Stroke and TIA

Dr. Matthew Engelbrecht Asheville Neurology Specialists

Objectives
Learn the definition of a stroke and TIA
Understand some of the common

symptoms of stroke Understand the mechanisms of stroke in individuals with FMD

What is a stroke?
Ischemic stroke

Accounts for 80% of all stroke Occurs when a blood vessel that carries nutrients and oxygen to the brain is blocked or closed off A clot can travel from another part of the body to the brain or the blood vessels in the brain itself can gradually become more narrow

 Hemorrhagic stroke

Occurs when a blood vessel ruptures and prevents blood flow to the brain Can occur due to aneurysms, vascular malformations, medications, high blood pressure, blood clotting disorders, or spontaneously

TIA Transient Ischemic Attack

Occurs when a blood vessel is blocked

only temporarily Can last for a few minutes to several hours By definition lasts less than 24 hours total Is not a mini-stroke Does not lead to any changes on CT or MRI

Major risk factors for stroke

Age
History of tobacco use History of high blood pressure

History of high cholesterol

History of diabetes

Stroke facts
About 795,000 individuals suffer a stroke

each year No. 4 cause of death in the U.S. 40% of stroke deaths occur in males and 60% in females $73.7 billion annual cost of stroke care and disability

Stroke data for women

425,000 women suffer stroke each year

about 55,000 more than men Only 27% of women can name more than 2 primary stroke symptoms African American and Hispanic women have higher stroke rates than Caucasian women but are less likely to recognize stroke symptoms and risk factors

 Women are twice as likely to die from

stroke than breast cancer A survey by the National Stroke Association showed that a majority of women surveyed believed that breast cancer was five times more prevalent than stroke

Stroke symptoms
Sudden numbness or weakness in the face,

arm, or leg especially if occurring only on one side Sudden confusion, trouble speaking, or understanding Sudden trouble seeing in one or both eyes Sudden trouble walking, dizziness, loss of balance, or coordination Sudden severe headache with no known cause

 Numbness consists of complete or

partial loss of sensation Weakness consists of loss of strength as opposed to a feeling of heaviness or decreased endurance Vision changes can consist of loss of vision in one eye, loss of part of the vision in both eyes, double vision

Stroke symptoms
Loss of consciousness
Memory loss Severe nausea

Generalized weakness
Limb pain

Stroke symptoms in women

Sudden facial pain
Sudden hiccups Chest pain

Heart palpitations

 Dizziness means different things to

different people

Lightheadedness, swimmy-headedness, head rush feeling, spinning sensation vertigo, a feeling of imbalance

FAST
FACE: Ask the person to smile. Does

one side of the face droop? ARMS: Ask the person to raise both arms. Does one arm drift downward? SPEECH: Ask the person to repeat a simple phrase. Is the speech slurred or strange? TIME: If you observe any of these signs, call 911 immediately.

Stroke mimics
Migraines

Migraine auras can cause transient strokelike symptoms Partial seizures do not cause loss of consciousness

Seizures

Low blood sugar

Stroke in FMD
Data from the US Registry for FMD 19.2% had TIA or stroke 19.0% had experienced an arterial dissection 17% had an aneurysm Overall, the most common presenting symptoms which led to diagnosis were high blood pressure, headache, and pulsatile tinnitus Men were more than twice as likely to have a dissection or an aneurysm Women were more likely to have symptoms related to disease of the carotid artery 91% of the people in the registry are female

Arterial dissection
Occurs when a tear develops in the

innermost lining of the blood vessel Blood then enters the space between the inner lining and the outer lining of the vessel, leading to narrowing of the vessel

Stroke prevention
Nutrition

Diet rich in fruits and vegetables Limit cholesterol and fats Avoid foods and drinks with added sugar Limit alcohol Fish and lean meats More plants, fewer animals

Stroke prevention
Physical activity

regular cardiovascular activity something you enjoy Some weight work Aspirin, Plavix, Aggrenox, blood thinners

Medications

 Risk factor control

Blood pressure and blood sugar control Cholesterol control Regular visits with primary physician