When the brain’s blood supply is inadequate, a stroke results. Stroke symptoms (for example, loss of arm or leg function or slurred speech) signify a medical emergency because without treatment, blood-deprived brain cells quickly become damaged or die, resulting in brain injury, serious disability, or death. Call 9-1-1 if you notice stroke symptoms developing in someone.

Initial symptoms of a stroke can occur in someone suddenly. Know these signs of a stroke:

• Difficulty speaking
• Difficulty understanding or confusion, especially with simple tasks
• Difficulty with muscle strength, especially on one side of the body
• Numbness, especially on one side of the body
• Severe headache
• Vision changes (in one or both eyes)
• Difficulty with swallowing
• Facial droop on one side

The F.A.S.T. test was designed in 1998 to help ambulance staff in the United Kingdom quickly assess stroke. It takes into account the most common symptoms of stroke and is designed to help quickly assess a stroke with very little training.

F.A.S.T. Test

• F means face: If one side of the face droops, it’s a sign of a possible stroke
• A means arms: If the person cannot hold both arms out, it’s another possible stroke sign
• S means speech: Slurring words and poor understanding of simple sentences is another possible stroke sign
• T means time: If any of the FAS signs are positive, it’s Time to call 9-1-1 immediately

Remember the FAST test for stroke. The “T” in FAST also means the longer the brain is blocked from its blood supply (usually due to a blood clot), the greater the brain damage possible.

For many patients, the time limit to diagnose and treat such a clot is usually within 3 hours (some physicians suggest a bit longer). In some qualified patients, the use of a clot-busting drug may be used to dissolve the clot and restore blood flow. Not all patients qualify for this treatment. There are also some risks like bleeding associated with this treatment that may cause problems.

Strokes are a leading cause of long-term disability in people.

There are two main types of strokes (ischemic and hemorrhagic) and they are treated differently. They are often emergently diagnosed by a head CT scan (or an MRI scan).

This slide shows a CT scan of an ischemic stroke, which is responsible for about 80% to 90% of all strokes. Ischemic strokes are caused by clots that reduce or stop blood flow to the brain. The clot may develop elsewhere in the body and circulate to become lodged in a blood vessel in the brain, or the clot may originate in the brain.

Ischemic strokes are usually divided into two main subtypes: thrombotic and embolic.

Thrombotic Stroke

Nearly half of all strokes are thrombotic strokes. Thrombotic strokes are caused when blood clots form in the brain due to a diseased or damaged cerebral artery.

Embolic Stroke

Blood clots also cause embolic strokes. However, in the case of embolic strokes, the blood clot forms in an artery outside the brain. Often these blood clots start in the heart and travel until they become lodged in an artery of the brain. The physical and neurological damage embolic strokes cause is nearly immediate.

This picture shows a hemorrhagic stroke using an MRI image. The circle inset outlines what composes a hemorrhagic stroke. A blood vessel in the brain breaks open, and blood escapes into the brain under pressure, compressing other blood vessels and brain cells causing damage and death. This bleeding into the brain is difficult to stop and is more likely to be fatal. There are two types of hemorrhagic strokes: intracerebral and subarachnoid.

Intracerebral Stroke

“Intracerebral” means “within the brain,” and it refers to a stroke caused by a diseased blood vessel bursting within the brain. Intracerebral strokes are usually caused by high blood pressure.

Subarachnoid Stroke

A subarachnoid hemorrhage refers to bleeding immediately surrounding the brain in the area of the head called the subarachnoid space. The main symptom of a subarachnoid stroke is a sudden, severe headache, possibly following a popping or snapping feeling. Many factors can cause a subarachnoid stroke, including head injury, blood thinners, bleeding disorders and bleeding from a tangle of blood vessels known as an arteriovenous malformation.

“Mini-strokes” (also termed transient ischemic attacks or TIAs) are temporary blockages of blood vessels in the brain. TIAs can produce mild stroke symptoms that resolve. TIAs often occur before a stroke happens, so they serve as warning signs that the person may need stroke preventive therapy.

Mini Stroke Symptoms

• Confusion
• Weakness
• Lethargy
• Paralysis
• Facial droop
• Vision loss

Mini Stroke Treatment

Treatment for a mini-stroke may include medication, changes in lifestyle, and possibly surgery to reduce the chances of another stroke occurring.

Common causes of stroke come from blood vessels both outside and inside the brain. Atherosclerosis (hardening of the arteries) can occur when plaque (deposits of cholesterol, calcium, fat, and other substances) builds up and narrows the vessel, making it easy for clots to form and further occlude the vessel. The clots can break free only to travel to and block smaller vessels inside the brain. The blood vessels inside the brain itself can accumulate this plaque. Occasionally, weakened vessels can burst and bleed into the brain.

