomfort in one or both arms, the back, neck, jaw or stomach.
- Shortness of breath along with, or before, chest discomfort.
- Other signs such as breaking out in a cold sweat, nausea or lightheadedness.
- If you or someone you’re with has chest, back, arm or jaw discomfort … especially with one or more of the other signs, call 911 and get to a hospital immediately.
These are the risk factors that can be treated, modified or controlled with medical treatment:
High blood pressure
This is the single most important risk factor. Know your blood pressure and have it checked at least once every two years, or more often if it is above the normal range. It should be lower than 140/90 mm. Hg.
Tobacco use
Cigarette smoking is the number one preventable risk factor for stroke. Do not smoke or use other forms of tobacco. 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 oral contraceptives combined with cigarette smoking greatly increases stroke risk.
Diabetes mellitus
While diabetes is treatable, having it still increases a person’s risk of stroke. People with diabetes often also have high blood pressure, high blood cholesterol and are overweight, increasing their stroke risk even more. If you have diabetes, work closely with your doctor to manage it.
Carotid or other artery disease
The carotid arteries in your neck supply blood to your brain. A carotid artery narrowed by fatty deposits from atherosclerosis may become blocked by a blood clot. Peripheral artery disease is the narrowing of blood vessels carrying blood to leg and arm muscles. People with peripheral artery disease have a higher risk of carotid artery disease, which raises their risk of stroke.
Atrial fibrillation
Atrial fibrillation 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 bloodstream and lodges in an artery leading to the brain, a stroke results.
Other heart disease
People with coronary heart disease or heart failure have more than twice the 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 also raise the risk of stroke.
Transient ischemic attacks (TIAs)
Recognizing and treating TIAs can reduce your risk of a major stroke. It is very important to recognize the warning signs of a TIA or stroke. Call 911 to get medical attention immediately if they occur.
Certain blood disorders
A high red blood cell count makes blood clots more likely, increasing the risk of stroke. Doctors may treat this problem by removing blood cells or prescribing “blood thinners.”
Sickle cell anemia
Sickle cell anemia is a genetic disorder that mainly affects African-American and Hispanic children. “Sickled” red blood cells are less able to carry oxygen to the body’s tissues and organs. They also tend to stick to blood vessel walls, which can block arteries to the brain and cause a stroke.
High blood cholesterol
A high level of total cholesterol in the blood (240 mg/dL or higher) is a major risk factor for heart disease, which raises your risk of stroke. Recent studies show that high levels of LDL (“bad”) cholesterol (greater than 100 mg/dL) and triglycerides (blood fats) directly increase the risk of stroke in people with prior coronary heart disease, ischemic stroke or transient ischemic attack (TIA). Low levels of HDL (“good”) cholesterol (less than 40 mg/dL) also may raise stroke risk.
Physical inactivity and obesity
Being inactive, obese or both can increase your risk of high blood pressure, high blood cholesterol, diabetes, heart disease and stroke. So go on a brisk walk, take the stairs, and do whatever you can to make your life more active for a total of at least 30 minutes on most days.
Excessive alcohol
An average of more than one alcoholic drink a day for women or more than two drinks a day for men raises blood pressure and can lead to stroke.
Illegal drug use
Intravenous drug abuse carries a high risk of stroke. Cocaine use has been linked to strokes and heart attacks. Some have been fatal even in first-time users.
These are the risk factors that you cannot modify or change:
- Increasing 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 in women. In most age groups, more men than women will have a stroke in a given year. However, more than half of total stroke deaths occur in women. Women who are pregnant have a higher stroke risk. So do women taking birth control pills who also smoke or have high blood pressure or other risk factors.
- Heredity and race - Your stroke risk is greater if a parent, grandparent, sister or brother has had a stroke. African Americans have a much higher risk of death from a stroke than Caucasians do. In part, this is because blacks have higher risks of high blood pressure, diabetes and obesity.
- Prior stroke - Someone who has had a stroke is at a much higher risk of having another one. If you have had a stroke, it is even more important to make healthy lifestyle changes and modify your controllable risk factors (with your doctor’s help). If you have had a heart attack, you are at a higher risk of also having a stroke.
One-half of all African American women will die from stroke or heart disease. African Americans’ risk for stroke is up to four times higher than non-Hispanic whites.
- High blood pressure: 1 in 3 African Americans suffer from high blood pressure.
Diabetes.
- Sickle cell anemia (sickle shaped cells can block a blood vessel to the brain).
- Higher occurrence of obesity and smoking than Caucasians.
Oftentimes, a woman will experience stroke symptoms different than the “typical” symptoms. It is important for everyone to learn and recognize the following stroke symptoms that may be unique to a woman:
- Sudden face and limb pain
- Sudden hiccups
- Sudden nausea
- Sudden general weakness
- Sudden chest pain
- Sudden shortness of breath
- Sudden palpitations
Twice as many women die of stroke than breast cancer every year.
Despite this startling statistic, women are more worried about their risk of getting breast cancer than their stroke risk. What’s more, women think stroke is a men’s disease. But the truth is more women than men will die from stroke.
80% of strokes are preventable.
Managing your stroke risk is important, but does not guarantee that you won’t be touched by stroke in some way or another. Stroke will affect 4 out of 5 families over the course of a lifetime.
Those lucky enough to survive strokes will often need a family caregiver, and more than half (59-75%) of all family caregivers in the United States are women.
Care giving is vital to the recovery process, but can be overwhelming for the caregiver. If you find yourself caring for a stroke survivor, consult the National Stroke Association for steps you can take to make the transition from hospital to home easier on everyone.
You can protect yourself against stroke by doing the following:
- Know your risk factors.
- Reduce your risk factors.
- Learn the warning signs of stroke.
- Know and learn what to do if you notice warning signs.
- About 700,000 Americans will have a new or recurrent stroke this year, and over 163,000 of them will die. Stroke is the number 3rd cause of death among Americans. It is also a leading cause of serious, long-term disability.
You can protect yourself against stroke!
For questions about Columbia St. Mary's Certified Primary Stroke Centers call (414) 291-1218.
Resources: American Stroke Association & National Stroke Association
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