Ischemic Stroke

What is an ischemic stroke?

An ischemic stroke happens when blood cannot flow to part of your brain. This can be caused by a blood clot or plaque build up in your artery. Plaque happens when fatty deposits and other things build up in an artery. A blood clot can form in an artery somewhere else, then break loose and travel to your brain. The clot may get stuck in a narrow blood vessel, stopping blood and oxygen from reaching your brain. When oxygen cannot get to an area of the brain, tissue in that area may get damaged. Damage to an area of the brain causes loss of body functions controlled by that area. You may have trouble talking, swallowing, thinking or walking after a stroke. You may not be able to move part of your body.

What are the signs and symptoms of an ischemic stroke?

Signs or symptoms may begin suddenly and worsen quickly. One or more of the following may appear within minutes or hours:

• You have a severe headache. It may feel like the worst headache of your life.
  
  
• You have blurred or double vision, or become blind in 1 eye.
  
  
• You have numbness (loss of feeling), tingling, weakness, or being unable to move 1 side of your body.
  
  
• You have trouble walking, swallowing, talking, or understanding.
  
  
• You have dizziness, or confusion, or you may pass out.

How is an ischemic stroke diagnosed?

Your caregiver will ask about your and your family's medical history. He will ask about the medicines you take and if you use street drugs. He will also do a physical exam and look for signs that show what part of your brain was injured. You may need blood tests and other tests to help your caregiver learn if you have had a stroke. Tests also help your caregiver know where in your brain a stroke happened, and how much damage from it you have. Ask caregivers for more information about the tests that you need. You may need one or more of the following:

• CT scan: This test is also called a CAT scan. An x-ray and computer are used to take pictures of your skull and brain. You may be given dye, also called contrast, before the test. Tell the caregiver if you are allergic to dye, iodine, or seafood.
  
  
• MRI: This scan uses powerful magnets and a computer to take pictures of your brain. It will also take pictures of the blood vessels and structures in your head. You may be given dye, also called contrast, before the test. Tell caregivers if you are allergic to dye, iodine, or seafood. Remove all jewelry, and tell caregivers if you have any metal in or on your body. Metal can cause serious injury. Tell caregivers if you cannot lie still or are anxious or afraid of closed spaces.
  
  
• Arteriography: X-rays are taken of your arteries to look for blood flow blockage.

How is an ischemic stroke treated?

Treatment depends on what caused your stroke, and your signs and symptoms. You may need any of the following medicines:

• Blood clot medicines: If your stroke was caused by a blood clot, you may need the following medicines:
  
  
  • Thrombolytics: This medicine is given to break apart blood clots and help blood flow more easily.
    
    
  • Aspirin: This medicine may be given to help thin the blood to keep blood clots from forming. This medicine makes it more likely for you to bleed or bruise.
    
    
  • Antiplatelets: This medicine is given to prevent blood clots from forming.
  
  
• Diuretics: You may get diuretic medicine to help decrease swelling in your brain. This may help your brain get better blood flow.
  
  
• Sedation: You may need sedation medicine to help decrease the pressure in your brain. It can also help decrease pain. If you have a tube in your throat attached to a ventilator to help you breathe, you may be given this medicine. This medicine makes you go into a deep sleep. This is done so you are not aware of any discomfort you may have from the throat tube.
  
  
• Other medicines: You may need medicine to treat diabetes, high blood cholesterol, or to prevent seizures. Medicine may be given to keep your blood pressure at a certain level if it is too high or too low.

What other treatment may be needed with an ischemic stroke?

• Ventilator: This is a machine that gives you oxygen and breathes for you when you cannot breathe well on your own. An endotracheal (ET) tube is put into your airway through your mouth or nose. You may need a trach if an ET tube cannot be placed. A trach is an airway tube put into an incision (cut) in the front of your neck. The ET tube or trach is attached to the ventilator.
  
  
• Surgery:
  
  
  • Ventriculostomy: If you have too much fluid and swelling around your brain, a tube may be placed into your skull to drain the fluid. This tube also checks the pressure in your brain.
    
    
  • Carotid endarterectomy: Blocked carotid arteries can cause poor blood flow to your brain. If your carotid arteries are blocked, surgery called carotid endarterectomy may be done. This surgery widens the arteries so that blood can flow through more easily.
    
    
  • Blood vessel filter: If you are at high risk of getting a clot in your leg (DVT), you may need to have a filter device placed in your blood vessel. This is called an inferior vena cava filter. Ask your caregiver for more information about this procedure.

What are the risks of an ischemic stroke?

• An ischemic stroke can affect your body, your brain, and your emotions. This may happen even if you get treatment for it soon after your stroke starts. Your breathing may worsen and you may need a machine to help you breathe. You may get blood clots in other parts of your body that can cause tissue damage or affect your lungs. The blood clot may break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause another stroke. These problems can be life-threatening. You may go into a coma (very deep sleep) and not wake up.
  
  
• After your stroke, you may be paralyzed (not able to move) on 1 or both sides of your body. You may get medical problems such as muscle shortening (contractures) or skin breakdown (bedsores) if you are less active. You are more at risk for lung infections if you are not able to move around or you have problems swallowing. You are at a greater risk of falling after a stroke. Your brain may be damaged by the stroke and you may have seizures (convulsions). Even with treatment, you may have lasting problems talking, thinking, or moving your body. You may not be able to care for yourself or live alone. You may die from having a stroke.
  
  
• Even with treatment, you could have another stroke. Without treatment, the damage caused by a stroke can get worse, other medical problems can develop, and your risk of having another stroke increases. Talk to your caregiver about these risks, your medicines, or your care.

