Neurology

It’s normal for people to forget things occasionally. But the symptoms of Alzheimer’s disease are different.

Alzheimer’s disease (AD) produces a steady loss of – not just memory – but a number of thought processes like reasoning and judgment. For example, according to the Alzheimer’s Association, it’s not unusual to forget where you put the house keys. But someone with Alzheimer’s may forget how to use the keys or what the keys are for. Eventually the loss can become severe enough to interfere with everyday life.

And the number of people affected by Alzheimer’s is on the rise. The American Medical Association says that Alzheimer’s disease or some related form of dementia (Read about “Dementia“) affects 5 percent to 6 percent of all older Americans. According to the American Academy of Neurology, over five million Americans now have Alzheimer’s disease, and that number is expected to continue climbing.

Causes and symptoms of Alzheimer’s

We don’t really know what causes Alzheimer’s, though there are several apparent things that may increase your risk. According to the National Institute on Aging (NIA), family history (Read about “Family Health History“) may be one factor. Age is another. Although Alzheimer’s can strike people as young as 30, the vast majority of people with the disease are over age 65.

One of the hallmarks of Alzheimer’s, according to the Alzheimer’s Disease Education and Referral (ADEAR) Center, is the presence in the brain of abnormal clumps (called amyloid plaques) and tangled bundles of fibers (called neurofibrillary tangles). The plaques consist of largely insoluble deposits of a protein called beta-amyloid. The ADEAR Center (which is a part of the National Institutes of Health) says scientists also have found other brain changes in people with AD, such as a loss of nerve cells in areas of the brain (Read about “The Brain“) that are vital to memory and other mental abilities. There also are lower levels of chemicals in the brain that carry complex messages back and forth between nerve cells. Whether these changes cause AD, or result from it, is under research.

Warning signs

Alzheimer’s starts gradually in most cases. Initially, a person may forget recent events or have problems doing everyday things. In more advances stages there can also be:

• mental confusion
• poor judgment
• behavioral changes
• depression
• problems communicating

Although memory lapses can become more frequent as we get older, they are not by themselves a sign of Alzheimer’s.

Ruling out other conditions

If a loved one starts to show signs of impaired mental functioning or dementia, it’s important to seek medical help. Remember too, that while Alzheimer’s is the leading cause of dementia in seniors, other conditions can result in similar symptoms.

For example, the American Academy of Neurology says a variety of brain disorders (Read about “The Brain“) can lead to impaired thinking. Depression can result in symptoms that are similar to dementia in older people. In addition, depression may be a risk factor for dementia. (Read about “Depression and Seniors“) Hypothyroidism, vitamin B12 deficiency, hydrocephalus, cerebral vasculitis, neurosyphilis, AIDS and stroke can also cause dementia, as can alcohol and some medications. (Read about “Thyroid” “Vitamins & Minerals” “Hydrocephalus” “HIV / AIDS” “Stroke” “Drug Interaction Precautions“)

Because of this, a diagnosis of Alzheimer’s is usually made by ruling out these other causes first, then following up with lab or psychiatric exams. (Read about “Laboratory Testing“) At specialized centers, doctors can diagnose AD correctly up to 90 percent of the time, according to the ADEAR Center. The Center says there are several tools that can diagnose “probable” AD:

• A complete medical history including information about the person’s general health, past medical problems, and any difficulties the person has carrying out daily activities.
• Medical tests such as tests of blood, urine or spinal fluid help the doctor find other possible diseases causing the symptoms.
• Neuropsychological tests measure memory, problem solving, attention, counting and language.
• Brain scans allow the doctor to look at a picture of the brain to see if anything does not look normal.

Information from the medical history and test results help the doctor rule out other possible causes of the person’s symptoms.

Treatment and research

Although AD has no cure, there is a great deal of research being conducted into drugs that can ease the symptoms.

Currently, medications are available to treat the more problematic behaviors of AD such as aggression or delusions. The National Institute of Mental Health (NIMH) says a class of drugs called cholinesterase inhibitors can help enhance memory and improve cognitive functioning in some patients with Alzheimer’s. These drugs are generally used in the early to middle stages of the disease, though some have been approved for more severe dementia. Another class of drugs – NMDA receptor antagonists – is also being used to treat moderate to severe Alzheimer’s. In addition, the Alzheimer’s Association says studies of antioxidants such as vitamin E have shown promise with Alzheimer’s. (Read about “Clinical Studies“) Always ask a doctor before using any kind of supplements. In excessively high doses (above 2,000 International Units daily, or IU/d), for example, vitamin E may be associated with increased risk of bleeding, and patients taking anti-coagulant medications may be especially at risk. Interactions with other medications commonly taken by older people are also of potential concern. People are advised to consult with their physicians before taking high doses of supplemental vitamin E or other antioxidants. In addition, because people with Alzheimer’s may have problems noting any medication’s side effects, the Alzheimer’s Association says caregivers should pay close attention for potential problems and ask the patient’s healthcare provider about the warning signs of possible drug interactions. (Read about “Drug Interaction Precautions” “Medicine Safety“)

