** Stroke, also called brain attack, is a medical emergency. Strokes happen when blood flow to your brain stops. Within minutes, brain cells begin to die. There are two kinds of stroke. The more common kind, called transient ischemic stroke (TIA), is caused by a blood clot that blocks or plugs a blood vessel in the brain. The other kind, called hemorrhagic stroke, is caused by a blood vessel that breaks and bleeds into the brain. "Mini-strokes"occur when the blood supply to the brain is briefly interrupted.Symptoms of stroke are:

• Sudden numbness or weakness of the face, arm or leg (especially on one side of the body)
• Sudden confusion, trouble speaking or understanding speech
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• A sudden, severe "bolt out of the blue" headache or an unusual headache, which may be accompanied by a stiff neck, facial pain, pain between your eyes, vomiting or altered consciousness.

If you have any of these symptoms, you must get to a hospital quickly to begin treatment. Acute stroke therapies try to stop a stroke while it is happening by quickly dissolving the blood clot or by stopping the bleeding. Post-stroke rehabilitation helps individuals overcome disabilities that result from stroke damage. Drug therapy with blood thinners is the most common treatment for stroke.

If someone appears to be having a stroke, watch the person carefully while waiting for an ambulance. You may need to take additional actions in the following situations:

·      If the person stops breathing, begin mouth-to-mouth resuscitation.

·      If vomiting occurs, turn the person's head to the side. This can prevent choking.

·      Don't let the person eat or drink anything.

Every minute counts when it comes to treating a stroke or TIA. In fact, sometimes a stroke is referred to as a "brain attack" to convey that, similar to a heart attack, quick care is important. So, don't wait to see if the signs and symptoms go away. The longer a stroke goes untreated, the greater the damage and potential disability. The success of most stroke treatments depends on how soon a person is seen by a doctor in a hospital emergency room after signs and symptoms begin.

Many factors can increase your risk of a stroke. A number of these factors can also increase your chances of having a heart attack. Stroke risk factors include:

·      A family history of stroke, heart attack or TIA

·      Being age 55 or older

·      High blood pressure — a systolic blood pressure of 140 millimeters of mercury (mm Hg) or higher, or a diastolic pressure of 90 mm Hg or higher

·      High cholesterol — a total cholesterol level of 200 milligrams per deciliter (mg/dL), or 5.2 mmol/L, or higher

·      Cigarette smoking

·      Diabetes

·      Obesity,  a body mass index of 30 or higher

·      Cardiovascular disease, including heart failure, a heart defect, heart infection, or abnormal heart rhythm

·      Previous stroke or TIA

·      High levels of homocysteine, an amino acid, in your blood

·      Use of birth control pills or other hormone therapy

Other factors that can increase your risk of stroke include heavy or binge drinking and the use of illicit drugs such as cocaine.

Although men and women have strokes at about the same rate, women more often die of strokes than do men. Blacks are more likely to have strokes than are people of other races.

Tests

If you've had a previous stroke or TIA or think you're at risk of stroke, talk with your doctor about screening tests.

The following are most often used as screening tools to determine your risk, but they may also be used as diagnostic tools if you're having a stroke: (Note: consult Blue Cross Blue Shield of Kansas City or Anthem Blue Cross Blue Shield for benefit coverage prior to any test)

·      Physical examination and tests. Your doctor may check for risk factors of stroke, including high blood pressure, high cholesterol levels, diabetes and high levels of the amino acid homocysteine. Your doctor may also use a stethoscope to listen for a whooshing sound over your arteries that may indicate atherosclerosis.

·      Carotid ultrasound. In this procedure, a wand-like device (transducer) sends high-frequency sound waves into your neck. The sound waves pass through tissue and then return, creating on-screen images that show any narrowing or clotting in your carotid arteries.

·      Arteriography. This procedure gives a view of arteries in your brain not normally seen in X-rays. Your doctor inserts a thin, flexible tube (catheter) through a small incision, usually in your groin. The catheter is manipulated through your major arteries and into your carotid or vertebral artery. Then your doctor injects a dye through the catheter to provide X-ray images of your arteries.

·      Computerized tomography (CT). In computerized tomographic angiography (CTA), a dye is injected into your vein and X-ray beams create a 3-D image of the blood vessels in your neck and brain. Doctors use CTA to look for aneurysms or arteriovenous malformations and to evaluate arteries for narrowing. CT scanning, which is done without dye, can provide images of your brain and show hemorrhages, but without as much detailed information about the blood vessels.

·      Magnetic resonance imaging (MRI). Using a strong magnetic field, an MRI can generate a 3-D view of your brain. This test can detect brain tissue damaged by an ischemic stroke. Magnetic resonance angiography (MRA) uses the magnetic field and a dye injected into your veins to evaluate arteries in your neck and brain.

