CD-ROM Today 1996 January/CD-ROM Today 1996 January.iso/dp/0424/04240.txt

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$Unique_ID{BRK04240}
$Pretitle{}
$Title{Stroke}
$Subject{Stroke Apoplexy Cerebrovascular Accident Cerebrovascular Disease
Infarct stroke thrombotic stroke embolic stroke Hemorrhagic stroke Transient
Ischemic Attack TIA Vascular Malformations Bell's Palsy }
$Volume{}
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Copyright (C) 1990 National Organization for Rare Disorders, Inc.

809:
Stroke

** IMPORTANT **
It is possible that the main title of the article (Stroke) is not the
name you expected.  Please check the SYNONYM listing to find the alternate
names and disorder subdivisions covered by this article.

Synonyms

     Apoplexy
     Cerebrovascular Accident
     Cerebrovascular Disease

Disorder Subdivisions:

     1) Infarct stroke
        a. thrombotic stroke
        b. embolic stroke

     2) Hemorrhagic stroke

Information on the following disorders can be found in the Related
Disorders section of this report:

     Transient Ischemic Attack (TIA)
     Vascular Malformations
     Bell's Palsy

General Discussion

** REMINDER **
The information contained in the Rare Disease Database is provided for
educational purposes only.  It should not be used for diagnostic or treatment
purposes.  If you wish to obtain more information about this disorder, please
contact your personal physician and/or the agencies listed in the "Resources"
section of this report.

Stroke is one of the most common neurological conditions affecting the
central nervous system.  Stroke is caused by a blockage of blood flow to part
of the brain.  This may happen because of a blood clot (embolus, cerebral
thrombosis), or because of the bursting of an aneurysm (a ballooned area of a
blood vessel) in the brain.

Temporary strokes may occur due to constriction of arteries from
atherosclerosis (also known as "arteriosclerosis" or "hardening of the
arteries"), heart irregularities, blood disorders or massive loss of blood.

Symptoms

Each type of stroke has its own symptoms, progression, and prognosis
depending upon the area of brain affected.

Clumsiness, headaches, speech difficulties, weakness or paralysis usually
of one side of the body may occur in infarct strokes.  In thrombotic strokes,
the symptoms may progress in stages starting with a feeling of clumsiness and
leading eventually to paralysis.  In embolic strokes, all the symptoms occur
within seconds or minutes, striking without warning or pain.

A sudden severe headache progressing to a stiff neck, nausea, vomiting,
and unconsciousness are symptoms of a hemorrhagic stroke.

Other symptoms of stroke may include difficulty in breathing, clammy
skin, and/or confusion.

Causes

A stroke occurs because the blood supply to the brain has been cut off or
decreased.  Thrombotic strokes occur when a blood clot has narrowed or
completely closed an artery in the neck or head.  This may be due to
atherosclerosis or "hardening of the arteries" which is the buildup of fat-
containing materials and calcium (plaque) on the inner linings of blood
vessels.  Embolic strokes occur when a blood clot breaks away from a diseased
artery in another part of the body and clogs a smaller artery in the brain.
Hemorrhagic strokes occur when a blood vessel ruptures in or around the
brain, depriving that area of its blood supply.

Temporary strokes may occur due to constriction of arteries due to
atherosclerosis, heart irregularities, anemia, massive blood loss, or
sometimes in patients with subacute endocarditis who have damaged heart
valves.

Diabetes may increase the risk of stroke.  In the person with diabetes,
there is a malfunction in the production of insulin.  Heart and blood vessel
diseases such as heart attack, hardening of the arteries (arteriosclerosis),
and stroke, are the leading causes of illness, disability and death among
diabetics.  Persons with diabetes are twice as likely to suffer from coronary
heart disease and stroke, and five times as likely to suffer from arterial
disease of the limbs than the non-diabetic population.  Exactly how diabetes
damages the cardiovascular system is not yet clear.  (For more information on
this disorder, choose "Diabetes" as your search term in the Rare Disease
Database).

Other risk factors for stroke are hypertension (high blood pressure),
atherosclerosis (arteriosclerosis or "hardening of the arteries"), heart
disease, obesity (especially when combined with high blood pressure or
diabetes), lack of exercise, emotional stress, hereditary disorders that
cause high levels of fat or cholesterol, and certain blood disorders such as
sickle cell anemia and polycythemia.  (For more information on these
disorders choose "hypertension," "hypercholesterol," "hyperlipoproteinemia,"
"sickle cell" or "polycythemia" as your search terms in the Rare Disease
Database).

When birth control pills are used for a long time, especially by women
who smoke, there is an increased possibility of forming blood clots that may
lead to stroke.  Moreover, people who form blood clots due to accident,
injury or illness must be vigorously treated with medications that dissolve
blood clots in order to assure that the clot will not travel to the brain
where it can cause a stroke.

The role of hereditary factors in stroke has not yet been established.

Affected Population

Stroke tends to affect the elderly, males, and black people more than the
general population.  80%  of stroke patients are over the age of 65.
Alcoholics, drug abusers, patients with atherosclerosis, diabetes or high
blood pressure, and people who smoke also have a greater risk of stroke.
People who have had a stroke are at a greater risk of having another one.

