What to Ask Your Doctor If You Just Had a Stroke

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Your brain needs a constant supply of oxygen-rich blood to nourish its 100 billion nerve cells. When this supply is reduced or shut off completely, starving brain cells die within minutes. That is why stroke is sometimes called a “brain attack.”

Blood flow to the brain can be cut off in two ways:

  • A clot or some other particle blocks the flow of blood to the brain. If the clot forms inside the brain, the stroke is thrombotic. About 40% to 50% of all strokes fall into this category. If the clot forms in another part of the body then breaks loose and travels to the brain, it can cause an embolic stroke. About 20% of all strokes are embolic.
  • When a blood vessel within the brain bursts or leaks, the result is a hemorrhagic stroke. Such strokes are often linked to high blood pressure. The force of high blood pressure can weaken blood vessel walls, eventually causing them to burst. Hemorrhagic strokes may also result from a burst or ruptured aneurysm – a sac formed on an artery wall either as a result of age or genetic predisposition.

You may think that strokes happen only to older people, physically inactive people, and men who are under job stress. In fact, 28% of people who have strokes are under age 65 and many are women.

What to Ask Your Doctor While Getting a Stroke

Suffering a stroke is a devastating and frightening medical crisis that affects an estimated 730,000 Americans each year, according to the National Stroke Association. But having a stroke, or “brain attack”, also can be a turning point that leads you to a much healthier lifestyle. Here are some questions you may want to ask during your initial consultation with a doctor following your stroke. If you are currently unable to communicate verbally or write legibly, have a loved one ask the questions for you.

  • What caused my stroke?
  • Will I need a brain scan to assess the damage?
  • Is the brain damage caused by my stroke permanent?
  • Has this stroke shortened my life expectancy?
  • Can other brain cells take over for the ones that have died?
  • What is my risk of having another stroke?
  • What are my chances of regaining full functioning?
  • Will my speech (or eyesight) always be impaired as a result of the stroke?
  • Will my cognitive functioning be affected?
  • What kind of rehabilitation program will I need?
  • What are my treatment options?
  • Are there any medications I can take to hasten my recovery?
  • Are there medications, including aspirin, that I can take to reduce my future stroke risk?
  • Am I a candidate for carotid endartectomy?
  • Are there lifestyle changes I can make now to reduce my future stroke risk?
  • Should I change my diet?
  • Is my risk for a heart attack elevated now that I’ve had a stroke?
  • Can I safely have sex?
  • Should I refrain from drinking alcohol?
  • What are the early warning signs of another stroke?
  • What should I do if I experience an early warning sign?
  • Are there stress-reduction techniques you can recommend?
  • Should I find a less stressful job?
  • Can you refer me to a support group for stroke survivors and their families?

Treating Stroke

Medication

Medications used to prevent and treat stroke include:

  • Anti-thrombotics. These drugs reduce the risk of blood-clot formation, a major cause of ischemic stroke.
  • Aspirin. Aspirin, an anti-platelet drug, prevents blood clots by decreasing the activity of platelets, blood cells that contribute to the clotting property of blood. Other anti-platelet drugs include clopidogrel and ticlopidine.
  • Anti-coagulants. These drugs, including warfarin (also known as Coumadin ) and heparin, reduce the clotting property of the blood, much like aspirin. The National Institute of Neurological Disorders and Stroke continues to study the effectiveness of anti-platelet drugs vs. anti-coagulants The Stroke Prevention in Atrial Fibrillation (SPAF) Trial found that, although aspirin is an effective therapy for the prevention of a second stroke in most patients with atrial fibrillation, some patients with additional risk factors do better on warfarin therapy. Another study, the Trial of Org 10127 in Acute Stroke Treatment (TOAST), tested the effectiveness of low-molecular weight heparin in stroke prevention and found that heparin anti-coagulants are not generally effective in preventing recurrent stroke or improving outcome.
  • Thrombolytic agents are used to treat an ongoing, acute ischemic stroke caused by an artery blockage. These drugs halt the stroke by dissolving the blood clot that is interfering with blood flow to the brain. One thrombolytic substance, recombinant tissue plasminogen activator (rt-PA), can be effective if administered intravenously within three hours of the onset of stroke symptoms, but NINDS recommends that it be used only after a physician has confirmed that the patient has suffered an ischemic stroke. These drugs can increase bleeding and therefore must be used only after careful patient screening.
  • Neuroprotectants protect the brain from secondary injury caused by stroke. The FDA has approved only a few of these drugs; others are undergoing clinical trial.

Surgery

Surgery can be used to prevent stroke, to treat acute stroke or to repair vascular damage or problems in and around the brain. For example, one surgery, carotid endartectomy, removes fatty deposits from arteries which supply blood to the brain. Extracranial/intracranial (EC/IC) bypass surgery is a procedure that restores blood flow to a deprived area of the brain by rerouting a healthy artery in the scalp to the area of brain affected by a blocked artery. A technique called “clipping” involves clamping off an aneurysm to reduce its chance of bursting or bleeding.

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