·      Echocardiography. Your doctor can use this ultrasound technology to make images of your heart to see if an embolus from your heart has caused your stroke. Your doctor may need to use transesophageal echocardiography (TEE) to see your heart clearly. During this procedure, you swallow a flexible probe with a transducer built into it. From there, the probe travels to your esophagus — the tube that connects the back of your mouth to your stomach. Because your esophagus is directly behind your heart, very clear, detailed ultrasound images can be created, allowing a better view of blood clots, which might not be seen clearly in a traditional echocardiography exam.

Treatment

Getting prompt medical treatment for stroke is important. Treatment itself depends on the type of stroke.

To treat an ischemic stroke, doctors must quickly restore blood flow to your brain.

Therapy with clot-busting drugs must start within three hours. Quick treatment not only improves your chances of survival, but may also reduce the amount of complications resulting from the stroke. You may be given:

·      Aspirin. Aspirin is the best-proven immediate treatment after a stroke to reduce the likelihood of having another stroke. In the emergency room, it's likely you'll be given a dose of aspirin. The dose may vary, but if you already take a daily aspirin for its blood-thinning effect, you may want to make a note of that in your purse or wallet on an emergency medical card so that the doctors will know if you've already had some aspirin. Do not take aspirin before you go to the hospital. If you are having a hemorrhagic stroke, taking aspirin could worsen the bleeding.

Other blood-thinning drugs, such as warfarin (Coumadin) and heparin also may be given, but they aren't as commonly used as aspirin.

·      Tissue plasminogen activator. Some people who are having a stroke can benefit from an injection of tissue plasminogen activator (TPA). TPA is a potent clot-busting drug that helps some people who have had stroke recover more fully. However, the drug can only be given to patients within a three-hour window of the stroke occurring, and it can only be given in situations in which doctors are certain that giving TPA will not worsen bleeding in the brain. TPA cannot be given to people who are having a hemorrhagic stroke.

Your doctor may recommend a procedure to open up an artery that's moderately to severely narrowed by plaques. (contact Blue Cross Blue Shield of Kansas City or Anthem Blue Cross Blue Shield for benefit coverage prior to any procedure)

To treat a hemorrhagic stroke, surgery may be used to treat or prevent another one. The most common procedures, aneurysm clipping and arteriovenous malformation (AVM) removal, carry some risks. Your doctor may recommend one of these procedures if you're at high risk of spontaneous aneurysm or AVM rupture:

·      Aneurysm clipping. A tiny clamp is placed at the base of the aneurysm, isolating it from the circulation of the artery to which it's attached. This can keep the aneurysm from bursting, or it can prevent re-bleeding of an aneurysm that has recently hemorrhaged. The clip will stay in place permanently.

·      Coiling (aneurysm embolization). In an embolization procedure, a catheter is maneuvered into the aneurysm. A tiny coil is pushed through the catheter and positioned inside the aneurysm. The coil fills the aneurysm, causing clotting and sealing the aneurysm off from connecting arteries.

·      Surgical AVM removal. It's not always possible to remove an AVM if it's too large or if it's located deep within the brain. Surgical removal of a smaller AVM from a more accessible portion of the brain, though, can eliminate the risk of rupture, lowering the overall risk of hemorrhagic stroke.

Coping and Support

Recovering from a stroke can be mentally exhausting. In addition to the various physical side effects, feelings of helplessness, frustration, depression and apathy aren't unusual. Diminished sex drive and mood changes also are common.

How quickly you recover from a stroke depends on the extent of damage to your brain, and the intensity and duration of the therapy you receive. But your recovery also is likely to be influenced by your personality, life experiences and coping styles. Your own motivation to recover is a key factor in obtaining an optimal level of rehabilitation.

If someone close to you has had a stroke, you can help by offering companionship and support. Here are some tips to help you communicate with someone whose speech has been affected by a stroke:

·      Stay in touch. Your friend or family member needs you but might not be able to tell you so. Make an effort to be there.

·      Keep conversation at an adult level. Address stroke survivors directly and don't talk down to them. Treat them just as you did before the stroke. Because someone has had a stroke doesn't mean he or she can't think anymore.

·      Use a normal tone of voice. Unless there's a hearing loss, you don't need to speak more loudly than usual.

·      Speak at a comfortable pace. Allow time for your words to be processed. Try to talk about only one topic at a time.

·      Avoid distractions. Reduce background noise and distractions from TVs, radios and physical activities.

·      Talk one-on-one. A stroke survivor may understand best when the conversation includes fewer people.

·      Keep caregivers in mind. They need support and friendship, too. Include them in your thoughts and plans.

Prevention

Knowing your risk factors and adopting a healthy lifestyle are the best steps you can take to prevent a stroke. In general, a healthy lifestyle means that you:

·      Control high blood pressure (hypertension). One of the most important things you can do to reduce your stroke risk is to keep your blood pressure under control. If you've had a stroke, lowering your blood pressure can help prevent a subsequent transient ischemic attack or stroke. Exercising, managing stress, maintaining a healthy weight, and limiting sodium and alcohol intake are all ways to keep high blood pressure in check. In addition to recommendations for lifestyle changes, your doctor may prescribe medications to treat high blood pressure, such as diuretics, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers.

