Jefferson University Hospitals

Frequently Asked Questions

Stroke is the third leading cause of death in the United States. Each year, 750,000 people suffer strokes and 150,000 of them do not survive. Better efforts and new drugs that help prevent stroke promise to lower the number of fatalities. Of those who do survive, about one-third have mild impairments, one-third are moderately impaired and one-third are severely impaired. Physicians now know that many strokes are not sudden "accidents of nature" but the predictable outcome of an unhealthy lifestyle. Taking action now can substantially reduce your risk. Below are answers to some commonly asked questions about stroke.

What is a stroke?

Stroke is a medical emergency, just like a heart attack. That’s why experts in the field now refer to it as a "brain attack." Strokes result from a sudden decrease in the flow of blood to parts of the brain. When blood can’t reach the brain, its cells are deprived of oxygen and die. Functions normally controlled by the damaged brain areas are impaired. Among the possible deficits are temporary or permanent paralysis of various parts of the body, impaired speech, vision or memory loss.

What is a mini-stroke or TIA?

Some strokes are preceded by TIAs (transient ischemic attacks). Although not a genuine stroke, it's your body's warning that you are vulnerable to the real thing. TIAs result when the brain's blood supply is temporarily interrupted, usually due to a blood clot in the arteries that breaks up or dissolves before causing permanent harm. The usual symptoms are similar to those of a full-fledged stroke, except that they're short-lived and cause no lasting damage. That's why many people ignore TIAs, thinking there's no reason for concern. In reality, TIAs are true emergencies. People who have had one are 10 times more likely to have a stroke than people of the same age and sex who haven’t had one. If you think you’ve had a TIA, see your doctor. There are many tests to determine whether you have actually suffered a stroke.

What are the different types of stroke?

One type of stroke is due to a blood clot that forms in an artery of the head or neck and then blocks it totally. Clots form most often in blood vessels already damaged by atherosclerosis, a condition in which fatty deposits build up on the inner walls of arteries.

An embolic stroke results when a blood clot formed in another part of the body and traveled through the bloodstream to block an artery supplying blood to the brain.

Sometimes a weakened blood vessel in or around the brain ruptures, spilling blood into the brain itself or the surrounding tissue. This most severe type of stroke is usually associated with high blood pressure or an aneurysm.

An aneurysm is an abnormal, balloon-like bulging of an artery's wall. As the artery bulges, it is weakened and its chances of rupturing increase. Aneurysms can occur in any part of the body, but only those affecting the arteries supplying blood to the brain can cause a stroke.

What are the risk factors for stroke?

Among the most common risk factors for stroke are

  • High blood pressure
  • Diabetes
  • Heart disease
  • High blood cholesterol level
  • Smoking
  • Carotid artery disease
  • Family history of early stroke or heart disease
  • Previous stroke or stroke-warning sign
  • Having had a mini-stroke or transient ischemic attack (TIA)
  • Lack of exercise
  • Being 55 years of age and older
  • Being more than 20 percent over your proper weight
  • Excess alcohol consumption
  • Being male or African American

How can you lower your risk of stroke?

Lowering your blood pressure is the first step to reducing your risk of stroke. It is also critical for those with diabetes to keep it under control.

Adopting and maintaining sound health habits, primarily a low-fat and low-salt diet, is the first step in preventing a stroke. Research indicates that a low-fat, low-cholesterol diet not only delays the development of atherosclerosis but may unclog already narrowed arteries. Reducing the amount of high-fat food you eat can bring down your blood pressure at the same time.

Regular exercise, ideally aerobic activity three times a week, limiting alcohol intake and stopping smoking will also reduce your risk of stroke.

There are also medical or surgical treatments that could be effective. Ask your doctor for information.

What are the symptoms of stroke?

Stroke symptoms are subtle and often painless. Knowing these signs and seeking medical help immediately if you have one or more of them may reduce the severity of a stroke. The most common are

  • Numbness, weakness or paralysis on only one side of your body
  • Difficulty speaking or understanding spoken language
  • Sudden blurred or visual disturbances in one or both eyes
  • Dizziness or loss of balance or consciousness
  • Difficulty swallowing
  • Sudden severe or unexplained headache

What should you do in case of a stroke?

