NIH - Stroke (Medical Encyclopedia) "The goal is to get the person to the emergency room immediately, determine if he or she is having a bleeding stroke or a stroke from a blood clot, and start therapy -- all within 3 hours of when the stroke began."

NIH - Stroke “A stroke is a medical emergency. Strokes happen when blood flow to your brain stops. Within minutes, brain cells begin to die. There are two kinds of stroke. The more common kind, called ischemic stroke, is caused by a blood clot that blocks or plugs a blood vessel in the brain. The other kind, called hemorrhagic stroke, is caused by a blood vessel that breaks and bleeds into the brain. "Mini-strokes" or transient ischemic attacks (TIAs), occur when the blood supply to the brain is briefly interrupted.”

NIH - Know Stroke: Know the Signs

NIH - Know Stroke: Know the Signs, Act in Time Video

NIH – Stroke (Medical Encyclopedia) “ISCHEMIC STROKE: This is the most common type of stroke. Usually this type of stroke results from clogged arteries, a condition called atherosclerosis. Fatty deposits collect on the wall of the arteries, forming a sticky substance called plaque. Over time, the plaque builds up. Often, the plaque causes the blood to flow abnormally, which can cause the blood to clot. There are two types of clots: • A clot that stays in place in the brain is called a cerebral thrombus. • A clot that breaks loose and moves through the bloodstream to the brain is called a cerebral embolism. Another important cause of cerebral embolisms is a type of arrhythmia called atrial fibrillation. Other causes of ischemic stroke include endocarditis, an abnormal heart valve, and having a mechanical heart valve. A clot can form on a heart valve, break off, and travel to the brain. For this reason, those with mechanical or abnormal heart valves often must take blood thinners. HEMORRHAGIC STROKE: A second major cause of stroke is bleeding in the brain hemorrhagic stroke. This can occur when small blood vessels in the brain become weak and burst. Some people have defects in the blood vessels of the brain that make this more likely. The flow of blood after the blood vessel ruptures damages brain cells. STROKE RISKS: High blood pressure is the number one reason that you might have a stroke. The risk of stroke is also increased by age, family history of stroke, smoking, diabetes, high cholesterol, and heart disease. Certain medications increase the chances of clot formation, and therefore your chances for a stroke. Birth control pills can cause blood clots, especially in woman who smoke and who are older than 35. Men have more strokes than women. But, women have a risk of stroke during pregnancy and the weeks immediately after pregnancy. Cocaine use, alcohol abuse, head injury, and bleeding disorders increase the risk of bleeding into the brain. … Symptoms: The symptoms of stroke depend on what part of the brain is damaged. In some cases, a person may not even be aware that he or she has had a stroke. Usually, a SUDDEN development of one or more of the following indicates a stroke: • Weakness or paralysis of an arm, leg, side of the face, or any part of the body • Numbness, tingling, decreased sensation • Vision changes • Slurred speech, inability to speak or understand speech, difficulty reading or writing • Swallowing difficulties or drooling • Loss of memory • Vertigo (spinning sensation) • Loss of balance or coordination • Personality changes • Mood changes (depression, apathy) • Drowsiness, lethargy, or loss of consciousness • Uncontrollable eye movements or eyelid drooping If one or more of these symptoms is present for less than 24 hours, it may be a transient ischemic attack (TIA). A TIA is a temporary loss of brain function and a warning sign for a possible future stroke. … IMMEDIATE TREATMENT Thrombolytic medicine, such as tPA, breaks up blood clots and can restore blood flow to the damaged area. People who receive this medicine are more likely to have less long-term impairment. However, there are strict criteria for who can receive thrombolytics. The most important is that the person be examined and treated by a specialized stroke team within 3 hours of when the symptoms start. If the stroke is caused by bleeding rather than clotting, this treatment can make the damage worse -- so care is needed to diagnose the cause before giving treatment. In other circumstances, blood thinners such as heparin and Coumadin are used to treat strokes. Aspirin may also be used. … Prevention To help prevent a stroke: • Get screened for high blood pressure at least every 2 years, especially if you have a family history of high blood pressure. • Have your cholesterol checked. If you are high risk, your LDL "bad" cholesterol should be lower than 70 mg/dL. • If you have high blood pressure, diabetes, high cholesterol, and heart disease, make sure you follow your doctor's treatment recommendations. • Follow a low-fat diet. • Quit smoking. • Exercise regularly -- 30 minutes a day if you are not overweight; 60 - 90 minutes a day if you are overweight. • Do not drink more than 1 to 2 alcoholic drinks a day. Aspirin therapy (81mg a day or 100mg every other day) is now recommended for stroke prevention in women under 65 as long as the benefits outweigh the risks. It should be considered for women over age 65 only if their blood pressure is controlled and the benefit is greater than the risk of gastrointestinal bleeding and brain hemorrhage. Ask your doctor if aspirin is right for you. Your doctor may also recommend that you take aspirin or another blood thinner if you have had a TIA or stroke in the past, or if you currently have a heart arrhythmia (like atrial fibrillation), mechanical heart valve, congestive heart failure, or risk factors for stroke.”

