Stroke

Stroke recovery can come with challenges, but knowing what to expect can help you feel more prepared. You may face some complications early on, and your care team will work with you to manage them. These may include trouble swallowing, blood clots, infections, or changes in breathing, thinking, or movement. Some issues can be treated with medication, therapy, or simple adjustments to your care plan. No matter what comes up, you're not alone—there are solutions, and your team is here to help you through them.

• Aspiration: Difficulty swallowing can lead to food entering the lungs, increasing infection risk.
• Brain swelling: Severe strokes may cause swelling, requiring medication or surgery.
• Deep vein thrombosis: Blood clots in the legs can be prevented with compression socks or medication.
• Dysphagia (trouble swallowing): Speech therapists assess swallowing ability and recommend safe eating strategies.
• Fever: Common after a stroke, fevers are managed with medication and cooling methods.
• Hyperglycemia (high blood sugar): Diabetes can worsen strokes, so blood sugar levels are monitored closely.
• Urinary tract infections (UTIs): Treated to help the body focus on stroke recovery. 

Recovery doesn’t look the same for everyone. Depending on your needs, your care team will help determine the best setting for your rehabilitation:

• Home: If you recover quickly, you may go straight home with support from family or friends.
• Home with support services: If you need extra care, visiting nurses and therapists can provide in-home nursing, physical, occupational or speech therapy.
• Acute rehabilitation hospital: If your stroke caused significant impairment, you may need intensive therapy at an acute rehab hospital, where specialists will help you regain function.
• Skilled nursing facility: If you need ongoing medical care but can't fully participate in intensive rehab, a skilled nursing facility may be the best option.
• Long-term acute care facility: If you require critical care, such as breathing support or IV medications, you may need a long-term acute care hospital before transitioning to another setting. 

When you do return to your home, Tufts Medicine Care at Home offers visiting nurses and palliative care, bringing expert support right to your door so that you can heal comfortably at home.

A stroke is a brain, spinal cord or retinal injury related to dysfunction of the blood vessels supplying these parts of the central nervous system, resulting in permanent damage. When cells (neurons) or nerve fibers (axons) are injured, specific nervous system functions are impaired or lost: the ability to speak or comprehend others, the ability to move the face or limbs, the ability to see throughout one's vision and more.

A stroke is typically classified in one of two ways:

1. Ischemic stroke (the majority of strokes): a blockage of a blood vessel supplying a specific portion of the brain, resulting in loss of oxygen and nutrient delivery to that area.
2. Intracerebral hemorrhage: a rupture of a blood vessel supplying the brain, resulting in bleeding into the brain tissue.

Ischemic strokes typically have a single cause, but the reason can differ significantly from one person to the next. For younger adults, the causes of stroke are often less connected to prior medical problems. Some of these include:

1. Patent foramen ovale – A small tunnel between two chambers of the heart, leading to the passage of a clot through the heart or a formation of a clot in the tunnel itself.
2. Arterial dissection – A tear in the wall of a blood vessel in the head or neck, leading to obstruction of blood flow.
3. Reversible cerebral vasoconstriction syndrome – Abnormal, excess squeezing of the walls of blood vessels in the head.
4. Cerebral venous sinus thrombosis – Clot formation in the blood vessels draining blood away from the head.
5. Hypercoagulability – A change in the body's balance between clotting and bleeding, leading to excess clot formation.
6. Vasculitis – A condition triggering an immune system attack on the blood vessels, leading to swelling of the blood vessel walls.

Intracerebral hemorrhages may have multiple contributing causes. These include:

1. Hypertension – High blood pressure can break the walls of tiny arteries, causing bleeding in the brain.
2. Cerebral amyloid angiopathy – With age, abnormal proteins, including amyloid, may deposit in the walls of arteries. These weaken the infrastructure of the arteries and make them more susceptible to injury and rupture.
3. Medication-related – Some medications such as anticoagulants (e.g., Coumadin/warfarin) or antiplatelet drugs (e.g., aspirin, Plavix/clopidogrel) that are used to prevent ischemic stroke and treat heart conditions can exacerbate bleeding in the brain.
4. Vascular malformations – Blood vessels can sometimes develop abnormally early in life (e.g., arteriovenous malformations, cavernous malformations) or change when exposed to conditions that damage blood vessels, such as hypertension and tobacco use (e.g., aneurysms). These are often more fragile than normal blood vessels and can rupture more easily.
5. Other medical conditions – Some illnesses, such as liver disease, hemophilia and kidney disease, increase the risk of bleeding.
6. Trauma – Physical injury from a fall or head strike can sometimes cause bleeding into the brain tissue (although this usually results in bleeding outside the brain tissue or on the scalp).

For stroke, sometimes the specific cause (or mechanism) is not determined after a comprehensive evaluation (including a careful history, examination and tests). In these cases, the stroke is deemed cryptogenic, and the stroke specialist will help guide you in determining the best course of action, even if there is no single, clear "right" answer.

Stroke is the leading cause of disability and the third leading cause of death in the United States. Stroke can affect people of any age, including babies, children, young adults, middle-aged adults and elderly adults.

