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S T R O K E P R E V E N T I O N
What causes a stroke?
A stroke occurs when circulation to a portion of the brain is cut off. The carotid arteries in the neck, if diseased, can release small pieces of debris or clot called emboli. These emboli can block small blood vessels in the brain and cause a stroke.
Sometimes the emboli are so small and soft that they break up and are washed away. This results in temporary stroke-like symptoms that resolve in a few minutes to an hour. These "mini-strokes" are a warning sign of an impending major stroke.
Severe high blood pressure and some heart conditions can also lead to a stroke. Strokes are a leading cause of death and disability in people over the age of forty. In this newsletter we will explore the symptoms of a stroke, who is at risk for a stroke, and what can be done to prevent a stroke.
What kind of symptoms are consistent with a stroke or mini-stroke?
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Weakness or numbness in one arm or leg |
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Sudden loss of vision in one eye only |
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Inability to speak |
Who is at risk for a stroke?
Patients with the following risk factors are at an increased risk for a stroke:
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Previous stroke or "mini-stroke" (as above) |
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Presence of a "bruit" in the neck (see below) |
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high blood pressure |
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high cholesterol |
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heart disease |
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smoking |
What is a Bruit (heard in the neck)?
A bruit is a sound heard by listening over narrowed arteries with a stethoscope. The blood makes a rushing sound, called a bruit, as it to passes through the narrowed area. The presence of a bruit in the neck warrants further investigation. Most importantly, anyone who has had a stroke or a mini-stroke is at high risk for a future stroke if a narrowed carotid artery goes untreated.
How can my risk for a stroke be assessed?
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History: special attention is given to symptoms, risk factors |
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Physical examination: listen over neck vessels, neurologic exam |
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Duplex ultrasound: non-invasive and painless |
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Angiography: used to help plan surgery in some patients |
What can be done to prevent a stroke?
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Surveillance and medical therapy (aspirin) |
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Risk
factor modification: Smoking cessation, control high blood pressure, and lower cholesterol levels |
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Stroke
prevention surgery (endarterectomy) for patients with carotid stenosis of 60% or greater |
Stroke prevention surgery (Carotid endarterectomy)
An incision is made in the neck and the diseased artery is exposed. The circulation in the artery is temporarily stopped, the artery is opened, and the diseased material removed. The opening in the artery is then sewn closed and circulation restored.
From Wylie's Atlas of Vascular Surgery, JB Lippincott
Co.
