Stroke

A stroke occurs when the blood supply to part of the brain is suddenly interrupted due to the presence of a blood clot (ischemic stroke) or when a blood vessel in the brain bursts spilling blood into the spaces surrounding brain cells (hemorrhagic stroke). Brain cells die when they no longer receive oxygen and nutrients from the blood or when they are damaged by sudden bleeding into or around the brain. This results in temporary or permanent neurologic impairment. Ischemic stroke also known as cerebral infarction accounts for 80 percent of all strokes while hemorrhagic stroke accounts for the other 20 percent. In addition some people suffer transient ischemic attacks (TIAs) which are mini-strokes that last only 5 to 20 minutes. In almost all TIAs the symptoms go away within an hour. An estimated 550 000 people in the United States suffer a stroke each year making this one of the most serious of all health problems. Half of stroke sufferers are left disabled with many undergoing years of rehabilitation.

Signs and Symptoms

Symptoms of stroke appear suddenly. If you notice any of these signs and symptoms seek emergency medical help immediately for yourself or for someone you are with.

• Numbness or weakness of the face arm or leg especially on one side of the body
• Confusion trouble talking or difficulty understanding speech
• Trouble seeing in one or both eyes
• Trouble walking dizziness or loss of balance or coordination; sudden severe headache with no known cause

What Causes It?

Ischemic stroke results from the following causes.

• A clot (embolus) forms in a part of the body other than the brain travels through blood vessels and becomes wedged in a brain artery.
• A blood clot (thrombus) forms in a brain artery and stays attached to the artery wall until it grows large enough to block blood flow

Hemorrhagic stroke results from the following causes.

• A bleeding aneurysm—a weak or thin spot on an artery wall that over time has stretched or ballooned out under pressure from blood flow. The wall ruptures and blood spills into the space surrounding brain cells.
• Artery walls lose their elasticity and become brittle and thin prone to cracking
• Arteriovenous malformation (AVM)—a tangle of defective blood vessels and capillaries within the brain that have thin walls that can rupture

Who's Most At Risk?

Individuals with the following characteristics or health conditions are at a higher-than-average risk for developing a stroke.

• More men suffer strokes than women
• African or Japanese Americans are at higher risk
• TIAs history of stroke
• Age (risk increases with age)
• Hypertension
• Heart disease
• Traumatic injury
• Substance abuse (cocaine alcohol)
• High total serum cholesterol (for older patients)
• Diabetes
• Increased blood viscosity (thickness)
• Use of oral contraceptives especially in smokers
• Smoking

What to Expect at Your Provider's Office

If you or someone you know experiences symptoms associated with stroke call 911 emergency immediately. There are now effective therapies for stroke that must be administered at a hospital within the first three hours after stroke symptoms appear. At the hospital a health care provider will make a diagnosis and guide you in determining which treatment or combination of therapies will work best for you. He or she will do a complete neurological exam and run a battery of tests such as blood tests an electrocardiogram and a test to measure the severity of the stroke. Imaging techniques such as CT scans magnetic resonance imaging (MRI) and magnetic resonance angiography(MRA) may be used to reveal the cause of the stroke and pinpoint blockages or reveal malformations.

Treatment Options

Prevention

Daily use of aspirin may reduce recurrence of stroke. Proper treatment of conditions that lead to stroke such as atrial fibrillation or diabetes can also reduce the risk of having one.

Treatment Plan

The primary goal in treating stroke patients is to prevent any neurological impairment from becoming irreversible. The therapeutic window is extremely short making it crucial for an individual to seek treatment immediately upon noticing signs or symptoms.

Drug Therapies

A wide range of therapeutic measures may be administered to stroke patients depending on the type and location of stroke and the extent of damage suffered. Many of these involve restoring proper blood flow to the brain.

Your provider may also prescribe medications such as the following.