NHS - Understanding stroke and TIA (UK) “There are some risk factors for stroke that cannot be changed, including: • Age You’re more likely to have a stroke if you're over the age of 65. However, about a quarter of strokes happen in younger people. • Family history If a close relative (parent, grandparent, brother or sister) has had a stroke, your risk is likely to be higher. • Ethnicity If you’re South Asian, African or Caribbean, your risk of stroke is higher, partly because rates of diabetes and high blood pressure are higher in these groups. • Your medical history If you’ve previously had a stroke, TIA or heart attack, your risk of stroke is higher. However, many of the major risk factors for stroke can be reduced by making lifestyle changes or taking the right medication. These risks include: • Hypertension (high blood pressure). This is the major, treatable risk factor for stroke. • Smoking. • High blood cholesterol. • An inactive lifestyle. • Diabetes. • Being overweight or obese. • Atrial fibrillation. • Drinking more than the recommended amounts of alcohol. Rarer risk factors are normally related to genetic problems, blood disorders, antibody abnormalities, migraine and other diseases of the heart and blood vessels. … Patients with a suspected stroke should have a scan of their brain to determine: • If the stroke has been caused by a blocked artery or a burst blood vessel. • Which part of the brain has been affected. • How severe the stroke is. The brain scan should be carried out as soon as possible after the symptoms of stroke start, so that the correct treatment can begin. The sooner treatment is started the greater the chance of survival and recovery. Minutes really do matter. There are some treatments, including aspirin, which cannot be given to patients with a haemorrhagic stroke as these may increase the damage to the brain. The brain scan is required in order to confirm the causes and type of stroke. For TIA, rapid diagnosis allows steps to be taken to reduce the risk of a second and potentially major stroke. … Stroke experts have set out standards which define good stroke care, including: • A rapid response to a 999 call for suspected stroke. • Prompt transfer to a hospital providing specialist care. • An urgent brain scan (for example, CT or MRI) undertaken as soon as possible. • Immediate access to a high quality stroke unit. • Early multidisciplinary assessment, including swallowing screening. • Stroke specialised rehabilitation. • Planned transfer of care from hospital to community and longer term support. “

Highlighted Articles

Transient ischemic attack: diagnostic evaluation. (Ann Emerg Med. 2008) “At a minimum, the following tests are recommended: fingerstick glucose level, electrolyte levels, CBC count, urinalysis, and coagulation studies; noncontrast computed tomography (CT) of the head; electrocardiography; and continuous telemetry monitoring. Vascular imaging studies, such as carotid ultrasonography, CT angiography, or magnetic resonance angiography, should be performed on an urgent basis and prioritized according to the patient's risk stratification for disease. Consideration should be given for echocardiography if no large vessel abnormality is identified.”

Transient ischemic attack overview: defining the challenges for improving outcomes. (Ann Emerg Med. 2008) “Transient ischemic attacks are reversible neurologic events that herald potentially catastrophic strokes. Well designed studies have documented that approximately 10% of patients who have a transient ischemic attack will have a stroke within the succeeding 90 days; half of these strokes occur within 48 hours of the transient ischemic attack.”

Transient ischemic attack: definitions and clinical presentations. (Ann Emerg Med. 2008) “Correct diagnosis depends on an accurate medical history and physical examination, combined with the appropriate neuroimaging. It is uncommon that syndromes such as syncope, isolated dizziness, drop attacks, or global amnesia are caused by cerebral ischemia or transient ischemic attack. With the careful evaluation of symptoms according to this definition of transient ischemic attack, a clinician can determine whether a transient ischemic attack has occurred and thus propose treatment that may decrease the likelihood of a subsequent stroke.”

Transient Ischemic Attack: A Dangerous Harbinger and an Opportunity to Intervene. (Semin Neurol. 2005) Transient ischemic attack (TIA) and ischemic stroke are both characterized by sudden onset of neurological symptoms due to focal cerebral ischemia, but they are distinguished by the duration of neurological symptoms, with TIA traditionally defined by resolution of symptoms within 24 hours and stroke reserved for symptoms of longer duration. ... The short-term risk of ischemic stroke after TIA is very high ..."