Common conditions that increase a person’s risk for strokes include high blood pressure, elevated cholesterol levels, diabetes, and obesity. People can reduce stroke risks by addressing these problems.

People can also reduce their stroke risk by altering some aspects of their lifestyle. For example, people who stop smoking, begin a consistent exercise program, and limit their alcohol intake (two drinks per day for men, one per day for women) can decrease their risk.

One of the best ways to reduce stroke risk is to eat a diet that has low fat and low cholesterol to reduce the chance of plaque formation in blood vessels. Foods high in salt may increase blood pressure. Cutting back on calories can help reduce obesity. A diet that contains a lot of vegetables, fruits, and whole grains, along with more fish and less meat (especially red meat) is suggested to lower stroke risk.

Unfortunately, there are some risk factors that people cannot control, such as family history of strokes, gender (men are more likely to have a stroke), and race (African Americans, Native Americans, and Alaskan Natives all have increased risk for strokes). In addition, women who get strokes are more likely to die from the stroke than men.

Emergency stroke treatment depends on the type of stroke and underlying health of the patient. Ischemic strokes are treated by methods designed to remove (dissolve) or bypass a clot in the brain, while hemorrhagic strokes are treated by attempts to stop the bleeding in the brain, control high blood pressure, and reduce brain swelling. Hemorrhagic strokes are more difficult to treat.

Aspirin

Aspirin is part of a group of drugs called antiplatelet agents. Antiplatelet agents like aspirin help prevent blood cell fragments from sticking together and forming clots and are therefore helpful in preventing some forms of stroke. The American Heart Association recommends taking aspirin within two days of an ischemic stroke to reduce the stroke’s severity. For those who have had a mini-stroke, a doctor may recommend daily aspirin treatment.

TPA

TPA is a clot-busting drug that can be used to treat ischemic strokes. It is given through the arm as an IV and helps dissolve blood clots and improve blood flow through areas of the brain blocked by clots. TPA may help if it is used within three hours of a stroke taking place.

Strokes that cause long-term damage are usually severe and/or not treated or treated after large sections of the brain have been damaged or killed. The type of damage depends on the location in the brain where the stroke occurred (for example, the motor cortex for movement problems or the brain area that controls speech). Although some problems will be permanent, many people that do rehabilitation can regain some or many of the abilities lost in the stroke.

If a stroke damages a person’s ability to use language and to speak or swallow, rehabilitation with a speech therapist can help a person regain some or most of the abilities they lost initially with the stroke. For those who have severe damage, rehabilitation can provide methods and skills that can help a person to adapt and compensate for severe damage.

Physical therapy is designed to improve a person’s strength, gross coordination, and balance. This type of rehabilitation helps people, after their stroke, regain their ability to walk and do other things like using stairs or getting out of a chair. Regaining fine motor skills like buttoning a shirt or using a knife and fork or writing a letter are activities that occupational therapy is designed to aid.

Some people have problems coping with their new disabilities after a stroke. It is common for people to have emotional reactions after a stroke. A psychologist or other mental health professional can help people adjust to their new challenges and situations. These professionals use talk therapy and other methods to help people with reactions such as depression, fear, worries, grief, and anger.

The methods previously discussed that may prevent or decrease a person’s stroke risk are essentially the same for people who have had a stroke (or TIA) and want to prevent or decrease their chances of having another stroke. In summary, quit smoking, exercise, and if obese, lose weight. Limit alcohol, salt, and fat intake and get into the habit of eating more vegetables, fruits, whole grains, and more fish and less meat.

Medications are usually prescribed for people with a high risk of stroke. The medicines are designed to lower risk by inhibiting clot formation (aspirin, warfarin and/or other antiplatelet medicines). Also, antihypertensive medications can help by reducing high blood pressure. Medications have side effects, so discuss these with you doctor.

There are some surgical options for stroke prevention. Some patients have plaque- narrowed carotid arteries. The plaque can participate in clot formation in the artery and can even shed clots to other areas in the brain’s blood vessels. Carotid endarterectomy is a surgical procedure in which the surgeon removes plaque from the inside of the arteries to reduce the chance of strokes in the future.

Some doctors also treat plaque-narrowed carotid (and occasionally other brain arteries) with a balloon on the end of a narrow catheter. Inflating the balloon pushes plaque aside and increases the vessel’s lumen (opens up the vessel). This opened artery then is reinforced (kept open) by an expandable stent that, when expanded, becomes rigid.

