Stroke Recovery Guide: Ishemic, Hemorrhagic, TIA Strokes

The Signs and Symptoms of a Stroke

Getting quick emergency medical assistance and treatment for anyone suffering from a stroke, or cerebrovascular accident (CVA), is of the utmost importance and could mean the difference between a complete recovery and long-term brain damage or even death. While many of the signs of a stroke mimic other medical issues, there is a key difference. Stroke symptoms will come on very suddenly and are usually more severe than if they are caused by other medical issues. These symptoms include:

• Severe headache with no known underlying cause
• Confusion
• Difficulty speaking normally
• Difficulty understanding what others are saying
• Weakness or numbness in the face or extremities, usually on one side of the body
• Difficulty seeing either out of one or both eyes
• Trouble walking
• Dizziness
• Lack of coordination or loss of balance

Complications of a Stroke

After a stroke, there are some common complications that may occur. These may be permanent or transient, depending on how quickly you receive medical assistance and how severe the stroke is.

• Muscle Weakness: Muscle weakness is a common complication. It is usually focused on just one side of your body. You may see stroke victims who limp, have little use of one arm, or whose face droops on one side.
• Blood Clots: Because of the muscle weakness that usually accompanies a stroke, patients are usually have much less mobility. This can quickly lead to blood clots, especially in the legs.
• Problems Swallowing: Strokes can sometimes affect the muscles you use to swallow, causing problems when you try to eat or drink. Patients occasionally overcompensate for the swallowing issues and wind up inhaling food or liquids, which end up in the lungs and can cause pneumonia.
• Bladder Control Issues: Strokes can also impact the muscles you use to urinate, which may require the use of catheters.

When Stroke Symptoms Disappear

Stroke symptoms usually don’t go away on their own, but there are some cases where the symptoms are transient, and this can lead to a dangerous situation. When the onset of symptoms is sudden and severe but they disappear within a few minutes, it is still possible that you have suffered a stroke. Although many people ignore the warning signs, the underlying condition is considered a medical emergency. It is imperative that you seek medical treatment right away to avoid more serious symptoms that can cause long-term damage from occurring in the future.

Stroke Test Checklist

It can be difficult for anyone who is not medically trained to differentiate the symptoms of a stroke from a number of other health issues, but it is critical to make that preliminary diagnosis and seek immediate medical assistance. The Centers for Disease Control and Prevention caution that stroke victims whose symptoms are recognized and diagnosed and who receive medical care within the first three hours after the stroke can receive the most effective treatment and have the best chance of recovery. When in doubt, remember FAST:

• Face: Look at the person’s face and ask him to smile. Check to see if one side droops more than the other.
• Arms: Ask the patient to raise his arms up from his sides. Make note if one arm tends to drift downward.
• Speech: Say a simple phrase and ask the patient to repeat it. Pay attention to whether there is any slurred or otherwise irregular speech.
• Time: Remember that time is of the essence. If the patient has demonstrated any of these symptoms of stroke, dial 911 immediately.

Different Types of Strokes

There are three different types of strokes. While each one may have the same lasting health consequences if not treated properly, each has its own set of causes and treatment.

• Ischemic Strokes: Roughly 85 percent of all strokes fall into this category. Ischemic strokes are usually caused by a blocked artery that can no longer supply the brain with the oxygen-rich blood it needs. The blockages are most often caused by simple blood clots.
• Hemorrhagic Strokes: When an artery that supplies the brain with blood ruptures or leaks, the resulting blood flow can put damage brain cells by putting too much pressure on them. A hemorrhagic stroke is often the result. An aneurysm or extremely high blood pressure is usually responsible for the rupture or blood leak. A stroke caused by a ruptured artery is called an intracerebral hemorrhagic stroke, while a simple blood leak causes the less common subarachnoid hemorrhagic stroke.
• Transient Ischemic Attacks (TIA): These “mini strokes” differ from full-blown strokes in that the causes and symptoms only last for a short time, although they are often a precursor to a major stroke in the near future. In fact, roughly 33 percent of people who experience a TIA and don’t seek medical treatment usually wind up suffering from a major stroke within 12 months, and 10 to 15 percent will have a major stroke within three months.

Stroke Severity

The National Institutes of Health has implemented a standard stroke severity scale that allows medical practitioners to quantify the level of impairment a patient experiences as the result of a stroke. The same scale is used for both ischemic and hemorrhagic strokes. Ten basic functions are assessed to determine the severity rating:

• Level of consciousness
• Horizontal eye movements
• Individual visual field tests of the eyes
• Facial paralysis
• Downward arm drift
• Downward leg drift
• Weakness or lack of coordination in the limbs
• Sensation
• Language
• Speech

The NIH scale gives detailed information on how to test each of these functions so that the resulting findings are truly on a standard scale. Each test is rated on a scale of zero to four, and the results are tallied at the end of the testing to determine the level of impairment and the severity of the stroke. The scale results include:

• 0: No stroke symptoms were found
• 1 to 4: Indicates a minor stroke
• 5 to 15: Indicates a moderate stroke
• 16 to 20: Indicates a moderate to severe stroke
• 21 to 42: Indicates a severe stroke

