A.

Definition
A stroke occurs when the supply of blood to the brain is either interrupted
or reduced. When this happens, the brain does not get enough oxygen or
nutrients, and brain cells start to die. In the U.S., approximately 40 percent of
people who die from stroke are male, with 60 percent of deaths occurring in
females. According to the American Heart Association(AHA), compared with
Caucasian people, African-Americans have nearly twice the risk of a first-time
stroke and a much higher risk of death from stroke.

B. Types
There are three main types of stroke:
1. Ischemic stroke: This is the most common type of stroke. A blood clot
prevents blood and oxygen from reaching the brain.
2. Hemorrhagic stroke: This occurs when a weakened blood vessel ruptures
and normally occur as a result of aneurysms or arteriovenous
malformations (AVMs).
3. Transient ischemic attacks (TIAs): Also referred to as a mini-stroke, these
occur after blood flow fails to reach part of the brain. Normal blood flow
resumes after a short amount of time, and symptoms cease.

C. Causes
The different types of stroke have different causes. However, stroke is
more likely to affect people if they have the following risk factors: being
overweight, being aged 55 years or older, a personal or family history of
stroke, an inactive lifestyle, a tendency to drink heavily, smoke, or use illicit
drugs.
1. Ischemic stroke
This type of stroke is caused by blockages or narrowing of the
arteries that provide blood to the brain, resulting in ischemia. Ischemia is
severely reduced blood flow that damages brain cells. These blockages are
often caused by blood clots, which can form in the brain arteries. They can
 also occur in other blood vessels in the body before being swept through
the bloodstream and into narrower arteries in the brain. Fatty deposits
within the arteries called plaque can cause clots that result in ischemia.
2. Hemorrhagic stroke
Hemorrhagic strokes are caused by arteries in the brain either
leaking blood or bursting open. Leaked blood puts pressure on brain cells
and damages them. It also reduces the blood supply that can reach the
brain tissue after the hemorrhage. Blood vessels can burst and spill blood
into the brain or near the surface of the brain, sending blood into the s pace
between the brain and the skull. The ruptures can be caused by conditions
including hypertension, trauma, blood-thinning medications, and
aneurysms. Aneurysms are weaknesses in the walls of blood vessels.
Intracerebral hemorrhage is the most common type of hemorrhagic stroke
and occurs when brain tissue becomes flooded with blood after an artery in
the brain bursts. Subarachnoid hemorrhage is the second type of
hemorrhagic stroke and is less common. In this type of stroke, bleeding
occurs in the area between the brain and the thin tissues that cover it.
3. Transient ischemic attack (TIA)
TIAs are different from the types above because the flow of blood
to the brain is only briefly interrupted. TIAs are similar to ischemic strokes
in that they are often caused by blood clots or other clots. They should be
regarded as medical emergencies, even if the blockage of the artery and its
symptoms are temporary. They serve as warning signs for future strokes
and indicate that there is a partially blocked artery or clot source in the
heart. According to the Centers for Disease Control and
Prevention (CDC), over a third of people who experience a TIA have a
major stroke within a year if they have not received any treatment.
Between 10 and 15 percent of people will have a major stroke within 3
months of a TIA.
D. Symptoms
Symptoms of a stroke often appear without warning. The main symptoms of
stroke are:
1. confusion, including trouble with speaking and understanding
2. a headache, possibly with altered consciousness or vomiting
3. numbness or inability to move parts of the face, arm, or leg, particularly on
one side of the body
4. vision problems in one or both eyes
5. trouble walking, including dizziness and lack of co-ordination
Strokes can lead to long-term health problems. Depending on how quickly
it is diagnosed and treated, an individual can experience temporary or
permanent disabilities in the aftermath of a stroke.
In addition to the persistence of the problems listed above, people may also
experience the following:
1. bladder or bowel control problems
2. depression
3. pain in the hands and feet that gets worse with movement and temperature
changes
4. paralysis or weakness on one or both sides of the body
5. trouble controlling or expressing emotions
Symptoms vary and may range in severity. The acronym F.A.S.T. is a way to
remember the signs of stroke, and can help identify the onset of stroke:
1. Face drooping: If the person tries to smile, does one side of the face
droop?
2. Arm weakness: If the person tries to raise both their arms, does one arm
drift downward?
3. Speech difficulty: If the person tries to repeat a simple phrase, is their
speech slurred or strange?
4. Time to call 911: If any of these signs are observed, contact the emergency
services.
 The faster a person with suspected stroke receives medical attention, the
better their prognosis will be, and the less likely they will be to experience
permanent damage or death.

