There are two types of strokes: Ischemic strokes are caused by a clot, and they’re the most common, accounting for 87 percent of all strokes. Hemorrhagic strokes are exactly what the name implies—they’re caused by a hemorrhage (bleeding) into the brain after a blood vessel breaks, an event called an aneurysm. And it’s not an old person’s disorder; 34 percent of strokes happen to people under 65.
Probably the most important point to know about a stroke is that you have to act fast and call 911 immediately. Brain cells will die within minutes, and if you don’t get help right away, the neurological damage could be permanent. It’s a true life-and-death situation, and you need to recognize the symptoms:
- Sudden weakness or numbness in the face, arm or leg, especially on one side
- A sudden, severe headache
- Sudden confusion, trouble speaking, or inability to understand what you’re saying
- Suddenly can’t see with one or both eyes
- Sudden problem with walking, coordination, dizziness or balance.
When it comes to strokes, ethnicity matters: all minority groups are at higher risk of stroke than Caucasians. African Americans have twice the risk of a first-time stroke. Age is a factor; older people are more likely to have a stroke, especially if they’re overweight, have high blood pressure or heart disease, or smoke.
Risks and Rewards: About 15 percent of strokes are preceded by a “mini-stroke,” or TIA (Transient Ischemic Attack), which means a blood clot temporarily blocked your blood vessels. In this case, clot-dissolving medications can reduce the damage, but only if the person is treated within three hours of the stroke. You can be sure the stroke treatment provided by Central Maine Healthcare is world-class. We recently were awarded the prestigious Joint Commission’s Primary Stroke Center Certification recognizing our top-quality stroke care. The Joint Commission mentioned our multidisciplinary approach to neurology, and for you that means your treatment covers every aspect of your recovery—speed, compassionate care and attention to every detail.
We also were granted the American Heart Association/American Stroke Association’s “Get With the Guidelines—GOLD PLUS Quality Achievement Award” for Central Maine Healthcare’s consistent excellence in stroke care, always based on the most current research.
There are 7 million stroke survivors in America today. Central Maine Healthcare treats more than 200 stroke patients each year, mostly through our Emergency Department where we can quickly evaluate and treat your condition. Once you’ve had a stroke or heart disease, your risk of stroking escalates.
Signs and Symptoms
Strokes can come on suddenly. The faster you seek help, the more brain cells you can save. Unfortunately, the damage to the brain caused by strokes can be permanent. That is why a fast reaction may help you or a stroke victim get the right treatment and have a better recovery and prognosis.
Know the Signs of a Stroke: If you notice any of the following symptoms, call 911 or seek emergency medical attention immediately:
- Sudden weakness or numbness of the face, arm or leg, especially on one side of the body
- 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
Stroke is the third leading cause of death in the United States. It is also a major cause of long-term disability. A critical element of a stroke is that impacts the brain, and as the American Heart Association and American Stroke Association note: “Time lost is brain lost.” In other words, brain cells that die cannot be replaced.
What is a stroke? A stroke is caused when an artery that delivers blood and oxygen to the brain becomes blocked or ruptures. Brain cells deprived of oxygen die within minutes. As a result, the effects of a stroke — neurological impairment — may be permanent, since the brain cells cannot be replaced.
A stroke that is caused by a clot that obstructs blood and oxygen flow is called an ischemic stroke. This is the most common type of stroke, occurring in 87 percent of cases. The remaining 13 percent are known as hemorrhagic strokes, which are caused by a blood vessel breaking and bleeding into the brain. Hemorrhagic strokes are caused by two types of defective blood vessels: aneurysms and arteriovenous malformations. Aneurysms are vessels that have weakened and ballooned outward; arteriovenous malformations are a collection of abnormal blood vessels that are prone to breaking.
What is a TIA? A TIA is a transient ischemic attack and is also known as a “mini stroke.” It occurs if a blood clot temporarily blocks blood vessels to the brain. Because TIAs precede about 15 percent of all strokes, they should never be ignored. Clot dissolving treatments are available to reduce damage from a TIA but are effective only if received within three hours of the stroke.
Can I lower my risk of stroke? Research indicates that living a healthy lifestyle lowers the risk of having a stroke. This includes:
- Controlling high blood pressure
- Not smoking
- Eating a low-fat, low-cholesterol diet
- Staying physically active
- Maintaining a healthy body weight
- Managing diabetes
- Moderate intake or abstinence from alcohol
To learn more about strokes:
- Talk to your healthcare provider
- Visit the American Stroke Association
Treatment
When you have a crisis as serious as a stroke, you want the finest care available. When the Joint Commission recently awarded Central Maine its esteemed Primary Stroke Center Certification, inspectors noted that ours was “among the leading programs in the nation.” That honor was affirmed by the American Heart Association and American Stroke Association when they presented us with their Get With the Guidelines—GOLD PLUS Quality Achievement Award for our outstanding stroke treatment. For you, these awards mean you can depend on us for the finest stroke care in the region. If you suspect you or a family member are having a stroke, call 911 immediately.
Fast Action Saves Lives: When someone is having a stroke, seconds count! Our Emergency Department will quickly assess the situation, then they’ll almost certainly administer a clot-busting drug, either aspirin or an injection of TPA to restore the blood flow. Medications might be sent directly to the brain through a catheter in the groin.
