What is Stroke? Risk Factors, Symptoms, and Treatment

Stroke is a disease that affects the arteries leading to and within the brain.  Stroke, also known as cerebrovascular accident (CVA), cerebrovascular insult (CVI), or brain attack, is when poor blood flow (less of oxygen) to the brain results in cell death.  The poor blood flow may be due to obstruction of flow by a clot or reduced flow due to rupture.

Stroke is the leading cause of grave long-term disability.  It particularly affects men, smokers, and senior citizens.  Strokes are, after all, the fourth most common cause of death in men -- behind heart disease, cancer, and accidents. They are indeed more likely in men over age 65, but they can happen at any age.  Strokes are also more likely to be fatal and strike earlier in men than in women.  The consequences of a stroke can be devastating. Not only can a stroke kill you, but nonfatal strokes can leave you severely debilitated, paralyzed, or unable to communicate.

  1. Hypertension (high blood pressure).
  2. Diabetes mellitus (high sugar).
  3. Obesity (excess weight and waist).
  4. Smoking.
  5. High blood cholesterol.
  6. Atrial fibrillation (AF is an irregular and often very fast heart rate causing symptoms like heart palpitations, fatigue, and shortness of breath, and is the most common heart cause for stroke.
  7. Bacterial endocarditis affecting the heart valves is the less common heart cause for stroke.
Stroke can be caused by a clot obstructing the flow of blood to the brain (called an ischemic stroke).

Blood vessel rupturing and preventing blood flow to the brain (called a hemorrhagic stroke) due to uncontrolled hypertension (raised BP), an aneurysm rupture, and arteriovenous malformations.

A TIA (transient ischemic attack), or "mini stroke," is caused by a temporary clot.

The brain is an extremely complex organ that controls various body functions.  If a stroke occurs and blood flow can't reach the region that controls a particular body function, then that part of the body won't work as it should.

If the stroke occurs toward the back of the brain, for instance, it's likely that some disability involving vision will result.  The effects of a stroke depend primarily on the location of the obstruction and the extent of brain tissue affected.

Because one side of the brain controls the opposite side of the body, a stroke occurring on one side will result in neurological complications on the other side of the body.  

For example, if the stroke occurs on the right side of the brain, then the left side of the body (including the left side of the face) is affected.  Any or all of the following can occur:
  1. Paralysis on the left side of the body.  
  2. Vision problems.  
  3. Quick, inquisitive behavioral style.  
  4. Memory loss.
On the other hand, if the stroke occurs on the left side of the brain, the right side of the body will be affected, producing some or all of the following:
  1. Paralysis on the right side of the body.  
  2. Speech slurring/language problems.  
  3. Slow, cautious behavioral style.  
  4. Memory loss.
  5. Balance loss.
When stroke occurs in the brainstem, depending on the severity of the injury, it can affect both sides of the body and may leave someone in a ‘locked-in’ state.  When a locked-in state occurs, the patient is generally unable to speak or achieve any movement below the neck.

  1. Sudden, severe headache and confusion with no known cause:  65 percent of women vs. 58 percent of men.
  2. Loss of vision or dimming (like a curtain falling) in one or both eyes: 69 percent of women vs. 67 percent of men.
  3. Loss of speech, difficulty talking, or difficulty comprehending what others are saying:  90 percent of women vs. 85 percent of men.
  4. Weakness or numbness of the face, arm, or leg on one side of the body:  95 percent of women vs. 93 percent of men.
  5. Sudden trouble walking, dizziness, and/or loss of balance: 87 percent of women vs. 85 percent of men.
  6. Throwing up (vomiting) or urge to being sick:  80% in women vs. 74% men.
The American Heart Association uses the memory tool known as F.A.S.T. to recognize signs of stroke:

Every second counts when a man is having a stroke.  The Need is to Act FAST.

F.A.S.T. is a mnemonic.

If you think someone may be having a stroke, perform the following three-part test and then take action:
  1. F - Face:  Ask the man if he can smile.  Check if one side of the face droops.
  2. A - Arms:  Ask the man to raise his arms.  See if one arm drifts downward.
  3. S - Speech:  Ask the man to repeat a simple phrase.  Check for slurred or odd speech.
  4. T - Time:  If you observe any of these signs, call 911 right away.
Stroke associated with endocarditis has significant mortality and morbidity rates, especially due to the frequent traveling clots (emboli) to multiple sites of the brain.  Endocarditis is an important, although less common, cause of cerebral embolism.  Embolism from any source (cardiac or arterial) accounts for 15-70% of ischemic strokes.  While not as prevalent as atrial fibrillation, endocarditis is an important source of cardiac embolism.

Endocarditis can have profound and devastating neurologic consequences.  The incidence of central nervous system (CNS) complications in infective endocarditis is approximately 30%, and these manifestations are often the first sign of illness (47% of the time in one series).

In most cases, the neurologic sequelae are present before the initiation of antimicrobial therapy (76%). Even amnesia can herald a diagnosis of infective endocarditis.

Three main forms of endocarditis have been described: infective endocarditis (IE), nonbacterial thrombotic endocarditis (NBTE –most commonly associated with malignancy), and Libman-Sacks endocarditis (LSE – in systemic lupus erythematosus and antiphospholipid syndrome. 

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