Signs and Symptoms of a stroke happening:

Symptoms of stroke include trouble walking, speaking, and understanding, as well as paralysis or numbness of the face, arm, or leg.

People may experience the following:                                                                      

Muscular: difficulty walking, paralysis with weak muscles, problems with coordination, stiff muscles, overactive reflexes, or paralysis of one side of the body

Visual: blurred vision, double vision, sudden visual loss, or temporary loss of vision in one eye

Whole body: balance disorder, fatigue, or lightheadedness

Speech: difficulty speaking, slurred speech, or speech loss

Sensory: pins and needles or reduced sensation of touch

Facial: muscle weakness or numbness

Limbs: numbness or weakness

Also common: difficulty swallowing, headache, inability to understand, mental confusion, numbness, or rapid involuntary eye movement

What is done for a stroke regarding diagnostic tooling:

 To determine the most appropriate treatment for your stroke, your emergency team needs to evaluate the type of stroke you’re having and the areas of your brain affected by the stroke. They also need to rule out other possible causes of your symptoms, such as a brain tumor or a drug reaction. Your doctor may use several tests to determine your risk of stroke, including:

CT scan of brain tissue damaged by stroke

Cerebral angiogram A cerebral angiogram showing a carotid aneurysm due to a stroke.

Physical examination. Your doctor will ask you or a family member what symptoms you’ve been having, when they started and what you were doing when they began. Your doctor then will evaluate whether these symptoms are still present.

Your doctor will want to know what medications you take and whether you have experienced any head injuries. You’ll be asked about your personal and family history of heart disease, transient ischemic attack or stroke.

Your doctor will check your blood pressure and use a stethoscope to listen to your heart and to listen for a whooshing sound (bruit) over your neck (carotid) arteries, which may indicate atherosclerosis. Your doctor may also use an ophthalmoscope to check for signs of tiny cholesterol crystals or clots in the blood vessels at the back of your eyes.

Blood tests. You may have several blood tests, which tell your care team how fast your blood clots, whether your blood sugar is abnormally high or low, whether critical blood chemicals are out of balance, or whether you may have an infection. Managing your blood’s clotting time and levels of sugar and other key chemicals will be part of your stroke care.

Computerized tomography (CT) scan. A CT scan uses a series of X-rays to create a detailed image of your brain. A CT scan can show a hemorrhage, tumor, stroke and other conditions. Doctors may inject a dye into your bloodstream to view your blood vessels in your neck and brain in greater detail (computerized tomography angiography).  The goal is if the CT scan determined the stroke to be a ischemic stroke start rtpa a drug IV if the symptoms of the stroke started in the past 3 hrs if not treat it another way OR if the stroke is determined to be hemorrhagic than its the OR.  Will go into treatment in more detail in Part III tomorrow.

Magnetic resonance imaging (MRI). An MRI uses powerful radio waves and magnets to create a detailed view of your brain. An MRI can detect brain tissue damaged by an ischemic stroke and brain hemorrhages. Your doctor may inject a dye into a blood vessel to view the arteries and veins and highlight blood flow (magnetic resonance angiography, or magnetic resonance venography).

Carotid ultrasound. In this test, sound waves create detailed images of the inside of the carotid arteries in your neck. This test shows buildup of fatty deposits (plaques) and blood flow in your carotid arteries.

Cerebral angiogram. In this test, your doctor inserts a thin, flexible tube (catheter) through a small incision, usually in your groin, and guides it through your major arteries and into your carotid or vertebral artery. Then your doctor injects a dye into your blood vessels to make them visible under X-ray imaging. This procedure gives a detailed view of arteries in your brain and neck.

Echocardiogram. An echocardiogram uses sound waves to create detailed images of your heart. An echocardiogram can find a source of clots in your heart that may have traveled from your heart to your brain and caused your stroke.

You may have a transesophageal echocardiogram. In this test, your doctor inserts a flexible tube with a small device (transducer) attached into your throat and down into the tube that connects the back of your mouth to your stomach (esophagus). Because your esophagus is directly behind your heart, a transesophageal echocardiogram can create clear, detailed ultrasound images of your heart and any blood clots.