Research continues into additional forms of therapy. The Alzheimer’s Association says scientists are also beginning to learn more about the plaques and tangles in the brains of people with Alzheimer’s. Plaques and tangles may play a role in the onset and progression of the disease, so an understanding of how and when they form may lead to the development of treatments to slow the effects of the disease.

In addition, a study funded by the National Institutes of Health has tied high levels of a protein called homocysteine to an increased risk of developing AD. (Read about “Homocysteine“) Homocysteine is an amino acid produced by the body. B-vitamins, including folic acid, help to break it down in the body, and studies are also considering the role of folic acid in helping to slow or prevent the development of AD.

Caregiving

Caring for someone with Alzheimer’s can be extremely stressful. (Read about “Stress“) The Alzheimer’s Association has some suggestions to help cope:

• Talk with a healthcare provider early on, if you suspect a loved one has Alzheimer’s.
• See what resources are available in your community to help. These can include support groups for caregivers as well as in-house assistance, adult day care and visiting nurse services.
• Plan ahead for legal and financial changes.

It’s also important for caregivers to take time to care for themselves and not be afraid to seek professional help if they need it. (Read about “Alzheimer’s and the Caregiver“)

All Concept Communications material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.

© Concept Communications Media Group LLC

Online health topics reviewed/modified in 2021 | Terms of Use/Privacy Policy

Just about all of us have had a headache. Headaches can be the result of many things. They can be symptoms of some very serious medical problems or infections, or they can be the result of stress (Read about “Stress“) and sometimes just the lack of sleep or food.

According to the National Institute of Neurological Diseases and Stroke (NINDS), there are different types of headache:

• Vascular headaches – A vascular headache involves the blood vessels. There are different types:
  • Migraine – The most common type of vascular headache is migraine. (Read about “Migraine Headaches“) The American Council for Headache Education (ACHE) says a migraine usually lasts a day and recurs on a regular basis. The pain tends to be on one side of the head and the person is often nauseous and sensitive to light and noise. Many people report auras or lights before a migraine begins. Women are more likely than men to have migraine headaches.
  • Toxic – After migraine, the most common type of vascular headache is the toxic headache. This type of headache is associated with fever resulting from an infection, such as pneumonia or the flu. (Read about “Pneumonia” “Influenza“) Headaches can also result from exposure to chemicals, alcohol or carbon monoxide. (Read about “Alcoholism” “Carbon Monoxide“)
  • Cluster – Cluster headaches are called that because they come in groups. (Read about “Cluster Headaches“) The National Headache Foundation (NHF) says they can be some of the most severe and painful of all headaches. They strike quickly, usually lasting 30 to 45 minutes before subsiding. The headache then returns later in the day once or more often.
  • Hypertension related – Headaches can also be the result of high blood pressure. (Read about “Hypertension: High Blood Pressure“)
• Tension headaches – Muscle contraction or tension headaches appear to involve the tightening or tensing of facial and neck muscles. Tension headaches are also the kind most people are familiar with. (Read about “Tension Headaches“) Tension headaches can be episodic, which means occurring randomly or only when you’re tired or stressed. Or they can be chronic, meaning they occur regularly and should be checked by a doctor. Causes can be tied to physical problems, as well as mental and emotional issues such as anxiety and depression. (Read about “Anxiety” “Depressive Illnesses“)
• Rebound headaches – A rebound headache is the result of over-medication for a previous headache. NHF says they are more common if the drug also includes caffeine. If you also ingest a lot of caffeine from coffee or soft drinks, it can set off a rebound headache. The rebound happens as the effects from the medication start to wear off. You then take more and the cycle continues. People who suffer rebound headaches should see their doctor for help in getting away from the drugs and back to a healthy lifestyle. (Read about “Medicine Safety“)
• Traction headaches – Traction headaches can occur if the pain-sensitive parts of the head are pulled, stretched, or displaced, as, for example, when eye muscles are tensed to compensate for eyestrain. They can also be a symptom of much more serious conditions. Traction headaches can be a symptom of a brain tumor for example, but not all brain tumors cause headaches. In fact, the American Cancer Society says that only 50 percent of brain tumors cause headaches. (Read about “Brain Tumors“)
• Inflammatory headaches – Inflammatory headaches are symptoms of other disorders.
  • Sinus headaches – A sinus headache is a common example of an inflammatory headache. Sinus headaches are the result of problems in the sinus cavities. They can often be the result of infections or allergies. (Read about “Allergies“) Sinus headaches can be serious and a physician should be consulted if you suspect you have sinus problems. (Read about “Sinusitis and Rhinitis“)
  • Other causes – Like other types of pain, headaches can serve as warning signals of more serious disorders. This is particularly true for headaches caused by inflammation, such as head pain related to meningitis. (Read about “Encephalitis and Meningitis“) A sudden sharp headache can also be a warning sign of a stroke, aneurysm or a vascular lesion. (Read about “Stroke” “Aneurysms” “Vascular Lesions of the Central Nervous System“) Headaches can result from other serious problems too, such as diseases of the sinuses, spine, neck, ears and teeth. (Read about “The Spine” “The Ear and Hearing” “Oral Health” “Head and Neck Cancers“)

