Massive Stroke: Symptoms, Treatments, and Long-Term Outlook
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Massive Stroke: Symptoms, Treatments, and Outlook

Overview

A stroke is what happens when blood flow to part of the brain is interrupted. The result is oxygen deprivation to brain tissue, which can have devastating consequences. The ability to recover from a stroke depends on the severity of the stroke and how quickly you get medical attention. A massive stroke can be fatal, but for many people experiencing a stroke, recovery is long but possible.

Symptoms of a stroke

Symptoms

The severity of symptoms depends on the location of the stroke and the size of the stroke. The symptoms of a stroke can include:

  • a sudden, severe headache
  • vomiting
  • neck stiffness
  • a loss of vision or blurred vision
  • dizziness
  • a loss of balance
  • numbness or weakness on one side of your body or face
  • sudden confusion
  • difficulty talking
  • difficulty swallowing

In severe cases, rigidity and coma can occur.

Causes

Causes

Strokes occur when blood flow to your brain is interrupted. They can be ischemic or hemorrhagic.

Hemorrhagic stroke

A hemorrhagic stroke occurs when blood vessels in the brain rupture, causing blood to accumulate in the surrounding brain tissue. This causes pressure on the brain and can leave part of your brain deprived of blood and oxygen. Thirteen percent of strokes are hemorrhagic, according to the American Stroke Association.

Ischemic stroke

The majority of strokes are ischemic. An ischemic stroke results from a clot that blocks blood flow to a particular region of the brain. The clot may be a cerebral thrombosis, meaning it forms at the site of the blockage in the brain. Alternatively, the clot may be a cerebral embolism, which means it forms elsewhere in the body and moves into the brain, causing a stroke.

Risk factors

Risk Factors

According to the Centers for Disease Control and Prevention, new or persistent strokes affect 800,000 Americans each year. The risk factors for a stroke include a family history of stroke, as well as:

Sex

Strokes are more common in men than in women in most age groups except older adults, yet stroke is more deadly in women than in men. This may be because women usually live longer than men and strokes are most common in older adults. Birth control pills and pregnancy can also increase a woman’s risk of stroke.

Race

People in the following groups have a higher risk of stroke than Caucasians, yet risk disparities among these people in these groups decreases with age:

  • Native Americans
  • Hispanics
  • Asians
  • African-Americans

Lifestyle factors

The following lifestyle factors all increase your risk of stroke:

  • smoking
  • diet
  • physical inactivity
  • alcohol abuse
  • drug abuse

Medications and medical conditions

Birth control pills and medications that thin the blood such as warfarin (Coumadin), Xarelto, or Eliquis can increase your risk.

Pregnancy and certain medical conditions can also increase your risk of stroke. Medical conditions that increase your risk include:

  • heart and vascular problems
  • diabetes
  • a history of stroke or ministroke
  • high cholesterol
  • high blood pressure, especially if it’s uncontrolled
  • obesity
  • metabolic syndrome
  • migraine
  • sickle cell disease
  • conditions that cause a hypercoagulable state
  • conditions that cause excessive bleeding, such as low platelets and hemophilia
  • treatment with medications that are clot busters
  • a history of aneurysms or vascular abnormalities in the brain
  • polycystic ovarian syndrome because it’s associated with aneurysms in the brain
  • tumors in the brain, especially malignant tumors

Age

Adults over age 65 are at the greatest risk of stroke, especially if they:

  • have high blood pressure
  • have diabetes
  • are sedentary
  • are overweight
  • smoke

Diagnosing a stroke

Diagnosis

If your doctor suspects you’re having a stroke, they’ll perform tests to help them make a diagnosis. They can also use certain tests to determine the type of stroke.