·      Lower your cholesterol and saturated fat intake. Eating less cholesterol and fat, especially saturated fat, may reduce the plaques in your arteries. If you can't control your cholesterol through dietary changes alone, your doctor may prescribe a cholesterol-lowering medication.

·      Don't smoke. Quitting smoking reduces your risk of stroke. Several years after quitting, a former smoker's risk of stroke is the same as that of a nonsmoker.

·      Control diabetes. You can manage diabetes with diet, exercise, weight control and medication. Strict control of your blood sugar may reduce damage to your brain if you do have a stroke.

·      Maintain a healthy weight. Being overweight contributes to other risk factors for stroke, such as high blood pressure, cardiovascular disease and diabetes. Weight loss of as little as 10 pounds may lower your blood pressure and improve your cholesterol levels.

·      Exercise regularly. Aerobic exercise reduces your risk of stroke in many ways. Exercise can lower your blood pressure, increase your level of high-density lipoprotein (HDL) cholesterol, and improve the overall health of your blood vessels and heart. It also helps you lose weight, control diabetes and reduce stress. Gradually work up to 30 minutes of activity — such as walking, jogging, swimming or bicycling — on most, if not all, days of the week.

·      Manage stress. Stress can cause a temporary spike in your blood pressure — a risk factor for brain hemorrhage — or long-lasting hypertension. It can also increase your blood's tendency to clot, which may elevate your risk of ischemic stroke. Simplifying your life, exercising and using relaxation techniques are all approaches that you can learn to reduce stress.

·      Drink alcohol in moderation, if at all. Alcohol can be both a risk factor and a preventive measure for stroke. Binge drinking and heavy alcohol consumption increase your risk of high blood pressure and of ischemic and hemorrhagic strokes. However, drinking small to moderate amounts of alcohol can increase your HDL cholesterol and decrease your blood's clotting tendency. Both factors can contribute to a reduced risk of ischemic stroke.

·      Don't use illicit drugs. Many street drugs, such as cocaine and crack cocaine, are established risk factors for a TIA or a stroke.

Follow a Healthy Diet
In addition, eat healthy foods. A brain-healthy diet should include:

·      Five or more daily servings of fruits and vegetables, which contain nutrients such as potassium, folate and antioxidants that may protect you against stroke.

·      Foods rich in soluble fiber, such as oatmeal and beans.

·      Foods rich in calcium, a mineral found to reduce stroke risk.

·      Soy products, such as tempeh, miso, tofu and soy milk, which can reduce your low-density lipoprotein (LDL) cholesterol and raise your HDL cholesterol level.

·      Foods rich in omega-3 fatty acids, including cold-water fish, such as salmon, mackerel and tuna.

Preventive Medications
If you've had an ischemic stroke, your doctor may recommend medications to help reduce your risk of having a TIA or stroke.  (contact Catalyst Rx for benefit coverage prior to taking new medications)   These include:

·      Anti-platelet drugs. Platelets are cells in your blood that initiate clots. Anti-platelet drugs make your platelets less sticky and less likely to clot. The most frequently used anti-platelet medication is aspirin, taken daily. Your doctor can help you determine the right dose of aspirin for you.

Your doctor may also consider prescribing Aggrenox, a combination of low-dose aspirin and the anti-platelet drug dipyridamole, to reduce blood clotting. If aspirin doesn't prevent your TIA or stroke or if you can't take aspirin, your doctor may instead prescribe an anti-platelet drug such as clopidogrel (Plavix) or ticlopidine (Ticlid).

·      Anticoagulants. These drugs include heparin and warfarin (Coumadin). They affect the clotting mechanism in a different manner than do anti-platelet medications. Heparin is fast acting and is used over the short term in the hospital. Slower acting warfarin is used over a longer term.

Warfarin is a powerful blood-thinning drug, so you'll need to take it exactly as directed and watch for side effects. Your doctor may prescribe these drugs if you have certain blood-clotting disorders; certain arterial abnormalities; or an abnormal heart rhythm, such as atrial fibrillation, or other heart problems.

Support Groups

The following links provide information for on-line and in-person support groups. Contact each group for availability, cost information, if any, etc.  (Note: please consult Blue Cross Blue Shield of Kansas City or Anthem Blue Cross Blue Shield for benefit coverage or out-of-pocket costs)

American Stroke Association

http://www.strokeassociation.org/presenter.jhtml?identifier=4730

The Stroke Network

http://www.strokenetwork.org/

National Stroke Association

http://www.stroke.org/site/PageServer?pagename=Event_calendar

** Information obtained from the Medline Plus and Mayo Clinic websites.