In reality going to an ER room if the pt comes suspected of a stroke and has symptoms or not than nationally in America the hospitals are to do the following:

-A neuro assessment should be done in 10 minutes  by the doctor.

-A CT SCAN ordered and pt sent off for the CT SCAN test and done within 25 minutes.

-The CT SCAN read and interpreted by the radiologist / neuro doctor within 45 minutes.                        At this point it tells the MD if the pt has a blockage or a hemmorage in the brain that caused the stroke. Remember a ischemic stroke and hemmoragic stroke are treated differently.

We’ll get into treatment tomorrow in Part III Treatment of a stroke.

“In 2020, 1 in 6 deaths from cardiovascular disease was due to stroke.  Every 40 seconds, someone in the United States has a stroke. Every 3.5 minutes, someone dies of stroke.  Every year, more than 795,000 people in the United States have a stroke. About 610,000 of these are first or new strokes.”

Center for Disease Control and Prevention (CDC)

Statistics to know about strokes:

Stroke was the third leading cause of death in the United States. Presently the CDC says under its statistics that Stroke is the fifth leading cause of death for Americans, but the risk of having a stroke varies with many factors.  Remember strokes have declined since 2003 based on CDC risk factors now compared to risk factors CDC listed in 2014.

More than 140,000 people die each year from stroke in the United States, that’s 1 out of every 20 deaths now.

Stroke costs the United States an estimated $34 billion each year.  This total includes the cost of health care services, medicines to treat stroke, and missed days of work.

Stroke is the leading cause of serious, long-term disability in the United States. Each year, approximately 795,000 people suffer a stroke.

About 600,000 of these are first attacks, and 185,000 are recurrent attacks. Nearly three-quarters of all strokes occur in people over the age of 65.  Stroke reduces mobility in more than half of stroke survivors age 65 and over.

The risk of having a stroke more than doubles each decade after the age of 55.

Strokes can & do occur at ANY age. Nearly one fourth of strokes occur in people under the age of 65.  Stroke risk increases with age, but strokes can—and do—occur at any age.

In 2009, 34% of people hospitalized for stroke were less than 65 years old.

Stroke death rates are higher for African-Americans than for whites, even at younger ages.

On average, someone in the United States has a stroke every 40 seconds.

Stroke accounted for about one of every 17 deaths in the United States in 2006. Stroke mortality for 2005 was 137,000.

From 1995–2005, the stroke death rate fell ~30 percent and the actual number of stroke deaths declined ~14 percent.  It still has declined from 2005 by CDC statistics which is good.

While stroke death rates have declined for decades among all race/ethnicities, Hispanics have seen an increase in death rates since 2013.

What is a Stroke?

A Stroke is a disease that affects the arteries leading to and within the brain. It is the No. 5 cause of death and a leading cause of disability in the United States.  A stroke occurs when a blood vessel which carry oxygen and nutrients to the brain is either blocked by a clot or bursts (or ruptures). When that happens, part of the brain cannot get the blood (and oxygen) it needs, so this in the end causes brain cells to die.

There is a stroke noted as a mini stroke which is a transient (temporary) ischemic attack= TIA, which we went over last Friday.  If you want to review it go right ahead, its listed under 5/08/2020 article.  A TIA is different than  strokes.  First some call it a mini stroke but remember the symptoms of a TIA are similar to stroke symptoms listed below for actual strokes; the difference for the patient is that they are completely reversible.  Take angina for example, in this case the pt has the heart affected but the symptoms are completely reversible, just a different organ.  The organs (the heart for angina and the brain for TIA) are simply having the symptoms of an infarction of the organ that is involved but both are due to lack of 0xygen, called ischemia.

Getting back to actual strokes lets review types of strokes.

There are 2 types of strokes:

Ischemic Stroke which are strokes that occur through an obstruction of blood flow by a clot called a thrombus.

Hemorrhagic stroke by a blood vessel rupturing and preventing blood flow to the brain.