In 1986, 400,000 Americans had a stroke.  However, stroke is occurring
less often now, possibly because there is improved treatment for
hypertension, diabetes and other disorders, and because Americans have a
greater interest in preventative health measures such as cholesterol
screening and low-fat diets.

Related Disorders

Symptoms of drug abuse or drug reactions, some types of brain tumors,
patients who are emerging from an epileptic seizure, or symptoms of head
injury can be similar to those of stroke.

Bell's Palsy is characterized by sudden onset of facial paralysis
resulting from ischemia (decreased blood supply) to part of the head and
compression of the facial nerve (cranial nerve VII).  It is not progressive.
Part or all of the face may be affected.  The affected muscles usually regain
their function after one to two months, although in cases of extensive nerve
damage, all or part of the paralysis may be permanent.  (For more information
of this disorder, choose "Bell's Palsy" as your search term in the Rare
Disease Database).

The following disorders may precede or increase the risk of developing
stroke:

A transient ischemic attack (TIA) often indicates an impending stroke,
which may occur shortly after the TIA or as much as five years later.
Symptoms include passing numbness; tingling or weakness in an arm, leg, or on
one side of the face; temporary blindness in either one or both eyes; or
difficulty with speech for a short period of time.  Other possible symptoms
are headache, nausea, dizziness, vomiting, or drowsiness which occur for no
apparent reason or appear to be unusual.  Poor judgement or forgetfulness,
and unusual personality changes may be other indications of TIA.  If these
types of symptoms occur, it is important to seek medical care at once.

Vascular Malformations are abnormal blood vessels.  When they occur in
the brain, they are classified into arteriovenous malformations (abnormal
arteries and veins), cavernous malformations (enlarged channels of blood
vessels), venous malformations (abnormal veins), and the telangiectasias
(enlarged capillary-sized vessels).  These types of malformations in the
brain may cause recurrent headaches, seizures and hemorrhaging.  Hemorrhaging
in the brain can cause strokes.  (For more information on these disorders,
choose "Vascular malformation" and "AVM" as your search terms in the Rare
Disease Database).

Therapies:  Standard

CT scans and angiograms (arteriograms) are diagnostic tests that show the
brain's tissues and blood vessels to determine whether a person has had a
stroke.  Other diagnostic tests include computer-coded X-ray images of the
brain's arteries (digitized intravenous ateriography, or DIVA), and a
technique that uses soundwaves to find defects in the arteries of the neck
that supply blood to the brain (ultrasonography).

Right after an infarct stroke, anticoagulant drugs such as heparin and
warfarin may be used to stop blood clots.  In some cases aspirin may be
prescribed.  Aspirin taken in small amounts can prevent blood clots from
forming, but it should be taken under supervision of a physician because it
can cause stomach ulcers as well as retard the ability of blood to clot
normally.

Right after a hemorrhagic stroke, drugs to help clotting at the site of
the rupture may be prescribed.  Drugs to reduce brain swelling or relieve
high blood pressure may also be used.

Occasionally, surgery may be necessary in hemorrhagic stroke patients to
remove aneurysms (part of a blood vessel wall that has abnormally widened or
stretched), or to remove large clots.  Patients who have had a stroke because
of atherosclerosis occasionally require surgery to remove the plaque that has
narrowed the interior of the arteries.

Treatment may also include exercise, speech therapy and physical therapy
depending upon the symptoms remaining after the stroke has occurred.

With proper medical care, most strokes can be prevented with medications
and/or diet in people with atherosclerosis, high blood pressure and diabetes.

Therapies:  Investigational

Research on improved treatments and prevention of stroke is being conducted
at cerebrovascular clinical research centers.

This disease entry is based upon medical information available through
August 1990.  Since NORD's resources are limited, it is not possible to keep
every entry in the Rare Disease Database completely current and accurate.
Please check with the agencies listed in the Resources section for the most
current information about this disorder.

Resources

For more information on Stroke, please contact:

     National Organization for Rare Disorders
     P.O. Box 8923
     New Fairfield, CT 06812-1783
     [phone]

     National Stroke Association
     8480 E. Orchard Rd., Suite 1000
     Englewood, CO  80111-5015
     [phone]

     The Stroke Foundation, Inc.
     898 Park Avenue
     New York, NY 10021
     [phone]

     NIH/National Institute of Neurological Disorders & Stroke (NINDS)
     9000 Rockville Pike
     Bethesda, MD  20892
     [phone]
     [phone]

To locate centers that specialize in rehabilitation of stroke patients,
contact:

     National Easter Seal Society
     70 East Lake Street
     Chicago, IL 60601
     [phone]
     [phone] (TDD)

References

INTERNAL MEDICINE, 2nd Ed.:  Jay H. Stein, ed.-in-chief; Little, Brown and
Co., 1987.  Pp. 2159.

THE MERCK MANUAL, Volume 1, 15th Ed.:  Robert Berkow, M.D., ed.-in-chief;
Merck, Sharp, and Dohme Laboratories, 1982.  Pp. 1381-1389.

WORLD BOOK MEDICAL ENCYCLOPEDIA:  Erich E. Brueschke, M.D., et al, eds;
World Book, Inc., 1988.  Pp. 834-836.