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 SymptomsSymptoms 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
- 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)
- Heart disease
- Traumatic injury
- Substance abuse (cocaine, alcohol)
- High total serum cholesterol (for older patients)
- Increased blood viscosity (thickness)
- Use of oral contraceptives, especially in smokers
What to Expect at Your Provider's OfficeIf 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.
PreventionDaily 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 PlanThe 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 TherapiesA 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 ProceduresSurgery 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 TherapiesThe goals of complementary and alternative therapies are to prevent strokes, treat risk factors (hypertension, diabetes, and cardiovascular disease), and prevent recurrences.
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)
- 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: 250 to 500 mg two times a day
- Bromelain: 250 mg three times a day between meals
- Alpha-lipoic acid: animal studies suggest that alpha-lipoic acid may increase survival rate after stroke.
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
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
Acupuncture Many studies have been conducted on the effects of acupuncture during stroke rehabilitation. These studies have found that acupuncture reduces hospital stays and improves recovery speed. Acupuncture has been shown to help stroke patients regain motor and cognitive skills and to improve their ability to manage daily functioning. Based on the available data, the National Institutes of Health recommended acupuncture as an alternative or supplemental therapy for stroke rehabilitation. In general, the evidence indicates that acupuncture is most effective when initiated as soon as possible after a stroke occurs, but good results have been found for acupuncture started as late as six months following a stroke.
People who have suffered a stroke often have a deficiency of qi in the liver meridian and a relative excess in the gallbladder meridian. In addition to a primary needling treatment on the liver meridian and the supporting kidney meridians, moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points) may be used to enhance therapy. Treatment may also include performing acupuncture on affected limbs. Certain scalp acupuncture techniques that have been developed by Chinese, Korean, and Japanese practitioners also show promise.
Chiropractors do not treat stroke, and high velocity manipulation of the upper spine is considered inappropriate in individuals who are taking blood-thinning medications or other medications used to reduce the risk of stroke. It should also be noted that chiropractic spinal manipulation of the neck is associated with an exceedingly small risk of stroke (0.5 strokes reported per 2 million spinal manipulations).
Prognosis/Possible ComplicationsThere are many possible complications associated with stroke.
- Cognitive (thinking) deficits
- Speech problems
- Emotional difficulties
- Daily living problems
Following UpFollowing hospitalization, stroke patients must be carefully monitored for potential recurrence.
Atorvastatin. NMIHI. Accessed at http://www.nmihi.com/a/atorvastatin.html on November 15, 2018.
Bartram T. Encyclopedia of Herbal Medicine. Dorset, England: Grace Publishers;1995:407-408.
Blumenthal M, ed. The Complete German Commission E Monographs. Boston, Mass: Integrative Medicine Communications; 1998:134, 136-138, 142-144, 176-177.
Bennett JC, ed. Cecil Textbook of Medicine. 20th ed. Philadelphia, Pa: W.B. Saunders; 1996.
Clark WM, Rinker LG, Lessov NS, Lowery SL, Cipolla MJ. Efficacy of antioxidant therapies in transient focal ischemia in mice. Stroke. 2001;32(4):1000-1004.
Clopidogrel. NMIHI. Accessed at http://www.nmihi.com/c/clopidogrel.html on November 15, 2018.
Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr. 1999;69(6):1086-1107.
Dambro MR. Griffith's 5-Minute Clinical Consult. 1999 ed. Baltimore, Md: Lippincott Williams & Wilkins, Inc.; 1999.
Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998.
Gosman-Hedstrom G, Claesson L, Klingenstierna U, et al. Effects of acupuncture treatment on daily life activities and quality of life. Stroke. 1998;29:2100-2108.
Gabapentin. NMIHI. Accessed at http://www.nmihi.com/f/gabapentin.html on November 15, 2018.
Gruenwald J, Brendler T, Jaenicke C, eds. PDR for Herbal Medicines. Montvale, NJ: Medical Economics Company; 1998:779-81, 1219-22.
JAMA Patient Page. How much vitamin C do you need? JAMA. 1999;281(15):1460.
Johansson K, Lindgren I, Widner H, Wiklund I, Johansson BB. Can sensory stimulation improve the functional outcome in stroke patients? Neurology. 1993;43:2189-2192.
Johansson BB, Haker E, von Arbin M, et al. Acupuncture and transcutaneous nerve stimulation in stroke rehabilitation. Stroke. 2001;32:707-713.
Johnston CS. Recommendations for vitamin C intake. JAMA. 1999;282(22):2118-2119.
Kaplan HW, ed. Comprehensive Textbook of Psychiatry. 6th ed. Baltimore, Md: Williams & Wilkins; 1995.
Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and recommendations for vitamin C intake. JAMA. 1999;281(15):1415-1453.
Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany, Calif: Hahnemann Clinic Publishing; 1993:3-6, 58-62, 198-199, 272-276.
Panigrahi M, Sadguna Y, Shivakumar BR, Kolluri SV, Roy S, Packer L, Ravindranath V. Alpha-Lipoic acid protects against reperfusion injury following cerebral ischemia in rats. Brain Res. 1996;717(1-2):184-188.
Naeser MA, Alexander MP, Stiassny-Eder D, Galler V, Bachman D. Acupuncture in the treatment of paralysis in chronic and acute stroke patients: improvement correlated with specific CT scan lesion sites. Acupunct Electrother Res. 1994;19:227-249.
Park J, Hopwood V, White AR, Ernst E. Effectiveness of acupuncture for stroke: a systematic review. J Neurol. 2001;248:558-563.
Rakel RE, ed. Conn's Current Therapy. 50th ed. Philadelphia, Pa: W.B. Saunders; 1998.
Rosen P, ed. Emergency Medicine: Concepts and Clinical Management. 4th ed. St. Louis, Mo: Mosby-Year Book; 1998.
Rothwell DM, Bondy SJ, Williams I. Chiropractic manipulation and stroke: a population-based case-control study. Stroke. 2001;32:1054-1060.
Statins. NMIHI. Accessed at http://drugs.nmihi.com/statins.htm on November 15, 2018.
Stroke. NMIHI. Accessed at http://www.nmihi.com/s/stroke.htm on November 15, 2018.
Stroke. MedlinePlus. Accessed at https://medlineplus.gov/stroke.html on November 15, 2018.
Stroke Health Center. WebMD. Accessed at https://www.webmd.com/ on November 15, 2018.
Stroke. Symptoms and causes. MFMER. Accessed at https://www.mayoclinic.org/ on November 15, 2018.
Siegel D, Neiders T. Vertebral artery dissection and pontine infarct after chiropractic manipulation. Am J Emerg Med. 2001;19(2):171-172.
Swain RA, St Clair L. The role of folic acid in deficiency states and prevention of disease. J Fam Pract. 1997;44(2):138-144.
Terrett AG. Current Concepts in Vertebrobasilar Complications Following Spinal Manipulation. Des Moines, IA: NCMIC Group; 2001.
What is stroke? American Academy of Family Physicians Accessed at https://familydoctor.org/ on November 15, 2018.