E. Rehabilitation
Strokes are life-changing events that can affect a person both physically
and emotionally. After a stroke, successful recovery will often involve specific
therapies and support, such as:
1. Speech therapy: This helps with any problems producing or understanding
speech. Practice, relaxation, and changing communication style can all
help.
2. Physical therapy: This can help a person relearn movement and co-
ordination. It is important to stay active, even if it is difficult at first.
3. Occupational therapy: This is used to help a person to improve their ability
to carry out routine daily activities, such as bathing, cooking, dressing,
eating, reading, and writing.
4. Support groups: These help with common mental health problems such
as depression that can occur after a stroke. Many find it useful to share
common experiences and exchange information.
5. Support from friends and family: The people closest to a person should
offer practical support and comfort after a stroke. Letting friends and
family know what can be done to help is very important.
Rehabilitation is an important and ongoing part of treatment. With the right
assistance and the support of loved ones, rehabilitation to a normal quality of
life is possible, depending on the severity of the stroke.

F. Prevention
The best way to prevent a stroke is to address the underlying causes. This is
best achieved through lifestyle changes, including:
1. eating a healthy diet
2. maintaining a healthy weight
 3. exercising regularly
4. not smoking tobacco
5. avoiding alcohol or drinking moderately
Eating a nutritious diet means including plenty of fruits, vegetables, and
healthy whole grains, nuts, seeds, and legumes. Be sure to eat little or no red
or processed meat and limit intake of cholesteroland saturated fats. Minimize
salt intake to support healthy blood pressure. Other measures taken to help
reduce the risk of stroke include:
1. keeping blood pressure under control
2. managing diabetes
3. treating obstructive sleep apnea
As well as these lifestyle changes, a doctor can help to reduce the risk of
future ischemic strokes through prescribing anticoagulant or antiplatelet
medication. In addition, arterial surgery can also be used to lower the risk of
repeat strokes, as well as some other surgical options still being studied.

G. Diagnosis
Strokes onset rapidly and will often occur before an individual can be seen
by a doctor for a proper diagnosis. For a person experiencing a stroke to get the
best diagnosis and treatment possible, they should be treated at a hospital
within 3 hours of their symptoms first appearing. There are several different
types of diagnostic tests that doctors can use to determine which type of stroke
has occurred:
1. Physical examination: A doctor will ask about symptoms and medical
history. They may check blood pressure, listen to the carotid arteries in the
neck, and examine the blood vessels at the back of the eyes to check for
indications of clotting.
2. Blood tests: A doctor may perform blood tests to find out how quickly the
clots occur, the levels of particular substances in the blood, including
clotting factors and whether or not an infection is present.
3. CT scan: A series of X-rays can show hemorrhages, strokes, tumors, and
other conditions within the brain.
4. MRI scan: Radio waves and magnets create an image of the brain to detect
damaged brain tissue.
5. Carotid ultrasound: An ultrasound scan to check the blood flow in the
carotid arteries and to see if there is any plaque present.
6. Cerebral angiogram: Dyes are injected into the brain's blood vessels to
make them visible under X-ray. This gives a detailed view of the brain and
the blood vessels in the neck.
7. Echocardiogram: This creates a detailed image of the heart to check for
any sources of clots that could have traveled to the brain to cause a stroke.
It is only possible to confirm the type of stroke someone has had by giving
them a brain scan in a hospital environment.