Call 911 immediately for emergency medical attention if you ever experience the symptoms yourself or notice them in someone else. Tell the operator you think you’re having a stroke and ask to be taken to the nearest emergency room.

How is stroke treated?

Stroke treatments include medications and various surgical procedures. New drugs and procedures are under investigation right now in medical centers throughout the country, including the Jefferson Stroke Center, the largest center dedicated to stroke care in our area.

Time is of the essence when a patient suffers a stroke. Thrombolytics, such as tissue plasminogen activator (t-PA), an acute clot buster is capable of dissolving a clot if given within a 3-hour window from symptom onset. The Mercer retriever and stenting procedures are available. Jefferson Hospital for Neuroscience is among the first hospitals in the nation to offer a new coiling procedure to treat aneurysm.

The Jefferson Stroke Center offers emergency transport and sophisticated treatments such as endovascular and interventional surgeries like inter-arterial thrombolysis, in which a catheter is inserted into the cerebral artery to dissolve a clot with a thrombolytic, outside a 3-hour window.

What are some of the common complications that can result from a stroke?

A complication resulting from stroke can be vascular dementia, which is loss of intellectual abilities, including memory. Vascular dementia occurs when brain tissue is damaged because of reduced blood flow to the brain cells. As a result, patients with stroke have difficulty processing information, decreased attention span and memory loss. Patients with vascular dementia become more dependent upon family members and caregivers for assistance with activities of daily living.

Also common after stroke is dysphasia or difficulty in swallowing. Swallowing problems affect 22 to 35 percent of patients with stroke and may persist for many months.

Swallowing abnormalities indicate that patients who have had stroke are at higher risk for pneumonia, aspiration and malnutrition. Aspiration occurs in patients with poorly coordinated swallowing, in which food enters the airway below the level of the vocal cords, making oral feeding a significant risk. Therefore, early detection of swallowing difficulties, via a bedside swallow assessment is essential.

Aphasia is a communication disorder that limits a person’s ability to process language. Although it does not affect intelligence, it does impair one’s ability to speak and understand others. Stroke is the most common cause of aphasia, which affects one in 250 people. When a person has aphasia, it is usually due to damage on the left side of the brain, unless the person is left handed, in which case damage is on the right side of the brain. Improvement is a very slow process that can continue over years and even decades. No medicines have been known to cure aphasia. Language skills often return spontaneously over a period of months as the brain continues to recover. Speech therapy is very helpful, especially when this intervention is started almost immediately after the stroke occurs.

What is atrial fibrillation?

Atrial fibrillation (AF) is the most common abnormality of heart rhythm, affecting more than two million Americans. In a normal rhythm, the heart beats between 60 and 100 times per minute; in AF, the upper chamber of the heart beats rapidly and irregularly, which can lead to an increased heart rate.

Who has AF?

AF is relatively rare in young, healthy people, although it can occur. It is found most often in people over age 65 and in those who have heart disease. AF's prevalence increases as the population ages; approximately 10 percent of patients over the age of 70 will develop it.

What does AF have to do with stroke?

In AF, the irregular contractions of the left atrium may cause blood to pool, which may result in the formation of blood clots. These clots can break loose and travel through the bloodstream to the brain, causing a stroke.

Clinical risk factors for stroke in patients with AF include advanced age, history of a previous stroke or transient ischemic attack (temporary paralysis, numbness, speech difficulty or other neurologic symptoms that start suddenly but from which the patient recovers within 24 hours), heart failure, diabetes and high blood pressure.

Patients who are under the age of 65 and have none of the other aforementioned risk factors are at low risk for stroke.

How can you tell if you have AF?

AF often has no strong outward symptoms. Some people with AF will experience heart palpitations - often described as a “pounding,” “racing” or “fluttering” heartbeat. In other people, the only symptom of AF may be dizziness, faintness or light-headedness. Others may experience chest pain ranging from mild to severe. And for some, AF has no symptoms at all.