Many strokes remain undiagnosed when individuals do not receive medical attention for their symptoms or are not recognized as stroke symptoms.

Common stroke symptoms relate to loss of function in the brain, spinal cord or the eye's retina. These include:

• Weakness of one side of the face (difficulty closing the eyes or moving the mouth)
• Weakness of one side of the body (difficulty moving the arm or leg on one side)
• Loss of sensation on one side of the face or body (numbness or tingling on one side)
• Trouble with speaking (expressing thoughts in words)
• Trouble with understanding others (comprehending spoken or written language)
• Trouble with seeing (partial loss of vision in one or both eyes or double vision)
• Trouble with coordination (moving the arms or legs appropriately)
• Trouble with balance (resulting in falling to one side)

Most stroke symptoms develop suddenly, but they can sometimes be gradual or come and go. The symptoms may be mild or severe.

If you or a loved one ever experiences any of these symptoms, call 911 immediately. An emergency medical team in an ambulance can call ahead to a hospital, allowing quicker treatment. Every minute an artery is blocked, 2 million brain cells die. Rapid treatment of a stroke can improve outcomes and save lives.

Risk factors are conditions that contribute to specific causes (or mechanisms) of stroke. Some of these contribute to both ischemic stroke and intracerebral hemorrhage. Risk factors are important to identify and address to reduce the chances of having another stroke in the future. Stroke can be prevented!

Common risk factors for ischemic stroke in younger adults are:

• Patent foramen ovale (a small tunnel between two chambers in the heart)
• Injury to the neck or neck manipulation
• Pregnancy
• Migraine
• Tobacco use
• Excess alcohol consumption
• Drug use (including marijuana, cocaine, heroin, amphetamines, etc.)

Common risk factors for intracerebral hemorrhage are:

• Hypertension (high blood pressure)
• Cerebral amyloid angiopathy
• Blood-thinning medications (i.e., anticoagulants)
• Vascular malformations (i.e., aneurysms, arteriovenous malformations, cavernous malformations)

Once we have determined the causes of your first stroke, it is important to address these risk factors and gain control so that you can take an active role in preventing recurring stroke. Some of the strategies our team will discuss with you may include:

• Stop smoking: Smoking doubles risk for another stroke.
• Manage high blood pressure: High blood pressure is the most important modifiable risk factor for stroke.
• Take medications: Taking your medications as prescribed is critical to recovery and preventing recurrent strokes.
• Manage high cholesterol: Cholesterol or plaque build-up in the arteries can block normal flow to the brain and cause a stroke, and increase the risk of heart disease.
• Keep diabetes under control: People with diabetes are up to four times as likely to have a stroke as someone who does not have the disease.
• Manage atrial fibrillation: Afib, a type of irregular heartbeat, increases your stroke risk five times, so it is important to work with a healthcare professional to control it.
• Eat a healthy diet: Maintaining a diet low in calories, trans-fats, saturated fats and cholesterol helps manage both obesity and healthy cholesterol levels in the blood, which also reduces risk for stroke.
• Increase physical activity: A recent study showed that people who exercise five or more times per week are less likely to have another stroke.
• Control alcohol use: Some studies say that drinking more than 2 drinks per day may increase stroke risk by 50%. Talk to our staff about alcohol use and how it can best be controlled to prevent another stroke.

Life can change a great deal after having a stroke, and we want to be here to support you along the road to recovery. There will be situations when you might want to reach out for more guidance. Generally, these break down into these categories:

1. You may experience new symptoms that might be caused by stroke.
2. You may experience similar or identical symptoms to your original stroke.
3. Your persistent neurologic deficits or symptoms may worsen.
4. You may develop some new symptoms that are not likely to be caused by a stroke.
5. You may have general questions about medications, test results, ways of improving your health, etc.

Generally, if you experience new stroke symptoms, call 911 and get the closest emergency department by ambulance as soon as possible! We know you here and have your records, and the ambulance can call ahead to notify our team so that we’re ready when you arrive. Every minute counts when saving the brain, so don’t wait!

If you experience similar or identical symptoms to your original stroke, this may be triggered by another illness: an infection, being dehydrated, having low blood sugar or being stressed. In these cases, it is still important to undergo a medical evaluation at the emergency department.

If your prior symptoms or deficits are worsening, it would be worth calling your neurologist or primary care doctor. In some cases, we may suggest that you be evaluated in the office sooner than scheduled or undergo some tests.

If you develop new symptoms that are not likely to be related to your stroke, then it would be worth discussing this with both your primary care physician and neurologist. 

Strokes are categorized into ischemic (blocked arteries) and hemorrhagic (bleeding in the brain). 

Diagnosis often involves CT scans, MRIs and blood tests to determine stroke type and severity. 

Recovery may involve physical, occupational, neurorehabilitaiton and speech therapy, depending on the severity of the stroke. 

Yes, lifestyle changes like eating a balanced diet, exercising and managing stress can significantly reduce your risk of a stroke