In the case of a stroke its a infarction to the brain due to lack of oxygen to the organ we call the brain, only the symptoms are not reversible but they can decrease in the intensity of the damage the caused in time with treatment (PT and OT) in time.  For some the symptoms are almost completely gone, again it depends on the intensity of the stroke to the brain, how bad was it with the symptoms it caused.

What puts you at risk for a stroke?

Non modiafiable risks meaning you can’t change them are:

–Age:  Stroke occurs in all age groups.  Studies show the risk of stroke doubles for each decade between the ages of 55 and 85.  But strokes also can occur in childhood or adolescence.  Although stroke is often considered a disease of aging, the risk of stroke in childhood is actually highest during the perinatal period, which encompasses the last few months of fetal life and the first few weeks after birth.

-Gender:  Men have a higher risk for stroke, but more women die from stroke.  Men generally do not live as long as women, so men are usually younger when they have their strokes and therefore have a higher rate of survival.

-Race:  People from certain ethnic groups have a higher risk of stroke.  For African Americans, stroke is more common and more deadly—even in young and middle-aged adults—than for any ethnic or other racial group in the United States.  Studies show that the age-adjusted incidence of stroke is about twice as high in African Americans and Hispanic Americans as in Caucasians.  An important risk factor for African-Americans is sickle cell disease, which can cause a narrowing of arteries and disrupt blood flow. The incidence of the various stroke subtypes also varies considerably in different ethnic groups.

–Family history of stroke:  Stroke seems to run in some families.  Several factors may contribute to familial stroke.  Members of a family might have a genetic tendency for stroke risk factors, such as an inherited predisposition for high blood pressure (hypertension) or diabetes.  The influence of a common lifestyle among family members also could contribute to familial stroke.

Modiafiable Risk Factors meaning you CAN change them:

–High Blood Pressure (hypertension)

RX: DIET & EXERCISE & MEDS that a MD would decide.

–High Cholesterol

RX: DIET and if necessary MEDS that a MD would decide.

–Diabetes Mellitus

RX: DIET & EXERCISE & MEDS that a MD would decide.

–Cigarette Smoking

RX: QUIT

–Carotid Artery Disease

RX: DIET & EXERCISE & MEDS  even possible SURGERY that a MD would decide.

–Atrial Fibrillation

RX: DIET & EXERCISE & MEDS even possible SURGERY that a MD would decide.

–Unhealthy Diet   RX: DIET

–Physical Inactivity and Obesity

RX: DIET & EXERCISE & possibly even MEDS that a MD would decide.

Go to your DOCTOR before doing any program and let your MD tell you what type of a program would be best for you especially if you are diagnosed with disease (EX. Diabetes, Cardiac, etc…).

“Disseminated intravascular coagulation (DIC) is a serious disorder in which the proteins that control blood clotting become overactive.

When injured, proteins in the blood that form blood clots go to injured site to help stop bleeding. If these proteins become abnormally active throughout the body, you could develop DIC. The underlying cause is usually due to inflammation, infection, or cancer.  DIC can also be caused in pregnancy.

In some cases of DIC, small blood clots form in the blood vessels. Some of these clots can clog the vessels and cut off the normal blood supply to organs such as the liver, brain, or kidneys. Lack of blood flow can damage and cause major injury to the organs.

In other cases of DIC, the clotting proteins in your blood are consumed. When this happens, you may have a high risk of serious bleeding, even from a minor injury or without injury. You may also have bleeding that starts spontaneously (on its own). The disease can also cause your healthy red blood cells to fragment and break up when they travel through the small vessels that are filled with clots.”

Medline Plus (https://medlineplus.gov/ency/article/000573.htm)

Disseminated intravascular coagulation (DIC) is a rare and serious condition that disrupts your blood flow. It is a blood clotting disorder that can turn into uncontrollable bleeding. It is sometimes called consumption coagulopathy.

Disseminated intravascular coagulation (DIC) is a rare, life threatening condition. It’s also sometimes called consumption coagulopathy.

In the early stages of the condition, DIC causes your blood to clot excessively. As a result, blood clots may reduce blood flow and block blood from reaching bodily organs.