Other than cluster headaches, NINDS says headaches tend to strike women more often than men. In women, headaches may also be tied in with the menstrual cycle. (Read about “Premenstrual Syndrome” “Menstrual Disorders“)

Not all headaches require medical attention. But some types of headache are signals of more serious disorders and call for prompt medical care. NINDS says these include:

• sudden, severe headache
• sudden headache associated with a stiff neck
• headaches associated with fever, convulsions, or accompanied by confusion or loss of consciousness
• headaches following a blow to the head (Read about “Head Injury“)
• headaches associated with pain in the eye or ear
• persistent headache in a person who was previously headache free
• recurring headache in children

NINDS says that headache patients don’t have to suffer, that about 90 percent can get relief. But first, you have to know what type of headache you’re dealing with. A doctor will often ask many questions, such as where you feel pain, what the pain feels like and how often it occurs. Your sleep habits and family and work situations may also be probed, along with past medical history of things like head trauma or surgery, eyestrain, sinus problems, dental problems and the use of medications.

In addition, NINDS says a blood test may be ordered to screen for thyroid disease (Read about “Laboratory Testing“), anemia or infections that might cause a headache. (Read about “Complete Blood Count” “Microorganisms” “Thyroid” “Anemia“) A test called an electroencephalogram (EEG) may also be given to measure brain activity. (Read about “EEG – Electroencephalograph“) Other diagnostic tools include an angiogram, a computed tomographic scan and/or a magnetic resonance imaging scan. (Read about “CT Scan – Computerized Tomography” “MRI – Magnetic Resonance Imaging“) These scans can help to rule out potential causes of the headaches. A physician analyzes the results of all these diagnostic tests along with a patient’s medical history and examination in order to arrive at a diagnosis.

If there is an underlying problem, such as high blood pressure, that problem will have to be treated. Some headaches respond to changes in diet or lifestyle. Medications can also be used. For some headaches, over-the-counter anti-inflammatory drugs such as aspirin and ibuprofen can be effective, but they can also have gastrointestinal side effects, such as stomach upset, heartburn and gastritis. (Read about “Digestive System” “Heartburn” “Gastritis“) Because of this, they should be used only occasionally for headache. If you are having headaches frequently, again, you should see your doctor.

Related Information:

    Head Injury

    Neck Pain and Work

    Migraine Headaches

    Tension Headaches

    Cluster Headaches

    Sinusitis and Rhinitis

All Concept Communications material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.

© Concept Communications Media Group LLC

Online health topics reviewed/modified in 2021 | Terms of Use/Privacy Policy

The nervous system includes the brain, the spinal cord (Read about “The Brain” “The Spine“) and the nerves that reach out to the rest of the body, acting as a two way street carrying information back and forth. The brain and spinal cord make up the central nervous system. The rest of the nervous system is called the peripheral nervous system.

The brain and the rest of the nervous system are composed of different types of cells, but the main one is a cell called the neuron. All sensations, movements, thoughts, memories and feelings are the result of signals that pass through neurons. The National Institute of Neurological Diseases and Stroke (NINDS) says neurons consist of three parts:

• Cell body – The cell body contains the nucleus, where most of the molecules that the neuron needs to survive and function are manufactured.
• Dendrites – Dendrites extend out from the cell body like the branches of a tree and receive messages from other nerve cells.
• Axons – Signals pass from the dendrites through the cell body and may travel down an axon to another neuron, a muscle cell or cells in some other organ.