The only way to know for sure if you have AF is to have your doctor perform a painless test called an electrocardiogram (ECG). During an ECG, sensitive electrodes are placed on your chest. These electrodes pick up the electrical impulses generated by your body that cause your heart to beat. The impulses are then transmitted to a device that records them on a piece of paper called an ECG strip. By examining the specific pattern of electrical impulses recorded on the ECG strip, your doctor can tell for certain whether you have AF.

What can I do if I have AF?

Doctors have several options for managing AF. Whenever possible, the first treatment efforts will be directed at cardioversion - restoring your heart's normal rhythm. This can be done either through the use of electrical stimulation (direct-current or DC cardioversion) or through pharmacologic (drug-based) therapy. For many people, one or the other of these measures will work to convert the heart to normal rhythm. Patients with recurrent AF may require long-term treatment with medication.

Those who fail drug therapy may be candidates for a procedure called radiofrequency (RF) catheter ablation. During this procedure, physicians insert small catheters into the heart and apply RF current to target or ablate areas that may trigger or sustain AF.

AF treatment also concentrates on protecting you from blood clots that may lead to stroke. Your doctor may prescribe a medication called an "anticoagulant" to prevent clots from forming or growing. Warfarin (brand-name Coumadin®) is the drug of choice for long-term anticoagulation in AF patients. Controlled trials of anticoagulation have demonstrated that warfarin significantly reduces the risk of stroke in patients with AF and clinical risk factors. Although bleeding is more common in patients treated with warfarin, careful monitoring by physicians minimizes the risk of bleeding.

If your doctor has prescribed AF medication for you, it's important to take your medication exactly as directed. Failure to take your AF medication properly can significantly increase your risk of stroke or bleeding.

For an appointment with a Jefferson physician, please call 1-800-JEFF-NOW (1-800-533-3669) or visit our Web site at www.JeffersonHospital.org.

Speech- or hearing-impaired callers can access JEFF NOW® by calling 1-800-654-5984.

Stroke is a "brain attack" cutting off vital sup-plies of blood and oxygen to the brain. It can damage brain cells that control everything we do – from thinking, to speaking, to walking to breathing. Symptoms include:

  • Sudden numbness or weakness of 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

A stroke happens when an artery leading into the brain becomes blocked or ruptures. These arteries can be blocked by blood clots formed in the heart or elsewhere in the body or by the gradual build-up of plaque and other fatty deposits such as cholesterol.

What is cholesterol?

Cholesterol is a soft, waxy, fatty material found in the bloodstream and in all of your body's cells. Your body naturally makes all the cholesterol it needs for use to form cell membranes, some hormones and vitamin D. Certain foods (such as egg yolks, liver or foods fried in animal fat or tropical oils) contain cholesterol and also saturated fats which increase blood cholesterol levels.

Cholesterol can not dissolve in the blood on its own. It has to be delivered to and from the cells by tiny particles called lipoproteins. The two main lipoproteins that have a direct effect on cholesterol levels are low-density lipoproteins (LDL) and high-density lipoproteins (HDL).

How does cholesterol affect stroke risk?

High cholesterol may indirectly increase stroke risk by increasing your risk for heart disease – an important stroke risk factor. In addition, plaque formation in the carotid arteries to the brain may also block normal blood flow and cause a stroke.

What is LDL cholesterol?

LDL cholesterol is also often referred to as "bad" cholesterol due to its artery clogging properties. LDL carries cholesterol in the blood stream to the tissues, where it can be used or stored in your body. This type of cholesterol can cause a build-up of plaque, a thick, fatty substance that can clog arteries. The plaque can eventually cause narrowing of the arteries or block them completely, causing a heart attack or stroke.

What is HDL cholesterol?

HDL has the opposite effect of LDL cholesterol. HDL transports cholesterol from the tissues to the liver, where it is expelled from the body. High levels of this type of cholesterol tend to protect against heart attack and stroke, and it is therefore known as "good" cholesterol. A low HDL level may indicate a greater risk of heart attack or stroke.

