Stroke(8)

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Fr equent l y A sk ed quest ions

U.S. Department of Health and Human Services, Office on Womens Health

http://www.womenshealth.gov

1-800-994-9662

TDD: 1-888-220-5446

Stroke

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A 911 Call Saved

My Life

Photo of a woman-

When I walked into

the locker room at

work, I realized some-

thing was wrong. I

couldn't speak. I tried to pick up my lock,

but my right hand couldn't grab it. One

of my co-workers noticed something was

wrong and asked if I could write. Withmy left hand, I scribbled 911 on a piece

of paper. Luckily, my friend knew the

signs of stroke and got help. She called

an ambulance, and I was rushed to the

emergency room. The doctors ran some

tests and put a drug into my IV. Within

10 minutes I could speak again. I didn't

know a thing about stroke before I had

one. Now, I make sure that all my family

knows the signs of stroke so they can get

help if they need it.

Q: What is a stroke?

A: stroke is sometimes called a brainattack. A stroke can injure the brainlike a heart attack can injure the heart.A stroke occurs when part of the braindoesn't get the blood it needs.

There are two types of stroke:

Ischemic stroke (most common type)

This type of stroke happens whenblood is blocked from getting to thebrain. This often happens becausethe artery is clogged with fattydeposits (atherosclerosis) or a bloodclot.

Hemorrhagic stroke This type ofstroke happens when a blood vesselin the brain bursts, and blood bleeds

into the brain. This type of strokecan be caused by an aneurysm athin or weak spot in an artery thatballoons out and can burst.

Both types of stroke can cause braincells to die. This may cause a person tolose control of their speech, movement,and memory. If you think you arehaving a stroke, call 911.

Q: What is a mini-stroke?

A: A mini-stroke, also called a tran-sient ischemic attack or (TIA), happenswhen, for a short time, less blood thannormal gets to the brain. You may havesome signs of stroke or you may notnotice any signs. A mini-stroke lastsfrom a few minutes up to a day. Manypeople do not even know they havehad a stroke. A mini-stroke canbe a sign of a full stroke to come. Ifyou think you are having a mini-

stroke, call 911.

Q: What are the signs of a stroke?

A: A stroke happens fast. Most people havetwo or more signs.

The most common signs are:

Suddennumbnessorweaknessofface, arm, or leg (mainly on one sideof the body)

Suddentroubleseeinginoneor

both eyes Suddentroublewalking,dizziness,

or loss of balance

Suddenconfusionortroubletalkingor understanding speech

Suddenbadheadachewithnoknown cause

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TDD: 1-888-220-5446



Women may have unique symptoms:

Suddenfaceandarmorlegpain

Suddenhiccups Suddennausea(feelingsicktoyour

stomach)

Suddentiredness

Suddenchestpain

Suddenshortnessofbreath(feelinglike you cant get enough air)

Suddenpoundingorracingheart-beat

If you have any of these symptoms,

call 911.

Q: How is stroke diagnosed?

A: The doctor will usually start by askingthe patient what happened and when

the symptoms began. Then the doctorwill ask the patient some questions tosee if she or he is thinking clearly. Thedoctor also will test the patient's reflex-es to see if she or he may have had anyphysical damage. This helps the doctorfind out which tests are needed.

The doctor may order one or more ofthe following tests:

Imaging tests that give a picture ofthe brain. These include CT (com-

puted tomography) scanning, some-

Dash line indicates

that organ is behind

other main organs.

Face, Arm, or Legnumbness or

weakness (mainly on

one side of the body)

Brainconfusion, trouble talking or

understanding speech, dizziness,

loss of balance, bad headache

Eyestrouble seeing in one or both eyes

Stomachthrowing up (or urge to)

Bodyfeel tired

Legstrouble walking

Signs of a Stroke

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times called CAT scans and MRI(magnetic resonance imaging) scan-ning. CT scans are useful for finding

out if a stroke is caused by a block-age or by bleeding in the brain.

Electrical tests, such as EEG (elec-troencephalogram) and an evokedresponse test to record the electricalimpulses and sensory processes ofthe brain.

Blood flow tests, such as Dopplerultrasound tests, to show any chang-es in the blood flow to the brain.

Q: What are the effects of stroke?

A: It depends on the type of stroke, thearea of the brain where the strokeoccurs, and the extent of brain injury.A mild stroke can cause little or nobrain damage. A major stroke can causesevere brain damage and even death.

side view

top view

Left Hemisphere

Right Hemisphere

CerebellumBrain stem

Brain

A stroke can occur in different parts ofthe brain. The brain is divided into fourmain parts: the right hemisphere (or

half), the left hemisphere (or half), thecerebellum, and the brain stem.

A stroke in the right half of the braincan cause:

ProblemsjudgingdistancesThestroke survivor may misjudge dis-tances and fall or be unable to guideher hands to pick something up.

ImpairedjudgmentandbehaviorThe stroke survivor may try to dothings that she should not do, such

as driving a car.

Short-termmemorylossThestroke survivor may be able toremember events from 30 years ago,but not what she ate for breakfastthat morning.