The neuron is usually surrounded by many support cells. Some types of cells wrap around the axon to form an insulating sheath. This sheath can include a fatty molecule called myelin, which provides insulation for the axon and helps nerve signals travel faster and farther. Axons may be very short, such as those that carry signals from one cell in the cerebral cortex to another cell less than a hair’s width away. Or axons may be very long, such as those that carry messages from the brain all the way down the spinal cord. The longest axon in the body is the sciatic nerve, which goes from the base of the spinal cord all the way down the leg. The space between an axon and the dendrites of another neuron is called the synapse. Cells communicate with each other by sending chemicals into the synapse that are picked up by the next cell and passed on.

The spinal cord starts at the base of the skull and runs down the middle of the spinal column, inside the vertebrae. At each vertebra, nerves exit the spinal cord and reach out to the rest of the body. If the spinal cord is cut, by an injury or disease, the messages stop at the point of injury and the functions of the nervous system below that point stop.

The brain and spinal cord make up the central nervous system. The peripheral nervous system is the immense network of nerves that send and receive information from the brain and spinal cord to all other parts of the body. The peripheral nervous system is divided into two major parts: the somatic nervous system and the autonomic nervous system. The autonomic nervous system is further divided into three parts: the sympathetic nervous system, the parasympathetic nervous system and the enteric nervous system.

The central nervous system is protected by the meninges and cerebrospinal fluid, but the peripheral nervous system does not have this kind of cushioning. Peripheral nerves are wrapped in myelin, however. Both parts of the nervous system are vulnerable to damage, and a wide range of diseases and complications can result.

Following the links below will give you more information on some conditions that affect the brain and nervous system, including mental health conditions.

All Concept Communications material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.

© Concept Communications Media Group LLC

Online health topics reviewed/modified in 2021 | Terms of Use/Privacy Policy

Imagine your world being literally turned upside down, and in that moment there’s nothing you or anyone else can do about it. Your mind puts a hold on time, as your body moves uncontrollably, stiffens or twitches. If you’re having a seizure, it may feel something like that, except the world is as it always has been. It is you who is changing – whether by an electrical disruption in the brain (Read about “The Brain“), emotional trauma, medication or some other physical or psychological condition. According to the National Institute of Neurological Disorders and Stroke (NINDS), doctors have described more than 30 different types of seizures. Some may last just a few seconds, others a few minutes, and it’s even possible to have one seizure, and never have another again. More than 2 million people in the United States have experienced an unprovoked seizure or been diagnosed with epilepsy. A single seizure does not mean a person has epilepsy. Only when a person has had two or more seizures is he or she considered to have epilepsy, according to NINDS. First seizures, febrile seizures, nonepileptic events, and eclampsia (Read about eclampsia in “Preeclampsia“) are examples of seizures that may not be associated with epilepsy.

Precautions

If you are with someone who has a seizure, the American Academy of Neurology (AAN) says to keep calm, help the person to the floor and loosen clothing around the neck. After that, AAN says do NOT put anything into the persons mouth, but you should remove any sharp or hot objects nearby that could injure the person, turn the person on one side so saliva can flow out of their mouth and place something such as a cushion under their head. If you know the person has epilepsy, AAN says an ambulance is probably unnecessary. However, an ambulance can be appropriate if:

• the seizure continues for more than five minutes
• you don’t know if the person has epilepsy
• the person is pregnant, diabetic, or seems otherwise ill

Epilepsy

Epilepsy is a brain disorder in which clusters of nerve cells, or neurons, in the brain can misfire. This in turn can lead to unusual sensations, emotions and behaviors; it can also cause convulsions, muscle spasms and loss of consciousness.

(Read more in “Epilepsy“)

Nonepileptic Seizures

A seizure that looks like an epileptic seizure, but is not caused by an electrical change in the brain is called a nonepileptic seizure. According to the Epilepsy Foundation (EF), nonepileptic seizures often resemble epileptic seizures both in the way they look and in the way the person having the seizure feels. EF says sometimes even trained medical professionals who are witnessing the seizure cannot tell the difference between an epileptic and nonepileptic episode.

There are two types of nonepileptic seizures. According to EF, they are:

• physiologic
• psychogenic

A physiologic nonepileptic seizure may be caused by a number of conditions that can trigger seizures. According to EF, they include:

• changes in heart rhythm (Read about “Arrhythmia“)
• sudden drops in blood pressure
• very low blood sugar
• sleep disorders (Read about “Sleep“)
• movement disorders
• vascular lesions (Read about “Vascular Lesions of the Central Nervous System“)

A psychogenic nonepileptic seizure appears to be caused by emotional trauma or excessive stress. (Read about “Stress“)

Diagnosing seizures can be done through special monitoring. EF says an electroencephalogram or EEG (Read about “EEG – Electroencephalograph“) can test brain waves during an actual seizure. According to EF, it’s the most accurate way to diagnose nonepileptic seizures. Certain blood tests (Read about “Laboratory Testing“) may also help in determining whether the episode is epileptic or nonepileptic. Once the data is thoroughly evaluated, experts can work on a treatment plan. Medication and/or counseling are just some of the ways that may help eliminate these episodes. EF says the outcome of treatment is usually better than for that of people with epilepsy.