• Antithrombotics to prevent the formation of blood clots that can become lodged in a cerebral artery and cause strokes; these include antiplatelet drugs and anticoagulants
• Thrombolytic agents to halt the stroke by dissolving the blood clot that is blocking blood flow to the brain
• Neuroprotectants to protect the brain from secondary injury caused by stroke

Surgical and Other Procedures

Surgery can be used to prevent stroke to treat acute stroke or to repair vascular damage or malformations in and around the brain. There are two major types of surgery for stroke prevention and treatment.

• Carotid endarterectomy involves removing fatty deposits (plaque) from the inside of one of the carotid arteries which are located in the neck and are the main suppliers of blood to the brain.
• EC/IC bypass surgery restores blood flow to a blood-deprived area of brain tissue by rerouting a healthy artery in the scalp to the area of brain tissue affected by a blocked artery.

Complementary and Alternative Therapies

The goals of complementary and alternative therapies are to prevent strokes treat risk factors (hypertension diabetes and cardiovascular disease) and prevent recurrences.

Nutrition

Nutritional tips include the following.

• Eat a diet high in fiber potassium and magnesium
• Decrease saturated fats and sodium
• Avoid alcohol (it increases risk of hemorrhagic stroke)
• Use garlic and onion (help regulate lipids and prevent atherosclerosis which is fat deposits inside the arteries)

Potentially beneficial nutritional supplements include the following.

• Folate (400 to 800 IU a day)
• Essential fatty acids; a mix of omega-6 (evening primrose) and omega-3 (flaxseed) may be optimal (2 tablespoons oil a day or 1 000 to 1 500 IU two times a day)
• Vitamin E: 400 to 1 600 IU a day
• Coenzyme Q10: 10 to 50 mg a day
• Vitamin C: 1 000 mg three times a day
• Bromelain: 250 mg three times a day between meals

Herbs

The use of certain herbal remedies may be helpful.

• Gingko biloba for depression and/or dementia following a stroke (60 to 80 mg three times a day). It may also be used for arterial occlusive disease. For hemorrhagic stroke patients check with your health care provider before using.
• Hawthorn (Crataegus species) for heart and vascular conditions
• Mistletoe (Viscum album) to treat and prevent atherosclerosis

Herbs may be used as dried extracts (pills capsules or tablets) teas or tinctures (alcohol extraction unless otherwise noted). Dose for teas is 1 heaping tsp. herb/cup water steeped for 10 minutes (roots need 20 minutes).

Homeopathy

An experienced homeopath can prescribe a regimen for treating stroke that is designed especially for you. Some of the most common acute remedies are listed below.

• Acontitum napellus for numbness and/or paralysis after a cerebral accident
• Belladonna for stroke that leaves person very sensitive to any motion with vertigo and trembling
• Kali bromatum for stroke resulting in restlessness wringing of the hands or other repeated gestures insomnia and night terrors
• Nux vomica for cerebral accident with paresis (muscular weakness caused by disease of the nervous system) expressive aphasia (language disorder) convulsions and great irritability

Acute dose is three to five pellets of 12X to 30C every one to four hours until symptoms are relieved.

Acupuncture

Acupuncture may be helpful for rehabilitation.

Prognosis/Possible Complications

There are many possible complications associated with stroke.

• Seizures
• Paralysis
• Cognitive (thinking) deficits
• Speech problems
• Emotional difficulties
• Daily living problems
• Pain

About 70 percent of stroke sufferers survive. They often undergo a long period of rehabilitation involving physical and occupational therapies. About 80 percent of stroke patients can walk and 60 percent achieve self-care while 25 percent experience moderate to severe impairment.

Following Up

Following hospitalization stroke patients must be carefully monitored for potential recurrence.

Supporting Research

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Copyright © 2000 Integrative Medicine Communications

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application use or misuse of any of the information contained herein including any injury and/or damage to any person or property as a matter of product liability negligence or otherwise. No warranty expressed or implied is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor pharmacist nurse or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage precautions warnings interactions and contraindications before administering any drug herb or supplement discussed herein.