Your guide for healthy aging

References
​Grotta, J., Savitz, S., Persse, D. (2013). Stroke severity as well as time should determine stroke patient triage. Stroke. 44:555-557

​National Institute of Neurological Disorders and Stroke, 2014. Retrieved from http://www.ninds.nih.gov/disorders/stroke/stroke.htm.

Royal College of Physicians (2012). National clinical guidelines on stroke. Retrieved from http://www.rcplondon.ac.uk/sites/default/files/documents/national_clinical_guidelines_for_stroke_-_fourth_edition.pdf



Author: Leah Korkis, BSN, RN.

A registered nurse specialized in geriatrics. She is experienced in long term care, community health, and acute care. She currently works as a nurse and clinical educator in one of the top inpatient hospitals in the nation.

Video A: Personal stroke story from Neuroanatomist Jill Bolte Taylor

Picture F: Example of visual vield loss

Picture E: VIsion loss due to a stroke. The picture resembling right side homonymous hemiaopia, or right vision field blindness.  

Picture D:  Transient Ischemic Attack (TIA)

Picture C:  Hemorrhagic stroke 

Picture B:  Ischemic stroke 

Causes

There are two causes for a stroke. The most common is due to a clot that blocks blood flow; called an ischemic stroke  (see photo A). This can either be due to either a large plaque forming in one place, or due to a piece of plaque breaking off and traveling to smaller vessels where it becomes lodged.  This usually occurs where two vessels branch off of one another as seen in photo B.  


The second cause for a stroke is when a weakened blood vessel ruptures; called a hemorrhagic stroke (see photo C).  This is usually as a result of uncontrolled high blood pressure. 


A Transient Ischemic Attack is referred to as a "TIA". Although symptoms of a TIA resemble that of a stroke, they spontaneously resolve on their own sometimes within minutes. This is because a TIA is actually a "mini-stroke",  caused by smaller clots that obstruct blood flow only momentarily before being pushed out of place by the backed up pressure of blood flow (see photo D).  A TIA is a serious warning for a stroke and should still be considered a medical emergency. 



Symptoms 

As an easy reminder for the stroke and TIA symptoms, remember "FAST".


F:  Ask the person to smile. Does one side of their face droop? 

A: Ask the person to raise both arms. Is one arm weaker?

S: Ask the person to seak. Does their speech sound slurred or garbled? 

T: Time is brain. If you observe any of these symptoms, call 911 immediately. 


Time is brain, meaning the more time the above symptoms last, the more damage there will be to the brain. Other symptoms include: 


  • ​Difficult walking

  • Vision Changes 

  • Difficultly understanding speech, as evidenced by answering questions incorrectly or inappropriately. (ie: Simply asking, "How are you?", may be answer with, "No, I got this shirt from my aunt."

  • ​Inability to identify common objects (ie: A pen may be describe as "a stick of some kind.")

  • ​Sudden numbness or tingling 

  • ​Sudden onset of a severe headache​

Risk Factors

​There are a handful of factors that increase your changes of having a stroke, however here are the top contributers to an increased stroke risk:

  • Smoking

  • Diabetes 

  • ​Uncontrolled high blood pressure

  • ​High Cholesterol

  • Heart Disease 

  • ​Heart Arrhythmia 


Long-Term Damage 

Whether a stroke causes long-term damage depends solely on how long the symptoms persisted, how quickly treatment was initiated, and what types of stroke it is (ischemic or hemorrhagic). Likewise, the type and the degree of damage depends on where in the brain the stroke occurs. The golden rule being; a stroke on one side of the brain will present as symptoms affecting the opposite side of the body. Common problems after a stroke include numbness one arm or leg, difficulty walking,  trouble swallowing, and problems with speech and comprehension. Vision problems may present as visual field loss, blurry vision, double vision and moving images. Visual field is the term used to describe the whole of our vision, from the centre to the periphery. It refers to everything we can see in the periphery (around the edges of our vision) as well as what we are directly looking at (central vision). Strokes can cause whole sections of the visual field to be missing (see photo E).  Due to the loss of vision,  individuals may also neglect or fail to ecknowledge people or objects within that area of vision loss. This phenomenon occurs unintentionally and unbeknownst to the individual.  Commonly, as part of post-stroke assessment, an individual may be asked to copy a simple drawing to the best of their ability. An excellent example of visual neglect  can be seen in the illustration of photo F.  

 

These problems can be permanent, however with time and therapy many people regain some of these abilities.

Picture A:  Atherosclerosis within an artery restricting blood flow, 

Helpful Videos and Pictures

A stroke, or cerebral vascular accident (CVA), is a rapid loss of brain function due to an interruption in blood flow. Within minutes, brain cells go into shock and eventually die as their oxygen and nutrients run out. 

Stroke and Transient Ischemic Attack (TIA)

Now & later