Febrile Seizures

Convulsions brought on by a high fever in small children are called febrile seizures. According to NINDS, a child experiencing a febrile seizure will often lose consciousness, shake, move limbs, become rigid or twitch. Most febrile seizures last just a minute or two, but they can be shorter and longer than that. NINDS says that approximately one in 25 children will have at least one febrile seizure, and many of them will have more before they turn 5 years of age. Febrile seizures usually occur in children between 6 months and 5 years.

There are a few factors that can increase a child’s risk for having recurrent febrile seizures. According to NINDS, they include:

• having the first seizure before 15 months of age
• frequent fevers
• having an immediate family member with a history of febrile seizures
• having a seizure shortly after a fever has started or when the temperature is low

Although febrile seizures may look frightening, NINDS says it is unlikely the child will be injured. According to NINDS, there is no evidence that this type of seizure causes brain damage. Here are some things a parent can do, according to NINDS that can help prevent injury or possible choking.

• remain calm
• place child on a protected surface, like the floor
• do not restrain the child during convulsion
• place child on stomach to prevent choking
• remove all items in the child’s path
• never place anything in the child’s mouth

NINDS also recommends that the child be taken to a doctor for evaluation as soon as possible, especially if he or she shows signs of a stiff neck, lethargy or vomiting.

Nonfebrile Seizures

Seizures that occur without a fever are called nonfebrile seizures. They are not uncommon, according to the American Academy of Pediatrics (AAP). Most nonfebrile seizures are a one-time event. AAP says they may be caused by a temporary interruption in normal brain functioning. If the seizures are recurrent, they may be epileptic seizures and could be a chronic problem.

AAP recommends that if your child has two or more seizures you should talk to your doctor. Tests can be performed to determine if epilepsy is present.

Partial or Focal Seizures

Partial or focal seizures occur in just one part of the brain. According to NINDS, about 60 percent of all people with epilepsy suffer from focal seizures. (Read about “Epilepsy“) There are two types of focal seizures, simple and complex.

In a simple focal seizure, the person will remain conscious, but may experience a number of feelings like joy, anger or sadness. The senses may also be affected. According to NINDS the person may see, smell, taste, hear, or feel things that aren’t even there.

In a complex focal seizure, there is a change in or loss of consciousness. People having such a seizure may act strangely. They may blink, twitch or even walk in circles. These seizures usually last just a few seconds.

Generalized Seizures

A generalized seizure is caused by abnormal neuronal activity on both sides of the brain. It may result in a number of physical symptoms like falls, muscle spasms and loss of consciousness. NINDS lists several types of generalized seizures and their symptoms. They include:

• absence seizure: staring and jerking or twitching muscles
• tonic seizures: stiffening of muscles in the back, legs and arms
• clonic seizures: repeated movement of the upper body, arms or legs
• atonic seizures: loss of normal muscle tone
• tonic-clonic seizures: stiffening of the body, repeated jerking of limbs, and loss of consciousness

Diagnosis and treatment options

Other conditions may be confused with seizures and/or epilepsy, such as syncope and stroke (Read about “Syncope/Fainting” “Stroke“). Therefore, if you are experiencing seizures, it’s important to get an accurate diagnosis. Diagnosis can include a number of tests such as electroencephalography (EEG), which is a recording of your brain-wave activity. (Read about “EEG – Electroencephalograph“) CT, MRI and PET can also be used. (Read about “CT Scan – Computerized Tomography” “MRI – Magnetic Resonance Imaging” “PET – Positron Emission Tomography“)

Treatment for seizures depends upon the type of seizure the person is having. Sometimes, a person may have one seizure and never have another. In some cases of nonepileptic seizures, professional counseling may be all the patient needs. If seizures continue to happen, anticonvulsant medications may be necessary. The specific medication used depends on the person’s age, type of seizure and side effects. For some patients, a special diet called the ketogenic diet (low in carbohydrates and high in protein) may be indicated. Other treatment options include surgery (Read about “Neurosurgery“) and vagus nerve stimulation (in which small pulses of energy are sent to the brain from the vagus nerve in the neck). It’s important that all treatment options be discussed with the patient’s physician.

All Concept Communications material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.

