People hear the word “stroke” and it strikes fear in them. The term has been used for hundreds of years and now is considered to be synonymous with cerebrovascular accident (CVA). According to Dr. Eliasz Engelhardt of Brazil, the name stroke came from the previously used term, apoplexy, which originated 2,500 years ago or earlier. In Greek, apoplexy means to violently strike down, an apt description of the precipitous presentation of many strokes.
We now know that there are two main types of strokes. The most common type is thrombotic, also called ischemic, when brain tissue dies because not enough blood reaches it due to plugged arteries. Most thrombotic strokes occur when a blood clot (“thrombus”) forms in an area of atherosclerosis (hardening of the arteries). Sometimes, a blood clot can form in the heart or in the carotid artery, break loose and lodge downstream, leading to an embolic stroke. An embolus is any material carried by the blood that can lodge in another area.
The second main type of stroke is hemorrhagic. This occurs when an artery in the brain tears or ruptures, leading to bleeding in the brain. The bleeding causes increased pressure in the tissue and less blood flow downstream of the hole in the artery, both resulting in brain cell death.
Very small strokes deep in the brain are called lacunar infarcts. These small strokes are probably caused by clots but some may represent bleeding.
The Centers for Disease Control and Prevention (CDC) reports that 87% of all strokes are ischemic. About 13% are hemorrhagic. Every year about 800,000 people have strokes. About 600,000 of those are experiencing their first strokes.
With either type of stroke, brain cells die after several minutes of decreased oxygen supply. Unlike some other tissues, like the skin, brain tissue does not regenerate after the cells have died.
During and after a stroke, the resulting symptoms depend on the location of the damage. The spectrum includes no symptoms (“silent strokes”), mild symptoms, severe symptoms and immediate death.
Those with mild symptoms usually do very well with rehabilitation by physical, occupational and speech therapists. Those with severe symptoms can achieve some improvement with therapy.
The limitations that people who have had strokes experience can include swallowing problems, partial loss of vision, speech difficulties and weakness on one side of the body. If the thinking and memory areas of the brain are affected, they might develop vascular dementia. Generally, vascular dementia occurs in steps, with the cognition worsening after each successive stroke. About 20% of all dementias are due to vascular disease.
Dementia robs patients and families of precious time both in terms of quantity and quality. Although it can be heartbreaking to see a loved one regress mentally, knowing what to expect and how to react can bring comfort to all those involved.
Aside from rehabilitative therapy, there is no treatment for stroke. The early focus is on prevention of future strokes. Since hypertension is the biggest stroke risk factor, controlling blood pressure is critically important. Additionally, high cholesterol levels and diabetes need to be aggressively treated.
Many patients with physical disabilities from stroke or vascular dementia can benefit from the Elizabeth Palliative Care program. Our team can add an extra layer of care to help with difficult symptoms and discussions of how much aggressive care a patient may or may not want.
Hospice care from The Elizabeth Hospice is an option to be considered for those who have six months or less to live. As the largest nonprofit hospice provider in San Diego County and Southwest Riverside County, we offer a comprehensive program that goes beyond managing symptoms and relieving pain. We become our patients’ trusted companion and customize the comfort care experience to meet their unique needs and wants. Our focus is not on the illness but on embracing experiences that bring meaning and joy to a person’s life.
The Elizabeth Hospice provides all the necessary durable medical equipment, like walkers, hospital beds and bedside commodes, as well as the hospice-related medicines. Each patient is placed under the care of an interdisciplinary team comprised of a hospice doctor or nurse practitioner, registered nurse case manager, social work, home health aide and spiritual counselor.
Family caregivers appreciate the support they receive from The Elizabeth Hospice. They are given the freedom to be loving family members since the hospice team takes care of their loved one’s medical and nursing details of care. Hospice even has respite care, a three-to-five-day stay in a nursing home, supervised by the hospice team, that allows family caregivers the opportunity to take a vacation or other needed breaks.
The important thing is that you and your loved one will receive the attention and treatment you need and deserve. We call this individualized, compassionate care, The E Way. To find out how your loved one who has been diagnosed with a stroke can benefit from palliative or hospice care, contact The Elizabeth Hospice at 800.797.2050.
By George Delgado, MD, Chief Medical Officer, The Elizabeth Hospice