The Causes of Strokes

The most common types of strokes, ischemic and TIA, are caused by blood clots or blockages in the arteries that interrupt the flow of blood to the brain. This deprives the brain of the oxygen it needs and causes damage that may be permanent. The most common conditions that cause blockages are:

• Atherosclerosis: This is a condition where plaque builds up in the arteries, limiting the amount of blood that can flow through them. This plaque buildup can rupture, which often causes clots that either partially or completely block the artery. Plaque buildup in the carotid arteries are one of the most common causes of ischemic and TIA strokes.
• Embolism: A stroke caused from an embolism is called an embolic stroke, which is a type of ischemic or TIA stroke. An embolism occurs when plaque that has built up on an artery’s walls breaks away and eventually gets stuck in an artery, which blocks the flow of blood.
• Atrial Fibrillation: This causes the heart muscles to contract very rapidly and irregularly, allowing some residual blood to pool inside the heart instead of flowing through the veins and arteries. This pooled blood can clot and cause a blockage, resulting in an ischemic or TIA stroke.

Hemorrhagic strokes are caused by sudden or severe bleeding in the brain. When the blood pools in the brain, it can cause the brain to swell, which increases pressure within the skull and causes damage to the cells and tissues in the brain. Most hemorrhagic strokes are caused by extremely high blood pressure, which can also cause several other medical conditions. It also increases the risk of stroke in patients who also have aneurysms.

Stroke Risk Factors

There are four broad categories of risk factors that can increase your risk of stroke: existing medical conditions, lifestyle choices, age and gender, and family history and genetics.

• Medical Conditions: There are a number of medical conditions that can greatly increase your risk of stroke over time. These include diabetes, high blood pressure, coronary heart disease, atrial fibrillation, cardiomyopathy, high cholesterol, aneurysms, arteriovenous malformations, vasculitis, sickle cell anemia, and several bleeding disorders.
• Lifestyle and Behaviors: The lifestyle choices you make can also increase your risk of stroke, especially as you age. Smoking packs a triple punch, as it can raise blood pressure, damage the blood vessels, and reduce the amount of oxygen that ultimately reaches the body’s tissues. A lack of consistent physical activity and an unhealthy diet are also common causes, and they can also lead to obesity, which can greatly increase your risk of stroke. Stress and depression may play a role, as well as consuming alcohol or using illegal drugs such as amphetamines or cocaine. Women of any age who take birth control pills also have a higher risk of stroke.
• Family History and Genetics: Your race and ethnic makeup may play a role in your predisposition to stroke. African Americans, Native Americans, and Alaskan natives tend to be more susceptible. You may also be more susceptible if there if a close relative has suffered a stroke, and you are at a much higher risk of stroke if you have suffered one in the past.
• Age and Gender: The risk of stroke increases for everyone as they age. Younger men, however, are more likely to suffer a stroke than younger women, although the women who do have a stroke are more likely to die from it.

Don’t assume you’re in the clear if you don’t meet any of this criteria. While eating right, watching your weight, and living a healthy lifestyle can certainly reduce your chances of a stroke, some people will have one without any of the above risk factors being involved.

Stroke Rehabilitation and Treatment

The treatment for stroke and the costs incurred will vary depending on each individual’s situation. A mild stroke may require little more than a trip to the emergency room and a few days in the hospital, while more severe strokes often require surgery, extended stays in acute care facilities, and then weeks, months, or even years of rehabilitation. Rehabilitation is often carried out at a nursing home or other outpatient facility, although in-home is sometimes available. The recovery rate after rehabilitation depends on a variety of factors, including the stroke’s severity and timeliness of diagnosis and treatment.

Stroke rehabilitation usually begins within days of diagnosis, and it uses motion exercises to strengthen the body so it can overcome the partial paralysis that often accompanies severe strokes. Whether the rehabilitation continues in an acute care facility, in the hospital, or at home depends on the degree of disability, any other medical conditions that may complicate the issues, and the amount of support the patient would have at home.

The cost of a stroke, particularly for the uninsured, is staggering. In the United States, stroke care costs nationwide are roughly $43 billion per year with an additional $6 billion spend on in-home care. A person suffering from a severe ischemic stroke, for example, can find themselves incurring medical bills in excess of $140,000 before ischemic stroke recovery is complete. Someone who suffers a mild stroke and who needs less than 90 days of rehabilitation may incur medical bills as low as $15,000, while those needing rehab in excess of 90 days may spend $35,000 or more.

Insurance can be a lifesaver for those who suffer from a stroke, although patients must understand exactly what their insurance covers. Ask the hospital or rehabilitation facility for an estimate of costs ahead of time, inquire about additional financial aid, and ask to speak to a financial counselor to discuss any expenses that may not be covered by insurance.

In addition to private medical insurance, there are other means that should be looked into that might be able to help defray medical expenses incurred after a stroke. Patients should first see if they quality for Medicare or Medicaid or if their employer’s insurance offered long-term disability coverage as part of the primary insurance plan. There are also facility charity programs that can help in specific cases, and some hospitals may be able to get patients into stroke care clinical trials. This is where a financial counselor can become invaluable, as their job is to help patients find ways to cover their medical expenses.