What increases blood cholesterol levels?

  • Blood cholesterol levels may be affected by a variety of factors, including:
  • Foods high in saturated fat
  • Being overweight
  • Lack of exercise
  • Inherited health traits
  • Age (Most but not all people experience gradual increases in blood cholesterol as they become older)
  • Gender – Before the age of 50, women tend to have lower cholesterol levels than men. However, once women reach menopause, their LDL "bad" cholesterol tends to rise and their HDL "good" cholesterol tends to fall. After the age of 50, women tend to have higher cholesterol levels than those of men of the same age. Throughout life, women's HDL cholesterol remains higher than that of men. This difference may help explain why women under the age of 80 usually experience lower rates of heart disease and stroke than men.

Should I be checked for high cholesterol?

According to the National Heart, Lung and Blood Institute's (NHLBI) Cholesterol Education Program, all adults 20 years of age or older should have their cholesterol levels checked at least once every five years. Your cholesterol should be checked more frequently if you are older than 45 or have a family history of high cholesterol or heart attacks. A simple blood test can determine your cholesterol levels.

What do my cholesterol levels mean?

According to the NHLBI, for people over age 18, a high cholesterol level is considered to be over 200 mg/dL for your total cholesterol, which combines both LDL and HDL levels. If the total blood cholesterol number is higher than 200, or if your HDL is lower than 45, you generally have an increased risk for heart disease and stroke. Your doctor can determine if you are at greater overall risk.

Total Blood Cholesterol Levels
Desirable: less than 200/mg/dL Borderline: 200-239 mg/dL High: 240 mg/dL or higher

HDL-Cholesterol Levels
Desirable: 45 mg/dL or higher

LDL-Cholesterol Levels
Desirable: less than 130mg/dL Borderline: 130-159 mg/dL High: 160 mg/dL or higher

If you have had a stroke or previous heart attack, your cholesterol levels may need to be even lower than as indicated here.

What can I do to lower my cholesterol levels?

A low-fat diet: A diet with 30 percent or fewer calories from total fat, and low in saturated fat is important for lowering cholesterol levels. Your diet should also include vegetables, fruits, lean meats such as chicken and fish, low-fat dairy products and a limited number of egg yolks. Adding fiber such as whole-grain bread, cereal products or dried beans to the diet may also help reduce cholesterol levels by 6 to 19 percent, according to published studies. Along with the diet, there should be a change in cooking habits, with an emphasis on baking, broiling, steaming and grilling rather than frying foods. If you do fry foods, use non-stick cookware and non-stick spray.

Exercise: Active people generally tend to have lower cholesterol levels. Regular exercise also seems to slow down or stop the clogging of blood vessels by fatty deposits. Your doctor may recommend a program of regular exercise to help lower your cholesterol. Be sure to check with your doctor before starting any exercise program. For the best results, you should take part in some aerobic activity most days of the week, for at least 20 or 30 minutes each time. This can be achieved by a brisk walk with a friend, taking the stairs instead of the elevator or parking farther away from your destination.

Medication: Although many people can successfully control their cholesterol levels through diet and exercise alone, a number cannot. For these people, medication may be prescribed by a doctor to lower cholesterol levels. If your doctor decides you need to add medication to help control your cholesterol, be sure to TAKE IT AS DIRECTED, even on days you feel fine. You and your doctor may have to try several different medications before you find the one that's right for you. This is very common, so don't be discouraged.

Statins are a widely used class of cholesterol lowering medications that may help reduce the size of the plaque that causes hardening and clogging of the arteries. New studies have also shown that some statins may prove to be effective in reducing the risk of stroke or a transient ischemic attack (TIA) in patients who have had a heart attack, even though they have average or only slightly elevated cholesterol levels.

Several other cholesterol-lowering drugs are also available and may prove effective in certain individuals. Talk with your doctor about which medication is right for you.

For an appointment with a Jefferson physician, more information or health information and education programs, please call 1-800-JEFF-NOW (1-800-533-3669).