About two-thirds of people (over 700,000) that have a stroke each year survive and usually need some level of rehabilitation. Some who get clot-busting drugs may recover completely, others will not. Many people who have disability after a stroke can function independently with therapy and rehabilitation methods. Although the risk of having a second stroke is higher after the first stroke, individuals can take the steps outlined in previous slides to reduce this risk.

Your arteries and veins have a big job to do. They’re part of a transportation system that moves blood around. Arteries carry blood loaded with oxygen from your heart to the rest of your body. Veins deliver the blood, now without much of the oxygen, back to your heart. From there, the pulmonary artery sends it to your lungs to restock it with oxygen. Your pulmonary vein brings blood back to your heart, and the process starts again.

Sometimes your arteries or veins get narrowed or blocked, and blood can’t go through them as easily. Any slowdown in blood flow keeps your organs from getting the oxygen and nutrients they need to do their job. If blood moves too slowly through the vessels, it can pool and form clots.

You have this condition when sticky fat called plaque builds up in the walls of your coronary arteries — vessels that supply your heart with blood. Plaque narrows the arteries, slowing blood flow to the heart. When a piece of plaque breaks off and lodges in an artery, it can block blood flow completely and cause a heart attack.

Peripheral arteries send blood to your arms and legs. In PAD, plaque builds up in artery walls. Just like in coronary artery disease, plaque narrows the arteries and leaves less room for blood to flow through. If your legs don’t get enough oxygen and nutrients, they’ll feel sore or tired when you walk or climb stairs. Having PAD raises your chance of getting a heart attack or stroke.

The carotid arteries run along either side of your neck. They supply blood to your brain, face, and neck. If you have carotid artery disease, plaque builds up and narrows these arteries, so less blood gets through. A piece of plaque can break off and form a clot. If it gets stuck in a blood vessel to your brain and blocks blood flow, it can cause a stroke.

Your brain needs a constant supply of oxygen-rich blood to work. Without it, brain cells die. Cerebrovascular diseases limit your brain’s blood supply. They include stroke, narrowed blood vessels, aneurysms (weakened arteries), and abnormal clusters of blood vessels called vascular malformations.

If you see thick, twisted, blue or flesh-colored veins in your legs, you may have varicose veins. Valves inside veins keep blood flowing toward your heart and prevent it from going backward. When your veins are weak, the valves can get damaged and allow blood to back up. As it collects, your vein swells up and twists to squeeze itself into the same small space. See your doctor if it hurts or you’re unhappy about the way you look.

They’re like varicose veins, but thinner. They get their name from their spider web-like pattern. You get them when blood backs up in a damaged vein. They can form on your legs or face, and are usually red or blue. You’re more likely to get spider veins after an injury or a lot of time in the sun. Hormone changes during menopause or pregnancy can also cause them to form.

When you get a cut, blood cells called platelets plug the hole in the damaged blood vessel with a clot that stops the bleeding. But sometimes, plaque can damage the inside of your blood vessels and cause a clot to form. This kind can be harmful. It can slow blood flow through your arteries and veins. And if one forms in your heart or brain, you might get a heart attack or stroke.

This condition happens when swelling and irritation cause a clot to form in one of your veins. You can get a clot after an injury, surgery, or if you’ve been on bed rest for a long time. It can form in veins close to the surface of your skin or deeper underneath it. Medicine called blood thinners can stop the clot from getting bigger and blocking your blood flow.

It’s a blood clot that forms in a deep vein, usually in your leg. You can get a DVT if you’ve been on bedrest after illness or surgery, or you sit for a long time in a plane or car. Lying or sitting for many hours slows your blood flow. Pooled blood can clump together and form clots. The risk with DVT is that a clot could break free and travel to your lungs.

A blood clot in your legs can break off and travel all the way up to your lungs. When that happens, it’s called a pulmonary embolism. The clot can block the flow of blood in your lungs. Without blood, they can’t work as well as they should. They won’t be able to release enough oxygen to supply the rest of your body. PE can cause chest pain and shortness of breath. It could be life-threatening if you don’t get treated right away.

Leg veins carry blood up to your heart. Valves in these veins shut to keep the blood flowing upward. When you have CVI, the valves don’t close all the way. Blood stops flowing up and instead pools in your veins. You can get CVI if a blood clot damages valves in your legs. Getting older or sitting for long periods of time can also weaken your leg veins and valves.

It happens when an artery wall weakens and bulges out like a balloon. Aneurysms can form in many different blood vessels, including ones in your brain, chest, and belly. If the artery stretches too much, it can burst. That can lead to dangerous bleeding inside your body. An injury or artery disease can cause an aneurysm.