As the condition progresses, platelets and clotting factors — the substances in your blood responsible for forming clots — are used up. When this happens, you may begin to experience excessive bleeding.

DIC is a serious condition that can lead to death. If you have bleeding that won’t stop, go to an emergency room or call 911 for prompt medical treatment.

Etiology of DIC (There is more than one cause factor):

1-Acute obstetrical hemorrhage is one of the leading causes for DIC in pregnancy and is one of the most avoidable etiologies of maternal death.  Disseminated intravascular coagulation (DIC) is a rare, life threatening condition. It’s also sometimes called consumption coagulopathy.

2-Disseminated intravascular coagulation has been linked to certain medical treatments or conditions. Medical treatments that can cause DIC include:

• Blood transfusion reactions.
• Recent surgery or anesthesia.

3-Medical conditions that can cause DIC include:

• Cancer, especially certain types of leukemia.
• Pancreatitis.
• Blood infections.
• Liver disease.
• Severe tissue injury including burns and head injuries.
• Unformed blood vessels called hemangioma.

What can you do?

Unfortunately, that means there’s very little you can do to prevent DIC. What you can do is to talk to your healthcare provider about DIC so you know what changes in your body might be a sign of it.

If you have DIC, you’re probably already coping with serious medical conditions such as sepsis and cancer, or you’re recovering from serious injuries. Fortunately, early diagnosis and supportive treatment can help to stop the blood clotting or bleeding that DIC causes so that your healthcare providers can focus on treating your underlying illnesses or injuries.

How to manage disseminated intravascular coagulation (DIC)?

Being diagnosed with disseminated intravascular coagulation means you have another medical concern to manage as you continue the treatment and testing for the medical condition that caused your DIC. Here are some suggestions that might help:

• Take all medicines regularly, as your healthcare provider prescribes. Do not change the amount of your medicine or skip a dose unless they tell you to.
• Ask your provider before taking any over-the-counter products such as pain relievers, vitamins, supplements or herbal remedies.
• Talk with your provider about how often you should schedule office visits and blood tests to monitor the medications you’re taking.
• If you’re taking blood thinners, make sure all your providers know so they can adjust treatment accordingly.

DIC can have serious complications. You should go to the emergency room right away if you have:

• Heavy bleeding that you can’t control.
• Heart attack symptoms-chest pain/discomfort, sudden squeezing of the heart, headache, palpitations, dizziness, SOB or dyspnea,  pain down L arm, vision change-one or both eyes, loss of balance, sudden fatigue.
• Stroke symptom-difficulty speaking, change in mental status, sudden confusion, drooping of the mount on one side, one side of the body weak or paralyzed, difficulty eating, aspiration, difficulty walking or standing.

“Blood has a seemingly impossible job: It must flow continuously and smoothly throughout your body for an entire lifetime, but quickly shut off to prevent spills when you get a cut or injury.  Blood clots are healthy and lifesaving when they stop bleeding.  Platelets get “turned on” by triggers released when a blood vessel is damaged. They stick to the walls in the area and each other, changing shape to form a plug that fills in the broken part to stop blood from leaking out. Blood clotting, or coagulation, is an important process that prevents excessive bleeding when a blood vessel is injured.”

WebM.D.

“Asthma is a disease that affects your lungs. It causes repeated episodes of wheezing, breathlessness, chest tightness, and nighttime or early morning coughing.  Asthma can be controlled by taking medicine and avoiding the triggers that can cause an attack. You must also remove the triggers in your environment that can make your asthma worse.  Since 1984, the Asthma and Allergy Foundation of America (AAFA) has declared May to be “National Asthma and Allergy Awareness Month.” It is a peak season for people with asthma and allergies, and a perfect time to educate patients, family, friends, co-workers, and others about these diseases.“.

Centers of Disease Control and Prevention – CDC

“Uncontrolled high blood pressure can lead to complications including: Heart attack or stroke. High blood pressure can cause hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications. Aneurysm.”