Speech- or hearing-impaired callers can access JEFF NOW® by calling 1-800-654-5984.

This information comes from the National Stroke Association.

People with diabetes are nearly three times as likely to have a stroke than someone who does not have the disease. This increased risk may be due to some of the same complications that result from diabetes are also associated with stroke.

What is a stroke?

Stroke is a medical emergency, just like a heart attack. That's why experts in the field now refer to it as a "brain attack." Strokes result from a sudden decrease in the flow of blood to parts of the brain. When blood can't reach the brain, its cells are deprived of oxygen and die, so functions normally controlled by the damaged brain areas are impaired. Among the possible effects are temporary or permanent paralysis of various parts of the body or impaired speech or vision.

What is diabetes?

Diabetes is a disease which affects a person's ability to move blood sugar (or glucose) out of the blood and into the cells – where it is used as the body's primary source of fuel.

There are two types of diabetes:

  • Insulin dependent (Type 1) – found in childhood and is characterized by the body's inability to produce enough insulin, which is a hormone that permits the body to metabolize blood sugar (glucose).
  • Non-Insulin dependent (Type 2) – more common type of diabetes that makes up over 90 percent of all diabetes cases. It usually develops in adulthood and may go unnoticed for some time. The body is able to produce insulin, but tissues develop a resistance to its actions and blood sugar levels rise above normal.

Why is there a link between stroke and diabetes?

There are a number of risk factors that increase the chance of vascular complications in individuals with diabetes. At the top of this list is high blood pressure.

Hypertension is twice as likely among patients with diabetes. This contributes to a higher stroke risk, and can lead to a stroke from a blood clot or hemorrhage.

Heart disease is another common problem that can result in higher stroke risk among patients with diabetes. Myocardial infarction (heart attack) and atrial fibrillation (irregular beating pattern) are common and increase stroke risk.

Brain damage may be more severe and extensive if blood sugar is high when a stroke happens. Careful regulation of blood sugar, either with insulin or oral blood sugar-lowering drugs, can reduce vascular complications.

What is the treatment for diabetes?

Both types of diabetes can be controlled, reducing the risk of long-term health complications such as stroke. Type I is treated closely by monitoring blood sugar and taking daily insulin injections. Type II, which is worsened by obesity, can frequently be controlled through weight loss, dietary changes and exercise. Daily insulin injections are not usually necessary and are reserved as a last resort.

For an appointment with a Jefferson physician, more information or health information and education programs, please call 1-800-JEFF-NOW (1-800-533-3669).

Speech- or hearing-impaired callers can access JEFF NOW® by calling 1-800-654-5984.

What is high blood pressure?

High blood pressure, also known as hyperten-sion, is the most prevalent cardiovascular condition. Sixty million men and women have blood pressure that's too high, and up to one third of them are unaware of it. Doctors call hypertension the silent killer because it usually causes no physical symptoms and people feel perfectly fine, even when their blood pressure is elevated. But damage to their body is occurring nonetheless.

If there are no symptoms, how can I tell if I have high blood pressure?

You can't, only your doctor can. Checking your blood pressure regularly, at least once a year, is the only way to determine if you have this condition. Even if you have a healthy blood pressure reading now, you can't necessarily count on it staying low forever.

What ranges of blood pressure readings are considerd high?

For adults, a blood pressure reading between 130/85 and 139/89 (read as "130 over 85" and "139 over 89") is considered high normal. Mild hypertension is defined as pressure between 140/90 and 159/99. People with moderate hypertension have a reading of 160/100 to 179/109. Severe hypertension is a blood pressure reading of 180/110 to 209/119.

What do the numbers mean?

The first and upper number (systolic pressure) represents the pressure in your arteries as the heart contracts to pump blood through the circulatory system. The second and lower number (diastolic pressure) is the pressure in your arteries between beats, when the heart is resting. Either the systolic or diastolic measurement, or both, can be elevated when your blood pressure is too high. High readings mean your heart is working unnaturally hard to circulate blood.