A stroke in the left half of the brain cancause:

Speechandlanguageproblems The stroke survivor may have

trouble speaking or understandingothers.

SlowandcautiousbehaviorThestroke survivor may need a lot ofhelp to complete tasks.

MemoryproblemsThestrokesurvivor may not remember whatshe did ten minutes ago or shemay have a hard time learning newthings.

A stroke in the cerebellum, or the partof the brain that controls balance andcoordination, can cause:

Abnormalreflexesoftheheadandupper body

Balanceproblems

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Dizziness,nausea(feelingsicktoyour stomach), and vomiting

Strokesinthebrainstemareveryharmful because the brain stem controlsall our bodys functions that we don'thave to think about, such as eye move-ments, breathing, hearing, speech, and

swallowing.Sinceimpulsesthatstartinthe brain must travel through the brainstem on their way to the arms and legs,patients with a brain stem stroke mayalso develop paralysis, or not be able tomove or feel on one or both sides of thebody.

In many cases, a stroke weakens themuscles, making it hard to walk, eat,

ordresswithouthelp.Somesymptomsmay improve with time and rehabilita-tion or therapy.

Q: Who is at risk for stroke?

A: It is a myth that stroke occurs only inolder adults. A person of any age canhave a stroke. But, stroke risk doesincrease with age. For every 10 years

after the age of 55, the risk of strokedoubles, and two-thirds of all strokesoccur in people over 65 years old.Strokealsoseemstoruninsomefami -lies.Strokeriskdoublesforawomanif someone in her immediate family(mom, dad, sister, or brother) has had astroke.

Compared to white women, AfricanAmerican women have more strokesand have a higher risk of disability

and death from stroke. This is partlybecause more African Americanwomen have high blood pressure, amajor stroke risk factor. Women whosmoke or who have high blood pres-sure, atrial fibrillation (a kind of irregu-lar heart beat), heart disease, or dia-

betes are more likely to have a stroke.Hormonal changes with pregnancy,childbirth, and menopause are also

linked to an increased risk of stroke.

Q: How do I prevent a stroke?

A: Experts think that up to 80% of strokescanbeprevented.Somestrokeriskfac-tors cannot be controlled, such as age,family history, and ethnicity. But youcan reduce your chances of having astroke by taking these steps:

Know your blood pressure. Yourheart moves blood through your

body. If it is hard for your heart todo this, your heart works harder, and

yourbloodpressurewillrise.Peoplewith high blood pressure often haveno symptoms, so have your bloodpressure checked every 1 to 2 years.If you have high blood pressure,your doctor may suggest you makesome lifestyle changes, such as eat-

inglesssalt(DASHEatingPlan)and exercising more. Your doctor

may also prescribe medicine to helplower your blood pressure.

Dont smoke. If you smoke, tryto quit. If you are having troublequitting, there are products and pro-grams that can help:

Nicotine patches and gums

Supportgroups

Programstohelpyoustopsmok-ing

Ask your doctor or nurse for help.For more information on quitting,visitQuittingSmokingathttp://www.womenshealth.gov/quitsmoking.

Get tested for diabetes.Peoplewith diabetes have high blood glu-cose (often called blood sugar).

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Peoplewithhighbloodsugaroftenhave no symptoms, so have yourblood sugar checked regularly.

Having diabetes raises your chancesof having a stroke. If you have dia-betes, your doctor will decide if youneed diabetes pills or insulin shots.Your doctor can also help you makea healthy eating and exercise plan.

Get your cholesterol and triglyc-eride levels tested. Cholesterol is awaxy substance found in all parts ofyour body. When there is too muchcholesterol in your blood, choles-

terol can build up on the walls ofyour arteries. Cholesterol can clogyour arteries and keep your brainfrom getting the blood it needs. Thiscan cause a stroke. Triglycerides area form of fat in your blood stream.High levels of triglycerides arelinked to stroke in some people.Peoplewithhighbloodcholesterolor high blood triglycerides oftenhave no symptoms, so have yourblood cholesterol and triglyceride

levels checked regularly. If yourcholesterol or triglyceride levels arehigh, talk to your doctor about whatyou can do to lower them. You maybe able to lower your cholesterol andtriglyceride levels by eating betterand exercising more. Your doctormay prescribe medication to helplower your cholesterol.

Maintain a healthy weight. Beingoverweight raises your risk for

stroke. Calculate your Body MassIndex(BMI)athttp://www.cdc.gov/nccdphp/dnpa/healthyweight/assessing/bmi/index.htmtoseeifyou are at a healthy weight. Makehealthy food choices and get plentyof exercise. Each week, aim for atleast 2 hours and 30 minutes of

moderate-intensity aerobic physicalactivity, 1 hour and 15 minutes ofvigorous-intensity aerobic physical

activity, or a combination of moder-ateandvigorousactivity.Startbyadding more fruits, vegetables, andwhole grains to your diet. Take abrisk walk on your lunch break ortake the stairs instead of the elevator.