© Concept Communications Media Group LLC

Online health topics reviewed/modified in 2021 | Terms of Use/Privacy Policy

Every year, according to the American Association of Neurological Surgeons (AANS), over half a million Americans suffer a stroke. A stroke (also called a “brain attack”) occurs when one of the blood vessels that carry oxygen to the brain either becomes clogged or bursts. (Read about “Vascular System: Arteries and Veins“)

When this happens, the nerve cells in the affected part of the brain can’t function. (Read about “The Brain“) As a result, AANS says whatever body part those nerve cells control will be impaired as well. That’s why stroke affects different people in different ways, sometimes causing problems with speech, for example, sometimes problems with movement, sometimes problems with memory (Read about “Dementia“), or sometimes there are several impairments in combination.

Risk factors

There are a number of risk factors that can put someone at a higher risk of having a stroke.

Our STROKE RISK ASSESSMENT can help you learn more about your own stroke risk factors.

Simply click on the link for the form. Fill it out online to learn more about how specific things affect the risk of stroke. When you’re done, you may want to print it out and share it with your doctor. Any information you enter will NOT be saved once you close the window. This is to protect your privacy. When you’re done, simply close the form window, and continue reading.

The National Institute on Aging says men are at a higher risk than women; African Americans (Read about “Minority Health“) also face a higher risk; and our risk increases, as we get older.

Other risk factors include:

• High blood pressure – The American Stroke Association (ASA) considers this the most important risk factor for stroke. The only way to find out for sure if you have high blood pressure is to have it checked by a healthcare professional. (Read about “High Blood Pressure“)
• Personal medical history that includes heart disease and/or diabetes. (Read about “Coronary Heart Disease” “Diabetes“)
• Family history of stroke (Read about “Family Health History“)
• Elevated cholesterol or triglyceride levels (Read about “Cholesterol“)
• Smoking – According to the American Stroke Association, smokers can reduce their risk of stroke by quitting, even if they’ve been long-time smokers. (Read about “Quit Smoking“)
• Atrial fibrillation (AF) – The American Stroke Association says AF is a type of heart rhythm problem that increases the risk of stroke. (Read about AF in “Arrhythmia“)
• Patent foramen ovale (PFO) which is an opening between the two upper chambers of our heart that fails to completely close and seal after we are born. (Read about “Patent Foramen Ovale“)

If you are considered to be at risk of stroke, there are several tests that can be used, including:

• Echocardiography – this shows the size, structure, and movement of various parts of your heart. It can be used to check for blood clots. (Read about “Cardiovascular Tests“)
• Carotid ultrasound exam – this checks the arteries in your neck for narrowing or stenosis (Read about “Ultrasound Imaging“)
• Abdominal ultrasound – this looks for aortic aneurysm in the abdomen (Read about “Aneurysms“)
• Ankle brachial index test – this looks for blocked arteries in your legs, which is called peripheral artery disease (Read about “Peripheral Arterial Disease“)
• Computed tomography angiogram (CTA) – this is a CT scan that can be used to diagnose problems of the brain and brainstem (Read about “CT Scan – Computerized Tomography” “The Brain“)
• Cerebral angiography or arteriogram – this is an x-ray (Read about “X-rays“) of the blood vessels of the brain
• Magnetic resonance angiography (MRA) – this is a special type of MRI (Read about “MRI – Magnetic Resonance Imaging“) that can be used to see the blood vessels in your neck or brain.

Your doctor may also order tests to see if there are blockages or other problems of the heart. (Read about “Cardiovascular Tests“) If any tests do indicate blockages in the brain, heart or elsewhere, your doctor may recommend treatment options, including lifestyle changes, medications, and/or surgery.

Warning signs

Stroke warning signs may be temporary. They may go away after a few hours. They may even go away in a few minutes. But regardless of how long the symptoms last, AANS says it’s essential that anyone experiencing the symptoms of stroke seek immediate medical help. The main symptoms include:

• Sudden weakness or numbness of the face, arm or leg, especially on one side of the body
• Sudden dimness or loss of vision, especially if this happens in just one eye (Read about “The Eye“)
• Sudden severe headache with no apparent cause (Read about “Headaches“)
• Loss of speech, problems talking, or problems understanding speech (Read about “Aphasia“)
• Unexplained dizziness or falls, especially if some of the other symptoms are present

The National Stroke Association says you can use the acronym 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 their speech slurred or strange?
• Time – If you observe any of these signs, call 9-1-1 immediately.

The Food and Drug Administration (FDA) says other symptoms that are less common, but still important, are sudden nausea, vomiting, brief loss of consciousness or decreased consciousness, such as fainting (Read about “Syncope/Fainting“) and convulsions. There is also what is called a “silent stroke,” in which there may be no noticeable symptoms.

