Stroke and Mini-stroke Treated by Specialists at Mercy in Baltimore

A stroke occurs when a blood vessel in the brain becomes blocked (transient ischemic stroke or TIA or mini-stroke) or bursts (brain hemorrhage stroke). When the blood supply stops for seconds, the brain is deprived of blood and oxygen, causing the cells to die, which leads to permanent damage. A stroke requires immediate medical attention.

Each year, hundreds of thousands of Americans suffer a stroke and the condition is a leading cause of serious, long-term disability. Early treatment can help reduce brain damage and other stroke complications. A mini-stroke is an early warning sign of a more harmful stroke, so its symptoms should be communicated to a doctor as soon as possible. Strokes are treatable and preventable.

Types of Stroke

• Ischemic stroke – caused by a blocked artery
• Thrombotic stroke –a blood clot forms in one of the arteries that supply blood to your brain
• Embolic stroke – a blood clot forms outside the brain, moves about through the bloodstream, and embeds in a narrow brain artery
• Hemorrhagic stroke – caused by a leaking or burst blood vessel
• Intracerebral hemorrhage – a blood vessel in the brain ruptures and flows into the surrounding brain tissue
• Subarachnoid hemorrhage – an artery located on or near the outside of the brain ruptures and flows into the area between the outside of the brain and the skull
• Transient ischemic attack (TIA or ministroke) – caused by a temporary disruption of blood flow

Risk Factors for Stroke

Stroke risks factors include:

• Cardiovascular disease
• Diabetes
• Excessive alcohol use
• High cholesterol
• High blood pressure
• Obesity
• Smoking or exposure to second hand smoke
• Use of illegal drugs like cocaine and methamphetamines

It is important to know the exact time the signs and symptoms of the stroke begin. The timing is critical in determining the best treatment options. Stroke symptoms include:

• Difficulty walking
• Difficulty speaking and understanding
• Numbness or paralysis of the face, arm, or leg
• Trouble seeing in one or both eyes
• Headache

These same symptoms can occur with a mini-stroke (transient ischemic attack –TIA) but they often don’t last as long. TIAs are indicators of blocked blood flow to the brain and are precursors to a stroke which can cause permanent brain damage. Even if symptoms have vanished, a person who has experienced a TIA needs immediate help.

In order to diagnose a stroke, the doctor will need to know the symptoms to assist with determining the type of stroke. The doctor will perform a physical exam along with testing. Tests may include:

• Blood tests
• CT Scan
• MRI
• Carotid ultrasound
• Cerebral angiogram
• Echocardiogram

Symptoms of stroke require immediate attention and anyone suffering from any of the listed symptoms should go to the hospital as soon as possible. Immediate medical care is the best hope for minimizing the long-term effects of stroke. 

Stroke Treatment

A stroke requires emergency treatment and will include a CT scan, oxygen for breathing, a physical exam and emergency surgery to drain blood and stop additional bleeding. The immediate goal is to control bleeding and reduce pressure on the brain. Once a patient is stabilized, he or she remains in the hospital for several days and medical care is focused on helping the patient regain their strength, recover as much body function as possible and return home. Plans will also be made for stroke recovery. Rehabilitation can include speech therapy, physical therapy, nutritional education, occupational therapy and help from social services.

Stroke treatment options will depend on the type of stroke. For ischemic strokes, it is important that the blood be restored to the brain quickly. Treatment may consist of the following clot-busting medications within the first four and a half hours of the stroke onset:

• Aspirin - reduce the forming of blood clots
• Intravenous injection of tissue plasminogen activator (TPA) - restores the blood flow by dissolving blood clots
• Direct medication to the brain – a catheter is inserted in the groin, threaded to the brain and released in the location where the stroke is taking place
• Mechanical clot removal – a catheter is used to position a small device into the brain to physically grasp and remove the blood clot

Other treatment options may include:

• Carotid endarterectomy – the removal of plague from the carotid arteries found along the both sides of the neck and the brain
• Angioplasty and stents