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Cerebrovascular
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CONDITIONS TREATED

Stroke

What is stroke?

Stroke occurs when there is an interruption of normal blood flow to the brain causing brain cells to die and subsequently the impairment of functions such as speech, vision, or movement. Severe cases of stroke may also cause coma and death.

Understanding the factors that increase the risk of a stroke and recognizing the symptoms may help you to seek the kind of early treatment and diagnosis that will improve your chances for complete recovery

How common are strokes?

Deaths

  • Stroke is the fourth leading cause of death in Canada.

  • Each year, about 16,000 Canadians die from stroke.

  • Each year, more women than men die from stroke.

Prevalence

  • There are between 40,000 to 50,000 strokes in Canada each year.

  • For every 10,000 Canadian children under the age of 19, there are 6.7 strokes.

  • About 300,000 Canadians are living with the effects of stroke.

  • After age 55, the risk of stroke doubles every 10 years.

  • A stroke survivor has a 20% chance of having another stroke within 2 years.

Effects

Of every 100 people who are hospitalized for stroke:

  • 20 die before leaving the hospital

  • 50 return home

  • 10 go to an inpatient rehabilitation program

  • 15 require long-term care

What causes a stroke?

Stroke Diagram

A stroke occurs when an artery leading to or within the brain becomes obstructed or ruptures. These arteries can become blocked by blood clots (formed in the carotid artery or heart) or by the gradual buildup of fatty plaques or deposits, a process known as atherosclerosis. A brain artery ruptures when a weak spot on the blood vessel wall breaks, as in aneurysms. When the blood supply to a portion of the brain is stopped, even for a few minutes, the cells within the brain begin to die.

The carotid artery is a large artery in the neck that is one of the major sources of blood flow to the brain. This artery may gradually become clogged by the buildup of fatty deposits or plaques secondary to a variety of causes, including high blood pressure, smoking, high cholesterol and fat levels in the blood, and hereditary factors. Blood clots usually develop in the heart secondary to an abnormal beating pattern known as atrial fibrillation. Blood thinning medications help prevent the formation of these clots.

A hemorrhagic stroke occurs when there is bleeding into the brain tissue. This may lead to irreversible damage to the delicate structures of the brain. Brain hemorrhages, or hemorrhagic strokes, occur for a variety of reasons and may be related to a systemic problem such as uncontrolled hypertension or and underlying structural abnormality such as a vascular malformation or tumour.

They usually come on suddenly, with little or no warning, and the results can be devastating.

What are the risk factors for stroke?

  • High blood pressure (Hypertension)

  • Cigarette smoking

  • High blood cholesterol level

  • Obesity

  • Heart disease

  • Diabetes

  • Transient Ischemic Attacks (TIAs)

  • Family history of stroke

  • African-American heritage

What are the signs of a stroke?

  • Numbness of the face, arm or leg on one side of the body

  • Weakness of the face, arm or leg on one side of the body

  • Sudden and severe headache with no apparent cause

  • Difficulty speaking or understanding language

  • Dizziness, loss of balance, or loss in coordination

  • Visual loss

About 30 percent of stroke patients have a history of transient ischemic attacks, or TIAs. These "small strokes" have basically the same symptoms, but usually subside quickly (often within a few minutes, and nearly always within 24 hours).

What should I do if I have these symptoms?

If you recognize these symptoms yourself or recognize them in someone else call 911 immediately. Early treatment ensures the best chance of recovery from a stroke.

What are the treatment options?

Carotid endarterectomy: One method for relieving the obstruction of blood flow in the carotid arteries is to surgically remove the fatty deposits causing the blockage. Patients who have had a TIA and have severe blockage of the corresponding carotid artery have been shown to have dramatic stroke risk reduction with surgery compared with medicine alone.

Thrombolytic therapy: One method of removing a blood clot obstructing a brain artery is to advance a tiny catheter through the affected blood vessel to the site of obstruction. Through this catheter a clot busting medicine (thrombolytic agent, TPA, urokinase) can be directly applied to the clot to dissolve it. Once the clot is dissolved normal blood flow to the brain can be reestablished avoiding permanent brain injury. This form of therapy needs to be instituted within 6 hours of the onset of stroke symptoms.

Blood clot removal: Timely removal of blood clots within the brain in carefully selected individuals can be lifesaving and may result in improvement of neurological impairment.

Medical Treatment: Antiplatelet medicines, such as ASA and blood thinners are used routinely in the prevention of stroke. There are many studies that show that good control of blood pressure, cholesterol and blood sugar lowers the risk of stroke.

Balloon angioplasty: In this procedure a plastic tube or catheter with a balloon is advanced over a guidewire to the site of carotid artery narrowing. The balloon is then inflated, widening the flow channel through the area of plaque.

Carotid stenting: At the time of angiography a metallic stent can be placed into the carotid artery to keep it open.


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