A word of caution, though: If your doctor tells you your blood pressure is a little high, don't panic and assume this automatically lumps you into the category of hypertensive. It's best that your doctor do several blood pressure checks over a few months and in a variety of circumstances to get a true reading. You and your doctor should begin treatment when measurements indicate that your blood pressure is consistently elevated.

How serious is high blood pressure?

High blood pressure shouldn't be taken lightly. It's a risk factor for deadly conditions such as coronary heart disease, heart attack, stroke and kidney disease. High blood pressure contributes to atherosclerosis, the build-up of sticky plaque on the artery walls, making it difficult for blood to flow freely.

When arteries in the brain or heart become clogged, you can suffer a stroke or heart attack. Impaired vision occurs when tiny blood vessels in the back of the eye rupture or become blocked. Kidney impairment results when vessels in the kidneys are narrowed.

What causes high blood pressure?

It's rare to pinpoint a specific cause of high blood pressure. Doctors do know that hypertension runs in families, and that lack of exercise, stress, being overweight, smoking and drinking heavily contribute to and even worsen hypertension. African Americans have a higher rate of hypertension and tend to have more severe hypertension than whites, but it's not yet known why this occurs. It's suspected that genes and diet play some role, though.

Does sodium cause high blood pressure?

Although salt restriction may reduce the blood pressure of some hypertensive people, normal amounts of sodium usually do not cause hypertension. But excess sodium can lead to fluid retention. More fluid in the body raises the total volume of blood flowing through your system; the higher the volume, the higher your blood pressure.

Cardiologists typically recommend low-sodium diets for those with hypertension or with a family history of the disease because in many people, blood pressure falls significantly if salt intake is restricted. These people are "salt sensitive," meaning their blood pressure rises when they ingest large amounts of sodium, and drops when they reduce sodium intake.

How is high blood pressure treated?

In general, the best approach to prevent and control high blood pressure is one that involves small, easy lifestyle fixes. Exercising regularly, giving up cigarettes, reducing stress and limiting sodium and alcohol intake can bring blood pressure down to safer levels. In fact, for many people with hypertension, losing 10 or 20 pounds can lower their pressure to a more normal range. Making physical activity a regular part of your everyday life, along with a reduced-fat diet, can help you shed excess pounds. Preliminary studies suggest that a diet rich in potassium and calcium may help reduce blood pressure. Eating a balanced diet that includes low-fat dairy products and more fruit and vegetables will automatically boost your intake of these nutrients.

These lifestyle improvements are the first step to controlling high blood pressure, no matter your age or risk status. The exception is if your blood pressure is so alarmingly high that immediate antihypertensive medication is needed.

What medications are used to treat high blood pressure?

Adopting a healthier lifestyle is often the only measure many people with high blood pressure need to take to bring their reading down. Others, however, need to combine medication with a healthy lifestyle to make their pressure respond in a more favorable way. Diuretics rid the body of excess salt and water. This reduces the volume, and therefore the pressure, of your blood. Beta blockers keep your heart from pumping too hard and too fast, thus reducing blood pressure. Calcium blockers, alpha blockers and ACE (angiotensin-converting-enzyme) inhibitors all keep blood vessels open, lowering resistance and, therefore, blood pressure. Calcium channel blockers relax the muscles in the blood vessel walls, alpha blockers intefere with impulses from the brain and nerves that constrict vessels, and ACE inhibitors block the action of an enzyme that causes arteries to narrow.

Are there any drawbacks to medications?

When trying to bring blood pressure down to normal levels with medication, some people complain of fatigue, depression and a general sense of "not feeling right." Since high blood pressure rarely has symptoms, the treatment sometimes seems worse than the disease, and some patients stop taking medication, which isn't a wise idea. Hypertension is a lifelong disease that requires lifelong treatment.

Yet, there's no reason to tolerate unpleasant side effects if you're on medication. There are many factors that figure into the choice of antihypertensive medication. With advances in drug therapy, sometimes all that's needed to get rid of undesirable complications is a minor reworking of the type of medication, the dosage, how frequently you take it or how it's delivered to your body.