MAYO CLINIC

High blood pressure in general can cause problems for you like:

1-Aneurysm. Over time, the constant pressure of blood moving through a weakened artery can cause a section of its wall to enlarge and form a bulge (aneurysm).  Aneurysms can occur anywhere but the body most common place is the abdominal aortic aneurysm.  The aorta is the largest blood vessel in the body. It begins at the left ventricle of the heart and travels down the abdomen where it splits off into both legs.  The abdomen gives the aneurysm plenty of room to grow before it bursts (if not diagnosed yet & treated via surgery), like in actor John Ritter’s case (he died of a ruptured aortic aneurysm).  Other areas of aneurysms seen are thoracic aortic aneurysms and cerebral aneurysms (in the brain).

2-Damaged and narrowed arteries.  High blood pressure can damage the cells of your arteries’ inner lining. When fats from your diet enter your bloodstream, they can collect in the damaged arteries. Eventually, your artery wall first is with the added force against it over time, this extra pressure can damage the arteries, making them more vulnerable to the narrowing and plaque buildup associated with arthero/arterio sclerosis.

High Blood Pressure most commonly impacts the following organs (remember their problem is lack of 02, nutrients, to the organ):

1-THE BRAIN:  Damage directly to the brain can cause many problems for that organ, including

• Transient ischemic attack (TIA). Sometimes called a ministroke, a TIA is a brief, temporary disruption of blood supply to your brain. Hardened arteries or blood clots caused by high blood pressure can cause TIA.  TIA is often a warning that you’re at risk of a full-blown stroke.  Most cases they are REVERSIBLE!
• Stroke. A stroke occurs when part of your brain is deprived of oxygen and nutrients, causing brain cells to die. Blood vessels damaged by high blood pressure can narrow, rupture or leak. High blood pressure can also cause blood clots to form in the arteries leading to your brain, blocking blood flow and potentially causing a stroke. Cat Scan the first test will show the bleed in the brain and ER will get pt to OR STAT if a candidate.
• Dementia. Narrowed or blocked arteries can limit blood flow to the brain, leading to a certain type of dementia (vascular dementia). A stroke that interrupts blood flow to the brain can also cause vascular dementia.
• Mild cognitive impairment. This condition is a transition stage between the changes in understanding and memory that generally come with aging and the more-serious problems caused by dementia. Studies suggest that high blood pressure can lead to mild cognitive impairment and definitely strokes can also but varied.

Your brain depends on a nourishing blood supply to function properly. High blood pressure can interfere with oxygen supply to brain tissue=LACK OF NUTRIENTS causing problems.

BRAIN DAMAGE not reversible completely or at all includes:

A-Ischemic Strokes

High blood pressure can also cause blood clots to form in the arteries leading to your brain  By narrowing of the arteries in the brain causes blockage of nutrients to an area of the brain.  The nutrients is oxygen to that area of the brain and without it the tissue dies causing the ischemic (meaning lack of 02) stroke.  This is the most common type of stroke. They occur when blood flow to an area of the brain is compromised by a blood clot or blockage. This leads to the death of brain cells and to brain damage.  If the brain damage is 100% reversible its cause is a transient ischemic attack (TIA).

B-Causes of Hemorrhagic Strokes

Most strokes occur due to a blockage of blood flow to a part of the brain, but approximately 13% of strokes occur due to bleeding in the brain.

2-THE HEART:  Damage directly on your heart can cause many problems for that organ, including:

A-Coronary artery disease. Arteries narrowed and damaged by high blood pressure have trouble supplying blood to your heart. When blood can’t flow freely to your heart, you can have chest pain (angina), irregular heart rhythms (arrhythmias) or a heart attack.

B-Enlarged left heart. High blood pressure forces your heart to work harder to pump blood to the rest of your body. This causes part of your heart (left ventricle) to thicken. A thickened left ventricle increases your risk of heart attack, heart failure and sudden cardiac death.

C-Heart failure. Over time, the strain on your heart caused by high blood pressure can cause the heart muscle to weaken and work less efficiently. Eventually, your overwhelmed heart begins to fail. Damage from heart attacks adds to this problem.