If it’s appropriate, your surgeon will perform a minimally invasive clot removal to remove plaque from your arteries. Some emergency treatment also involves an angioplasty—inserting a small balloon into one of your blood vessels to widen it and improve the blood flow. Or doctors might insert a stent, a tiny mesh tube to keep the artery open.
For a hemorrhagic stroke, doctors might give you a drug to lower your blood pressure or reduce pressure on your brain. Another common procedure is “clipping,” clamping your aneurysm to stop the bleeding. “Coiling” is another option, where a surgeon inserts a tiny coil into the aneurysm to fill it and block the bleeding. Radiosurgery sometimes works as well, shooting beams of focused radiation into your brain to repair the blood vessels.
Getting a Diagnosis: Firming up a stroke diagnosis is a high-tech affair. Once the crisis is past, your doctors may want to look at your brain through a 64-slice scanner, a machine that provides faster, higher-res images than less cutting-edge scanners, and shows them a detailed, 3-D reconstruction. With this technology, doctors can identify specific parts of the brain that were affected by the stroke but might still respond to treatment.
You might also undergo a MEG (magnetoencephalography) lab test, a safe, non-invasive exam that measures your brain activity. Over the coming days or weeks, you might receive a 3-Tesla MRI scan, which will track the recovery of your brain tissue to see which parts started working normally again after your stroke.
Stroke Rehab: Once you get past the emergency stroke treatment and you’re stabilized, your neurologist will want your rehabilitation to begin as soon as possible. The faster you start your rehab, the more independence and quality of life you’re likely to regain. Every aspect of your rehab is customized to you, shaped by the collaborations between your medical care team. It’s likely to incorporate these features:
- Occupational therapy, to help you rebuild skills for performing everyday activities. Depending on the severity of your stroke, you may need to re-learn writing, bathing, dressing and other simple tasks.
- Physical therapy, to improve your stamina, minimize your pain, build coordination and balance, and regain control of your extremities.
- Speech and language therapy to strengthen your ability to communicate and, if needed, to swallow.
Most rehab happens on an outpatient basis, available at centers throughout the Central Maine system. We also offer a menu of education options and support groups, both for the stroke patient and their family.
Rehabilitation: The aim of neurological rehab is to get you living independently again as soon as possible. That can be a lengthy process, especially if you have to re-learn basic skills like talking, writing and dressing yourself. At Central Maine Healthcare’s Rehab Center, we provide a long list of therapies designed to get you to the highest possible level of functioning and well-being.
If you’ve had a neurological disorder and think you’re a good candidate for rehabilitation, call: (207) 795-2927.
Types of Neurological Rehab
At Central Maine we can help you rehab from a variety of disorders, including brain injuries, movement disorders, spinal cord injuries, head and neck cancer, and stroke. While the specifics of your rehab program vary according to the disorder and your personal condition, most rehab takes you through your daily functions such as mobility, thinking abilities and communication. For neurological rehab, you may work with physical therapists, occupational therapists, speech and language pathologists, exercise specialists, nutritionists and others. They’ll make up your rehab team, and they will stay in close communication with your doctor and each other, monitoring your progress as you continue. Their goal is your smooth transition to outpatient care and independent living.
Pain management is included in many neurological rehab plans, because a number of neurological disorders cause pain and you may not find total relief during your treatment. In this case, you may be referred to CMH’s pain management program, which includes education and education. If you’ve suffered back pain after an injury or spinal disorder, you’ll undergo a program to regain strength, mobility and independence in terms of caring for yourself. Aquatic therapy is especially effective in relieving back pain, with the added bonus of relaxing sore muscles, too.
Other neurological rehab strategies might be new to you, or they could be continuations of your treatment plan, such as relief from stress, anxiety or depression. You might undergo training to regain lost social and behavioral skills, and nutritional counseling to plan meals that will support your wellness.
Rehab After a Stroke
Your after-stroke rehab plan will feature a special set of skills and goals. Many of these are found in other neurological rehab programs, but almost all are likely to be part of your program after a stroke:
- Motor-skill training: You probably will start a regimen of exercises to improve your muscle strength and coordination, including the muscles involved in swallowing.
- Mobility training: You may need to learn how to use devices to help you move around, such as a walker, wheelchair or cane. Some patients wear an ankle brace during this phase; it supports their ankles while they get better at walking again.
- Constraint-induced therapy: It might sound counter-intuitive, but in this therapy, your unaffected limb—say, your left arm if your right arm had been affected by the stroke—is put in restraints. The idea is to exercise your limbs that were affected, without getting “help” from the healthy limbs.
- Range-of-motion therapy: These exercises show how far you can move your limbs in different directions, and work to increase their range.
- Electrical stimulus: Small electrical charges are applied to weakened muscles, causing them to contract and respond when they’re stimulated.
- Therapy for cognitive disorders: This type of rehab is highly personalized, and could include techniques for improving your memory, problem solving skills, social skills and safety awareness.
- Speech therapy: Many stroke patients need to learn to speak clearly again.
Your rehab might happen at home, in a skilled nursing center, or in an outpatient facility such as a doctor’s office. The sooner you begin rehab after a stroke, the better your skills will be.