If you drink alcohol, limit it tono more than one drink (one 12ounce beer, one 5 ounce glass ofwine, or one 1.5 ounce shot ofhard liquor) a day.

Find healthy ways to cope withstress. Lower your stress level bytalking to your friends, exercising, orwriting in a journal.

Q: Should I take a daily aspirin to

prevent stroke?

A: Aspirin may be helpful for women athigh risk, such as women who havealready had a stroke. Aspirin can haveserious side effects and may be harmful

when mixed with certain medications.If you're thinking about taking aspirin,talk to your doctor first. If your doctorthinks aspirin is a good choice for you,be sure to take it exactly as your doctortells you to.

Q: Does taking birth control pills

increase my risk for stroke?

A: Taking birth control pills is generallysafe for young, healthy women. Butbirth control pills can raise the riskof stroke for some women, especiallywomen over 35; women with highblood pressure, diabetes, or high cho-lesterol; and women who smoke. Talkwith your doctor if you have questionsabout the pill.

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If you are taking birth control pills,and you have any of the symptomslisted below, call 911:

Eyeproblemssuchasblurredordouble vision

Painintheupperbodyorarm

Badheadaches

Problemsbreathing

Spittingupblood

Swellingorpainintheleg

Yellowingoftheskinoreyes

Breastlumps

Unusual(notnormal)heavybleed-ing from your vagina

Q: Does using the birth control

patch increase my risk for

stroke?

A: The patch is generally safe for young,healthy women. The patch can raisethe risk of stroke for some women,especially women over 35; women with

high blood pressure, diabetes, or highcholesterol; and women who smoke.

Recent studies show that women whouse the patch may be exposed to moreestrogen (the female hormone in birthcontrol pills and the patch that keepsusers from becoming pregnant) thanwomen who use the birth control pill.Research is underway to see if the riskfor blood clots (which can lead to heartattack or stroke) is higher in patch users.

Talk with your doctor if you have ques-tions about the patch.

If you are using the birth controlpatch, and you have any of thesymptoms listed below, call 911:

Eyeproblemssuchasblurredordouble vision

Painintheupperbodyorarm

Badheadaches

Problemsbreathing

Spittingupblood

Swellingorpainintheleg

Yellowingoftheskinoreyes

Breastlumps

Unusual(notnormal)heavybleed-ing from your vagina

Q: How is stroke treated?

A: Strokescausedbybloodclotscanbetreated with clot-busting drugs such as

TPA,ortissueplasminogenactivator.TPAmustbegivenwithinthreehoursof the start of a stroke to work, and testsmust be done first. This is why it is soimportant for a person having a stroketo get to a hospital fast.

Other medicines are used to treat and

to prevent stroke. Anticoagulants, suchas warfarin, and antiplatelet agents, suchas aspirin, block the blood's ability toclot and can help prevent a stroke inpatients with high risk, such as a personwho has atrial f ibrillation (a kind ofirregular heartbeat).

Surgeryissometimesusedtotreatorprevent stroke. Carotid endarterectomyis a surgery to remove fatty depositsclogging the carotid artery in the neck,which could lead to a stroke. For hem-orrhagic stroke, a doctor may performsurgery to place a metal clip at the baseof an aneurysm (a thin or weak spotin an artery that balloons out and canburst) or remove abnormal bloodvessels.

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Q: What about rehabilitation?

A: Rehabilitation is a very important partof recovery for many stroke survivors.

The effects of stroke may mean thatyou must change, relearn, or redef inehowyoulive.Strokerehabilitationisdesigned to help you return to indepen-dent living.

Rehabilitation does not reverse theeffects of a stroke. Its goals are to buildyour strength, capability, and confi-

dence so you can continue your dailyactivities despite the effects of yourstroke. Rehabilitation services may

include: Physicaltherapytorestoremove-

ment, balance, and coordination

Occupationaltherapytorelearnbasic skills such as bathing and dress-ing

Speechtherapytorelearnhowtotalk n

For more information

For more information on stroke, contact the National Womens Health InformationCenter(NWHIC)at1-800-994-9662orthefollowingorganizations:

National Institute of NeurologicalDisorders and StrokePhoneNumber(s):(800)352-9424Internet Address:http://www.ninds.nih.gov/

National Heart, Lung, and BloodInstitutePhoneNumber(s):(301)592-8573Internet Address:http://www.nhlbi.nih.gov/index.htm

American Heart AssociationPhoneNumber(s):(800)242-8721Internet Address:http://www.americanheart.org/

National Stroke AssociationPhoneNumber(s):(800)787-6537InternetAddress:http://www.stroke.org/

All material contained in this FAQ is free of copyright restrictions, and may be copied,reproduced, or duplicated without permission of the Office on Women's Health in the

DepartmentofHealthandHumanServices.Citationofthesourceisappreciated.

This FAQ was reviewed by:

PatriceDesvigne-Nickens,M.D.

Leader,CardiovascularMedicineSRGClinicalandMolecularMedicineProgram Division of Heart and Vascular DiseasesNational Heart, Lung, and Blood Institute

Content last updated January 28, 2009.

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