First, your doctor will perform a physical exam, testing your mental alertness, coordination, and balance. They’ll look for:

  • numbness or weakness in your face, arms, and legs
  • signs of confusion
  • difficulty speaking
  • difficulty seeing normally

If you’ve had a stroke, your doctor may also perform tests to confirm the type of stroke you’ve had and to make sure they’re giving you the right kind of treatment. Some common tests include:

  • a CT of the brain
  • an MRI
  • a computed tomography angiogram
  • a magnetic resonance angiogram
  • a carotid ultrasound
  • a carotid angiogram
  • an electrocardiogram
  • an echocardiogram
  • blood tests

Emergency treatment for a massive stroke

Warning

If you’re having a stroke, you need emergency care as soon as possible. The sooner you get treatment, the better your odds are of survival and recovery.

Hemorrhagic stroke

If you’re having a hemorrhagic stroke, emergency caregivers may give you medications to lower your blood pressure and slow the bleeding. If you’ve been on blood thinners, they may give you drugs to counteract them because these medications worsen bleeding.

If you have a hemorrhagic stroke, you may need emergency surgery depending on the severity of the bleeding. They’ll do this to repair the broken blood vessel and to remove excess blood that may be putting pressure on the brain.

Ischemic stroke

For an ischemic stroke, emergency care can involve dissolving the clot if you arrive in the emergency room for treatment within a specific time frame after symptoms begin. Clot-busting drugs called thrombolytics are often used for this purpose. Doctors often give aspirin in emergency settings to prevent any additional blood clots from forming.

Before you can get this kind of treatment, however, caregivers must confirm that the stroke is not hemorrhagic. Blood thinners can make a hemorrhagic stroke worse, which can even lead to death.

Complications associated with a massive stroke

Complications Icon

Complications and resulting impairments become more serious depending on the severity of the stroke. Complications can include the following:

  • paralysis
  • difficulty swallowing or talking
  • balance problems
  • dizziness
  • memory loss
  • difficulty controlling emotions
  • depression
  • pain
  • changes in behavior

Rehabilitation services can help minimize complications and may include working with:

  • a physical therapist to restore movement
  • an occupational therapist to learn how to perform daily tasks, such as activities involving personal hygiene, cooking, and cleaning
  • a speech therapist to improve speaking ability
  • a psychologist to help cope with feelings of anxiety or depression

Coping after a stroke

Coping

Some people who have a stroke recover quickly and can regain normal function of their body after just a few days. For other people, recovery may take six months or longer.

No matter how long it takes you to recover from your stroke, recovery is a process. Remaining optimistic can help you cope. Celebrate any and all progress you make. Talking to a therapist can be helpful if you find yourself in poor spirits.

Support for caregivers

During the recovery process after a stroke, a person may need ongoing rehabilitation. Depending on the stroke’s severity, this may be for a few weeks, months, or even years.

It can be helpful for caregivers to educate themselves about strokes and the rehabilitation process. Caregivers may also benefit from joining support groups where they can meet others who are helping their own loved ones recover after a stroke. Some good resources to find help include the National Stroke Association, American Stroke Association, and Stroke Network.

The long-term outlook

Outlook

Your outlook depends on the severity of the stroke and how quickly you get medical care for it. The outlook is better for an ischemic stroke. Hemorrhagic strokes have more complications because of the pressure they put on the brain.

Preventing a stroke

Prevention

Follow these tips to prevent a stroke:

  • Quit smoking and avoid exposure to secondhand smoke.
  • Eat a healthy diet.
  • Exercise at least 30 minutes on most or all days of the week.
  • Maintain a healthy weight.
  • Limit your consumption of alcohol.
  • If you have diabetes, follow your doctor’s instructions for maintaining healthy blood glucose levels.
  • Follow your doctor’s instructions for maintaining healthy blood pressure levels

Your doctor may recommend or prescribe certain medications to help reduce your risk of stroke. These may include:

  • antiplatelet medication, such as clopidogrel, which can help prevent blood clots from forming in your arteries or heart
  • aspirin to help prevent stroke in older adults or those at risk of stroke
  • anticoagulants, such as Warfarin

You Asked, We Answered

  • What is a transient ischemic attack (TIA)?
  • A transient ischemic attack, or TIA, is defined as symptoms consistent with a stroke that resolve within 24-48 hours without any evidence of a stroke on CT or MRI of the brain.

    - Graham Rogers, MD

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