Ischemic stroke

Some 80 percent of all strokes are caused by blockages of the blood vessels in the brain. They are called ischemic strokes. Ischemic strokes are also divided into two categories, according to the American Stroke Association. They are:

• Thrombotic – these are the result of two things, the slow narrowing of the arteries as fatty deposits build up and the formation of a clot that then lodges in this narrowed opening. (Read about “Arteriosclerosis & Atherosclerosis“) ASA says uncontrolled high cholesterol is a risk factor for this type of stroke. (Read about “Cholesterol“)
• Embolic – these happen when a clot forms somewhere else in the body, breaks free and eventually lodges in the brain. For example, a type of arrhythmia called atrial fibrillation affects the heart’s ability to pump blood, so it may pool and clot. The clot can travel to the brain. In fact, ASA says about 15 percent of strokes occur in people with atrial fibrillation. (Read about “Arrhythmia“)

Thrombolysis is the term used for the breaking up of a clot with drug therapy. Ischemic strokes can be treated with a drug called tPA, according to National Institute of Neurological Disorders and Stroke (NINDS). It dissolves blood clots obstructing blood flow to the brain. To be evaluated and receive treatment however, patients need to get to the hospital as quickly as possible. Potential dangers from the drug include internal bleeding in the brain. Some patients may be helped by a procedure that involves the use of a tiny device that can remove the blood clot or clots that are blocking the artery.

After an ischemic stroke, blood thinners, antiplatelet drugs or anticoagulants may be prescribed. If a doctor determines that a stroke has been caused by a blockage of a blood vessel leading to the brain, surgery may be needed too. (Read about “Neurosurgery“) In a procedure called carotid endarterectomy, surgeons open up the carotid artery in the neck and scrape out plaque. Surgeons also may open up a clogged carotid artery with a small balloon and insert a small tube called a stent to keep the artery open. (Read about “Angioplasty“) Following surgery, drugs that prevent more clots from forming may be prescribed. For some patients, who are considered at high risk of having a stroke, carotid artery surgery may be recommended as a prophylactic measure, to prevent a stroke from occurring. Depending on the severity of the stroke, and on the area of the brain impacted, physical rehabilitation may be necessary. (Read about “Rehabilitation“) Again, since treatment and rehabilitation should begin as soon after a stroke as possible, it’s essential for everyone to recognize the symptoms of a stroke and get help right away.

Hemorrhagic stroke

According to the American Stroke Association, 20 percent of strokes are hemorrhagic strokes. They happen when a weakened vessel ruptures and bleeds into the surrounding brain. This type of stroke can be caused by a head injury (Read about “Head Injury“), for example, or if an aneurysm (a blood-filled pouch that forms on weak spots in the artery wall) bursts. (Read about “Aneurysms“) This type of stroke can also be caused by an arteriovenous malformation (AVM), a congenitally malformed mass of thin-walled blood vessels. (Read about “Vascular Lesions of the Central Nervous System“) Subarachnoid hemorrhage refers to bleeding in the space between the surface of the brain and the skull. Intracerebral hemorrhage refers to bleeding that occurs within the brain tissue. A hemorrhagic stroke is very dangerous because the accumulated blood from the burst artery may put pressure on surrounding brain tissue and interfere with how the brain functions.

Treatment for hemorrhagic stroke depends on the cause of the hemorrhage and how much damage was done to the brain. With hemorrhagic stroke, doctors want to clot the blood and stop the bleeding. Medication can be used to do this. FDA says hemorrhagic stroke can also be treated with surgery that removes abnormal blood vessels or places a clip at the base of an aneurysm. Aneurysms may also be treated by using catheters. Surgery can also be used to remove the AVM, if this is the cause of the stroke. If high blood pressure caused the hemorrhagic stroke, medication may be used to bring blood pressure down. Depending on the severity of the stroke, and on the area of the brain impacted, physical rehabilitation may be necessary. Again, since treatment and rehabilitation should begin as soon after a stroke as possible, it’s essential for everyone to recognize the symptoms of a stroke and get help right away.

TIA’s and “silent” strokes

AANS says many people are unaware of the warning signs of a stroke. This is particularly true in the case of a transient ischemic attack (TIA). A TIA is a temporary situation in which you suddenly experience the symptoms of a stroke, but then the symptoms go away after a few minutes. People often ignore a TIA, thinking the problem has disappeared. This can be a fatal mistake because a TIA is serious warning. In fact, according to AANS, approximately 10 to 15 percent of patients who have TIA’s will suffer a stroke within one year of the first attack.