Get medical help right away if you notice any of these things:

• Sudden shortness of breath
• Chest pain
• Dizziness, fainting
• Fast heartbeat
• Sudden, severe headache
• Nausea, vomiting
• Sudden blurred or double vision
• Sudden pain above or behind your eye
• Trouble seeing in one or both eyes
• Sudden weakness or numbness in your face or body
• Trouble talking or understanding others
• Seizure
• Confusion

Blood is the fluid that supplies oxygen and nutrients to your heart, lungs, organs, muscles, and other systems. Good circulation optimizes the delivery of oxygen and nutrients throughout your body.

The food you eat impacts circulation. You can eat to boost blood flow. Healthy habits including regular exercise, staying well hydrated, maintaining a healthy weight, and avoiding smoking can all improve circulation. A healthy diet and good habits also decrease the risk of deep vein thrombosis (DVT). When you go to the grocery store, choose foods that will make your heart and blood vessels “happy”.

Cayenne red pepper is an orange-red spice that can help boost blood flow. A compound called capsaicin in the red pepper helps relax muscles that line blood vessels. This, in turn, allows for blood to flow more easily and it decreases blood pressure.

Beets are root veggies that are rich in nitrate, a compound your body converts to nitric oxide. Nitric oxide helps widen blood vessels and increases blood flow. In one study, researchers found that beet juice decreases systolic blood pressure, which is the first number of a blood pressure reading.

If you’re wondering how to increase blood flow, look no further than berries. Berries are rich in a compound called anthocyanin, which is an antioxidant responsible for berries red and purple hues. Anthocyanin protects artery walls and keep blood vessels flexible. They also stimulate the release of nitric oxide to lower blood pressure.

Researchers say fish is a heart-healthy food, but why? Certain fish, including salmon, herring, mackerel, trout, and halibut are rich in omega-3 fatty acids. These healthy fats boost circulation and lower resting blood pressure. Fatty fish is among the foods that increase blood flow and keep arteries unclogged.

Tart pomegranate seeds are rich in nitrates and antioxidants that boost circulation. These compounds keep arteries wide open, or dilated, and they help lower blood pressure. This leads to better blood flow to the brain, heart, muscles, organs, and tissues. Athletes who eat pomegranate seeds may notice that increased blood flow boosts performance, too.

Garlic is rich in a compound called allicin, which helps blood vessels relax. People who eat ample amounts of garlic experience improved blood flow through the heart. When blood flows through the heart more easily, this reduces the workload on the heart. Blood pressure is decreased when your heart doesn’t have to work as hard to pump blood.

Eating nuts, especially walnuts, benefits your heart and blood vessels. Omega-3 fatty acids in walnuts called alpha-linolenic acid helps blood flow smoothly. In one study, people who ate walnuts regularly for 8 weeks experienced improvements in blood vessel health and reduced blood pressure. Their blood vessels were also more flexible, too.

Deep purple grapes are rich in antioxidants that boost blood flow by relaxing blood vessel walls and helping blood vessels work better. Compounds in grapes decrease inflammation and make blood less sticky, so you’re less likely to suffer from blood clots. Grapes are a sweet treat that may help curb circulation issues.

Turmeric is a yellow spice used commonly in Indian cuisine. The spice derives its golden yellow color from the compound curcumin. Curcumin may increase levels of nitric oxide, which in turn widens blood vessels. When blood vessels are wider, blood flows more easily and reaches your heart, brain, organs, muscles, and tissues.

If you suffer from high blood pressure, reach for spinach. This leafy green is rich in nitrates. Your body converts nitrates to nitric oxide, which makes blood vessels wider so blood can flow through more easily. Results of one study found that eating spinach makes arteries flexible and decreases blood pressure.

People reach for oranges and other citrus fruits because they are rich in vitamin C, but there are other reasons to make citrus a regular part of your diet. Antioxidants in citrus fruits decrease inflammation, boost circulation, and help prevent blood clots. Results of one study found that people who drank orange juice regularly experienced lower blood pressure.

Is chocolate your favorite sweet treat? If so, you’re in luck. Compounds in chocolate seem to improve blood vessel function and blood flow. And antioxidants in chocolate dilate blood vessels and lower blood pressure. Choose dark chocolate to reap the benefits, but be mindful of portion sizes. Chocolate is high in fat and calories.

Many people know ginger aids digestion and helps relieve nausea, but it benefits circulation, too. Ginger acts as a vasodilator, meaning it widens blood vessels and can reduce blood pressure. Ginger is an ingredient in Asian and Indian cuisine. You can also use ginger to make a tea.