Facts about Strokes

Stroke recovery statistics show that:

• Stroke is the third leading causes of death in the United States, with cancer and heart disease holding the top two spots.
• Strokes cause more long-term or permanent disability among adults in the United States than any other type of illness, disease, or injury.
• Roughly 35 percent of people who suffer from a stroke recovery completely or suffer only minor impairment.
• Roughly 25 percent of people who have a stroke will suffer another one within five years.
• More than 1 million people suffer a stroke each year in the United States.
• Only 10 percent of patients who have suffered a stroke require long-term care in a nursing home or other long-term medical care facility, and another 10 percent will recover from the stroke completely with no disabilities or impairment.
• People who do not keep their blood pressure under control are up to seven times more likely to have a stroke than those who do.
• A staggering 75 percent of those who live in the United States are unable to identify the warning signs of stroke, according to the American Stroke Association.

Stroke Gender Differences

Researchers have identified differences in the outcome, treatment, and epidemiology of stroke in men versus women, although the basis for the differences is not clearly understood. Both men and women suffer a significantly higher risk of stroke as they age, but men younger than 85 have a higher chance of developing a stroke than women. Once age 85 is reached, the tide turns and women become more at risk, and stroke recovery treatment often takes much longer.

Some believe that stroke statistics are misleading because the risk of stroke increases with age, and women tend to live longer than men. Researchers still trying to determine whether these numbers are truly gender related or if they are really based on age. It is also possible that hormonal differences play a role, since premenopausal women tend to develop vascular disease much less frequently than men. Despite that, it has reported that 43 percent of strokes occur in women, but they have a much higher percentage of death from stroke at 61 percent than men. They also tend to suffer more severe or permanent disabilities.

Post-Stroke Recovery

Once the acute medical issues are taken care of, post-stroke recovery and treatment has three main goals:

• Relearn any basic skills that may have been lost, such as walking, talking, or eating.
• Become stronger, regain physical endurance, develop more flexibility, and ensure good motor recovery.
• Regain as much physical independence as possible.

Post-stroke recovery may take place in one of five different settings, depending on the severity of the physical limitations and the amount of support the patient has at home:

• Acute care and rehabilitation offer 24-hour medical care for stroke victims who have a variety of medical issues and need ongoing medical treatment.
• Subacute facilities offer daily nursing care and various rehabilitation programs for those who have severe impairment as well as other minor medical issues that need treatment.
• Long-term care facilities are designed for stroke victims who need around-the-clock care but have no other major medical issues.
• Standard outpatient facilities need rehabilitation but are able to live independently and travel to and from the facility.
• In-home care is ideally suited for those who are able to live independently but cannot travel back and forth to a rehabilitation facility.

Depending on the severity of the medical issues and level of disability, a team of professionals is usually assigned to oversee a victim’s rehabilitation. This team may include a physiatrist, neurologist, rehabilitation nurse, physical therapist, occupational therapist, speech-language pathologist, dietician to oversee the stroke recovery diet, social worker, neuropsychologist, case manager, and recreation therapist. Teams like this ensure that the rehabilitation is complete and comprehensive and takes into account all of a patient’s needs.

What Factors Impact Stroke Rehabilitation’s Outcome?

The type of medical care, rehabilitation, and level of impairment stroke causes each have an impact on the stroke recovery prognosis and recovery rate. It depends on how quickly the stroke was diagnosed and treated, the type of stroke, and its severity. Recovery also varies from patient to patient, but successful rehabilitation often has a few things in common:

• The stroke victim is very motivated and willing to be an active participant in the rehabilitation process all along the way.
• The stroke rehabilitation team is skilled at what they do.
• The patient’s family and friends offer a comprehensive support network.
• Rehabilitation starts very quickly after the stroke, usually while still in acute medical care.
• The stroke victim takes responsibility for rehabilitation activities and works on them even when not in therapy sessions.

How to Prevent a Stroke

While strokes may happen to people who take care of themselves and who are otherwise healthy, there are some things you can do to minimize the risk of stroke as you age:

• Stop smoking: Smoking or using tobacco in any way can damage your blood vessels, which can predispose you to strokes.
• Maintain a healthy weight: Keeping your weight within recommended ranges and maintaining a body mass index (BMI) of 25 or less is key to minimizing the risk of a stroke. If your BMI his higher than 25 but less than 30, your risk goes up, but the risk of stroke is significantly higher for those with a BMI of 30 or higher.
• Follow a healthy diet: Stay healthy and give yourself the best chance of avoiding strokes later in life by following a diet filled with grains—particularly whole grains—fruits and vegetables. Follow a low-sodium diet to keep your blood pressure within a normal range, and keep your sugar and alcohol consumption to a minimum.
• Stay physically active: Participating in regular physical exercise can help to maintain a healthy weight, keep your blood pressure cholesterol at acceptable levels. These factors combined can help you to avoid strokes as you age.