STROKE OR TRANSIENT ISCHEMIC ATTACK
Stroke and transient ischemic attack (TIA) both result from the
interruption of blood flow of the cerebral artery which supplies a
specific area of the brain. Both of these conditions are also
referred to as a CVA (cerebrovascular accident). Death from
stroke is the third leading cause of death in the United States.
Stroke implies a PERMANENT interruption in blood flow to a
specific area of the brain. A transient ischemic attack is a
TEMPORARY interruption in blood flow (duration of symptoms is less
than 24 hours). Blockage of the cerebral arteries, which supply
the brain, most often occurs secondary to blood clots that are
released from one of the carotid arteries in the NECK.
Carotid arteries, which have been narrowed by the progressive
effects of atherosclerotic vascular disease, (see the DISEASE
FILE) tend to form blood clots. These clots can travel through
the blood stream (embolize) and be deposited in the cerebral
circulation. There they can block a smaller caliber blood vessel,
depriving the brain cells in that area of oxygen. It is the lack
of oxygen (ischemia), to that specific area of the brain that is
responsible for the varied symptoms of stroke (see below).
The effects of atherosclerotic vascular disease in the carotid
arteries are the most common cause for stroke. However, a stroke
can also occur if a blood clot embolizes from a another clot
forming source, the heart. This can occur as a complication of
acute myocardial infarction, or in some cases, a cardiac
arrhythmia (atrial fibrillation). The risk factors for stroke are
essentially the same as those for the development of
atherosclerotic vascular disease.
STROKE AND TIA RISK FACTORS
2. HYPERTENSION (high blood pressure)
3. FAMILY HISTORY FOR STROKE
4. PRIOR STROKE HISTORY
5. HIGH BLOOD CHOLESTEROL
8. CARDIAC ARRHYTHMIA (atrial fibrillation)
* STROKE AND TIA SYMPTOMS *
2. SLURRED SPEECH
3. INABILITY TO TO SPEAK
4. VERTIGO (spinning sensation)
5. NUMBNESS TO AN ARM, LEG, OR HALF OF THE FACE
6. WEAKNESS TO AN ARM, LEG, OR HALF OF THE FACE
7. DIFFICULTY WALKING (falling to one side only)
8. DOUBLE VISION (actually seeing two of one object)
9. LOSS OF VISION IN ONE EYE (like a "shade" coming down over the eye)
IMPORTANT: ARM and LEG WEAKNESS or NUMBNESS should occur on the
Evaluation will include history and physical examination to
document the presence of any neurologic deficits listed above.
CT-scanning of the brain can (in most cases) reveal the acute
stroke. MRI scanning of the brain has also been a useful
diagnostic tool. The carotid angiogram is a special x-ray that
shows the extent of blood vessel narrowing in the carotid vessels.
Those with significant narrowing may be candidates for surgical
intervention (see below).
Newer imaging technology, SPECT scanning, is beginning to be
applied in the treatment of these patients and may provide earlier
detection of stroke in some cases. Treatment may include
medications to anticoagulate (thin) the blood (e.g. warfarin,
aspirin, Ticlid, and Persantine) and dissolve clots (e.g. heparin,
streptokinase). Patients with a cardiac arrhythmia will require
management of their heart condition first, with the administration
of additional anticoagulation at the discretion of their
Studies show that surgery (carotid endarterectomy) performed on
the diseased carotid arteries BEFORE a stroke has occurred, can
decrease the incidence of a major stroke.
Physical rehabilitation of the stroke patient by a trained
professional is an important part of ongoing care.
1. To lessen the risk of stroke, follow a diet low in fats and
2. Have your cholesterol and lipoprotein levels checked routinely.
3. If you have high blood pressure or diabetes, allow your doctor
to monitor you closely. Get involved in the management of
your own disease through continued education (such as this
4. Don't smoke
5. Avoid becoming overweight (obesity).
6. Before starting any exercise program, discuss the program with
7. There is evidence which suggests that taking 1 baby aspirin
each day can decrease your risk of TIA and stroke. See your
physician prior to starting any new mediations.