 A-Kidney Scarring:

This type of kidney damage occurs when tiny blood vessels within the kidney become scarred and unable to effectively filter fluid and waste from your blood.  Glomerulosclerosis can lead to kidney failure.

B-Kidney failure:

High blood pressure is one of the most common causes of kidney failure. Damaged blood vessels prevent kidneys from effectively filtering waste from your blood, allowing dangerous levels of fluid and waste to accumulate. You might ultimately require dialysis or kidney transplantation.

4-EYES:  Damage directly on your eyes can cause many problems for that organ, including:

High blood pressure can damage the tiny, delicate blood vessels that supply blood to your eyes, causing:

• Damage to your retina (retinopathy). Damage to the light-sensitive tissue at the back of your eye (retina) can lead to bleeding in the eye, blurred vision and complete loss of vision. You’re at an even greater risk if you have diabetes in addition to high blood pressure.
• Fluid buildup under the retina (choroidopathy). Choroidopathy can result in distorted vision or sometimes scarring that impairs vision.
• Nerve damage (optic neuropathy). Blocked blood flow can damage the optic nerve, leading to bleeding within your eye or vision loss.

5-Sexual dysfunction

The inability to have and maintain an erection (erectile dysfunction) becomes increasingly common in men as they reach age 50. But men with high blood pressure are even more likely to experience erectile dysfunction. That’s because limited blood flow caused by high blood pressure can block blood from flowing to your penis.

Women can also experience sexual dysfunction as a result of high blood pressure. Reduced blood flow to the vagina can lead to a decrease in sexual desire or arousal, vaginal dryness, or difficulty achieving orgasm.

What your heart is doing what we call compensating and saving blood for the main organs including the brain, heart, kidneys, lungs to stay alive.  Areas not a priority are usually furthest away from the heart the feet, genitals, hands, etc…  So less blood the heart is sending their due to high blood pressure related to hypertension causing vessel narrowing to problems in the body.

High blood pressure emergencies:

High blood pressure is usually a chronic condition that gradually causes damage over the years. But sometimes blood pressure rises so quickly and severely that it becomes a medical emergency requiring immediate treatment, often with hospitalization.

In this situation occurs, know high blood pressure can cause:

• Memory loss, personality changes, trouble concentrating, irritability or progressive loss of consciousness
• Stroke
• Severe damage to your body’s main artery (aortic dissection)
• Chest pain
• Heart attack
• Sudden impaired pumping of the heart, leading to fluid backup in the lungs resulting in shortness of breath (pulmonary edema)
• Sudden loss of kidney function
• Complications in pregnancy (preeclampsia or eclampsia)
• Blindness

THE KEY IS PREVENTION!  So stay in your average healthy weight range, eat overall healthy foods, see your MD once or more a year for a physical (if under 50) or go to y0ur primary care doctor when he prescribes especially if you have a disease of some sort (Example Diabetes or HTN, ect..), stay active and don’t be inactive home especially during this COVID situation.

Another thing is simply to have your own BP machine at home so you can take it everyday and keep an eye on changes especially is your diagnosed, age, especially with the diagnosis hypertension and taking meds for it or diagnosed with cardiac disease!  You can stay on top of it this way with staying healthy and not unhealthy!

Always check with your doctor when to be seen if not sure, he or she would know best especially if he or she already knows your medical history!

“If left untreated, high blood pressure may lead to a heart attack, heart disease, heart failure, stroke, kidney damage and peripheral arterial disease, among other health problems. And, while patients with high blood pressure are not considered at high risk from COVID-19, the U.S. Centers for Disease Control and Prevention (CDC) points out that many patients with hypertension have other conditions, such as obesity, diabetes and heart conditions, that do put them at higher risk. The CDC recommends that patients with high blood pressure stick to their medication and treatment regimens. It’s vital to get your blood pressure checked regularly and to know the signs of high blood pressure: Take steps to improve their overall health and help manage their blood pressure.  Some patients may not feel any ill effects from hypertension, which is why it is sometimes called the “silent killer.” .

Cancer Treatments of America