What can I do to help recover from a stroke?

• Go to rehabilitation sessions:
  
  
  • Rehabilitation (rehab) is an exercise and activities program. Rehab can help you return to your usual activities and help prevent problems, such as muscle shortening (contractures) and skin breakdown (bedsores). Physical therapists may work with you to strengthen your arms, legs, and hands. They may help you relearn or improve how you walk (gait training). Occupational therapists may teach you new ways to do daily activities, such as getting dressed. A speech therapist may help you relearn or improve your ability to talk and swallow.
    
    
  • Your rehab program may include functional electrical stimulation to help your muscles work better. You may do weight lifting to increase your strength. You may do exercises to improve your balance and movement to decrease your risk of falling. Stretching exercises, riding a bike, or walking can also help you recover. Ask your caregivers what activities you should do to help you recover from your stroke.
  
  
• Get help for depression: The way you think and feel about things may change after a stroke. You may be forgetful, or have trouble thinking clearly. You may get angry or start crying easily, or you may feel depressed. Talk to caregivers about your feelings. Counseling, medicines, and support groups can help you cope with the changes that happen after a stroke.

What increases my risk of an ischemic stroke?

• You are at least 55 years old.
  
  
• You are a man.
  
  
• You are a woman and use birth control pills, or you take hormone replacement medicine after menopause. Menopause occurs when an adult woman stops having monthly periods.
  
  
• You are pregnant or had a baby within the past 6 weeks.
  
  
• You are African American or Native American.
  
  
• Your father or mother had a stroke, or you had a low weight when you were born.
  
  
• You have high blood pressure, or blood vessel or sickle cell disease that is not being treated.
  
  
• You have atrial fibrillation, diabetes, or other heart or blood vessel conditions.

What lifestyle changes can decrease my risk of a stroke?

• Lower your blood pressure. Take your blood pressure medicine as ordered by your caregiver. Do not stop taking these medicines without asking your caregivers. Follow your caregiver's instructions to check your blood pressure, and write the numbers down to show him.
  
  
• Manage your diabetes. Diabetes (high blood sugar) increases your risk of having a stroke . Manage diabetes by keeping your blood sugar level within the range of numbers your caregiver tells you it should be. Follow your caregiver's instructions to check your blood sugar, and write the numbers down to show him.
  
  
• Eat healthy foods. What you eat can help prevent or manage high blood pressure, high cholesterol, and diabetes. Any of these medical conditions increases your risk of stroke. Eat foods low in fat, cholesterol, salt, and sugar. Eat at least 5 servings of fruits and vegetables each day. Eat foods that are high in potassium, such as potatoes and bananas.
  
  
• Reach or stay at a healthy weight. If you are overweight or obese (weigh more than your caregiver suggests), you may need to lose weight. Weight loss can decrease your blood pressure and your risk of stroke. Ask your caregiver how much you should weigh and about how you can lose weight.
  
  
• Exercise. Get 30 minutes of moderate exercise each day to help prevent a stroke. Good exercises are cycling, fast walking, and jogging. Ask your caregiver what exercises you should do.
  
  
• Limit alcohol. Your risk of stroke increases if you have 5 or more drinks of alcohol a day. Alcohol can damage your brain, heart, and liver. Men should not have more than 2 drinks per day. Women should not have more than 1 drink per day. Tell your caregiver if you drink alcohol.
  
  
• Quit smoking. If you smoke, you should quit. Cigarette smoke increases your risk of a stroke. It is never too late to quit smoking. You are more likely to have heart disease, lung disease, cancer, and other health problems if you smoke. Quit smoking to improve your health and the health of those around you. Ask for help if you are having trouble quitting.
  
  
• Do not use street (illegal) drugs. Cocaine, methamphetamines (meth), and heroin are street (illegal) drugs that increase your risk of having a stroke.

How can I tell if someone is having a stroke?

Know the F.A.S.T. test to recognize the signs of a stroke:

• F = Face: Ask the person to smile. Drooping on one side of the mouth or face is a sign of a stroke.
  
  
• A = Arms: Ask the person to raise both arms. One arm that slowly comes back down or cannot be raised is a sign of a stroke.
  
  
• S = Speech: Ask the person to repeat a simple sentence that you say first. Speech that is slurred or strange sounding is a sign of a stroke.
  
  
• T = Time: If you see that the person has any of these signs, it is an emergency. Call an ambulance to take the person to the hospital.

When should I call my caregiver?

Call your caregiver if:

• Your blood pressure is higher or lower than your caregiver has told you it should be.
  
  
• You have skin tears, or sores on your heels, head, or buttocks from lying in bed.
  
  
• You have bowel movement problems.
  
  
• Your arm or leg feels warm, tender, and painful. It may look swollen and red.
  
  
• You cannot make it to your next appointment.
  
  
• You have questions about your therapy, medicine, or care.

When should I get immediate help?

Seek care immediately or call 911 if:

• You have a seizure .
  
  
• You are bleeding from your rectum, nose, or another body area.
  
  
• You suddenly feel lightheaded and have trouble breathing.
  
  
• You have new and sudden chest pain. You may have more pain when you take deep breaths or cough. You may cough up blood.
  
  
• You have signs of a stroke: The following signs are an emergency. Call 911 immediately if you have any of the following:
  
  
  • Weakness or numbness in your arm, leg, or face (may be on only one side of your body)
    
    
  • Confusion and problems speaking or understanding speech
    
    
  • A very bad headache that may feel like the worst headache of your life
    
    
  • Not being able to see out of one or both of your eyes
    
    
  • Feeling too dizzy to stand

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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