In addition, there is also a “silent stroke.” The American Stroke Association says silent strokes are far more common than once thought. Basically, silent strokes occur when small blood vessels in the brain become blocked or rupture. A silent stroke is not accompanied by the classic warning signs of stroke; in fact, someone experiencing silent strokes may not even be aware of it. But eventually, as blood and oxygen supply to the brain diminishes, cells die. This can lead to problems with memory or concentration. It can also create mood changes and lead to depression. (Read about “Depressive Illnesses“)

Because of this, the American Stroke Association says seniors should be monitored more carefully for depression since depression may indicate that a silent stroke has already occurred. (Read about “Depression and Seniors“)

After a stroke

Treatment following a stroke depends on the type of stroke involved.

• TIA – If a transient ischemic stroke is suspected, there will be tests to determine the cause. Tests can include a physical examination, CT scan, MRI. (Read about “CT Scan – Computerized Tomography” “MRI – Magnetic Resonance Imaging“) Arteriography, which can provide x-ray images of blood vessels, may also be used to look for problems in the arteries of the brain. (Read about “X-rays“) Depending on the results of these tests, medications may be used to reduce the risk of more TIA’s or a full stroke. Medications can include antiplatelet drugs or anticoagulants to prevent blood clots from forming. For some people, carotid endarterectomy and/or carotid stenting, may be recommended to keep the carotid artery clear and open.
• Ischemic stroke – Following an ischemic stroke, the goal is to quickly restore blood flow to the brain. In appropriate patients, the drug tPA can be used to dissolve blood clots. Surgery with a tiny device may be used in some cases for clot removal. After initial treatment, blood thinners, antiplatelet drugs or anticoagulants may be prescribed to prevent additional blood clots from forming. For some people, carotid endarterectomy and/or carotid stenting may be recommended to keep the carotid artery clear and open.
• Hemorrhagic stroke – Following a hemorrhagic stroke, medication may be used to clot the blood and stop the bleeding. Surgery may also be used for treatment and/or prevention of another stroke Options include clipping or embolization to keep the aneurysm from bursting. If the stroke was caused by an arteriovenous malformation (AVM), surgery to remove the AVM may also be needed.

Although stroke is a disease of the brain, it can affect the entire body. A common disability that results from stroke is complete paralysis on one side of the body, called hemiplegia. A related disability that is not as debilitating as paralysis is one-sided weakness or hemiparesis. Stroke may cause problems with:

• thinking
• awareness
• attention
• learning
• judgment
• memory

Stroke survivors often have problems understanding or forming speech. (Read about “Aphasia“) A stroke can lead to emotional problems. Stroke patients may have difficulty controlling their emotions or may express inappropriate emotions.

Depression can also develop after a major stroke. In fact, according to the National Institutes of Health, an estimated 10-27 percent of people who suffer a stroke also experience major depression and an additional 15-40 percent experience depressive symptoms within two months following the stroke. It is important to monitor patients for signs of depression. (Read about “Depressive Illnesses“)

Stroke survivors may also have numbness or strange sensations. (Read about “Paresthesia“) The pain is often worse in the hands and feet and is made worse by movement and temperature changes, especially cold temperatures.

Generally, there are three treatment stages following a stroke: therapy immediately after the stroke, prevention of another stroke and post-stroke rehabilitation. Acute stroke therapies try to stop a stroke while it is happening by quickly dissolving the blood clot causing an ischemic stroke or by stopping the bleeding of a hemorrhagic stroke. Therapies to prevent a recurrent stroke are based on treating an individual’s underlying risk factors for stroke, such as hypertension, atrial fibrillation and diabetes. (Read about “Hypertension: High Blood Pressure” “Arrhythmia” “Diabetes“) Post-stroke rehabilitation (Read about “Rehabilitation“) helps individuals overcome disabilities that result from stroke damage. Medication or drug therapy is the most common treatment for stroke, according to NINDS. NINDS says that the most popular classes of drugs used to prevent or treat stroke are antithrombotics (antiplatelet agents and anticoagulants) and thrombolytics.

It is also important to make lifestyle changes to reduce the risk of having another stroke. According to NINDS, about 25 percent of people who recover from a first stroke will have another within five years, and the chance of death and disability increases with each stroke. So it’s essential that you work to lower your stroke risk through lifestyle changes and medication that lowers blood pressure and cholesterol.

Related Information:

    The Heart & Cardiovascular System

    Cardiovascular Tests

    Peripheral Arterial Disease

    Thrombophilia

    Deep Vein Thrombosis

    Glossary of Heart Terms

    Glossary of Stroke Terms

All Concept Communications material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.

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