62
Stroke
Michelle Bussard
http://evolve.elsevier.com/Lewis/medsurg/
CONCEPTUAL FOCUS
Family Dynamics Mobility
Functional Ability Safety
Intracranial Regulation Sensory Perception
LEARNING OUTCOMES
1. Describe the incidence of and risk factors for stroke. 7. Describe the acute nursing management of a patient with a
2. Explain mechanisms that affect cerebral blood flow. stroke.
3. Compare and contrast the etiology and pathophysiology of 8. Describe the rehabilitative nursing management of a patient
ischemic and hemorrhagic strokes. with a stroke.
4. Correlate the clinical manifestations of stroke with the 9. Explain the psychosocial impact of a stroke on the patient,
underlying pathophysiology. caregiver, and family.
5. Identify diagnostic studies done for patients with strokes.
6. Distinguish the interprofessional care for patients with
ischemic strokes and hemorrhagic strokes.
KEY TERMS
aneurysm intracerebral hemorrhage
aphasia ischemic stroke
cerebrovascular accident (CVA) stroke
dysarthria subarachnoid hemorrhage (SAH)
dysphasia thrombotic stroke
embolic stroke transient ischemic attack (TIA)
hemorrhagic strokes
Stroke occurs when there is (1) ischemia (inadequate blood in the United States have had a stroke.1 With an aging pop-
flow) to a part of the brain or (2) hemorrhage (bleeding) into the ulation, we can expect these numbers to increase. However,
brain that results in the death of brain cells. In a stroke, func- stroke can occur at any age. 34% of strokes occur in people
tions such as movement, sensation, thinking, talking, or emo- younger than 65 years old.2
tions that were controlled by the affected area of the brain are Stroke is currently the fifth most common cause of death in
lost or impaired. The severity of the loss of function varies based the United States.1 More than 150,000 deaths occur each year
on the location and extent of the brain damage. from stroke.3 While deaths due to stroke have declined, stroke
The terms brain attack and cerebrovascular accident (CVA) is the leading cause of serious long-term disability. 15% to 30%
are also used to describe stroke. The term brain attack com- have a permanent disability.4
municates the urgency of recognizing the warning signs of a Common long-term disabilities include hemiparesis (partial
stroke and treating it as a medical emergency, as we do with a paralysis on 1 side), inability to walk, complete or partial depen-
heart attack (Table 62.1). After the onset of a stroke, immediate dence for activities of daily living (ADLs), aphasia (dysfunction
medical attention is crucial to decrease disability and the risk in communication), and depression. In addition to the physical,
of death. cognitive, and emotional impact of the stroke on the survivor,
Stroke is a major public health concern. About 800,000 the stroke affects the lives of the stroke patient’s caregiver and
people have a stroke each year.1 An estimated 7 million adults family. A stroke is a lifelong change for both the stroke survivor
1515
,1516 SECTION 12 Problems Related to Movement and Coordination
Optic chiasm
TABLE 62.1 PATIENT & CAREGIVER Circle of Willis
TEACHING
Anterior
FAST Warning Signs of Stroke communicating artery
FAST is an easy way to remember the signs of stroke. Include the following Anterior cerebral artery
information in the teaching plan for a patient at risk for stroke and the
patient’s caregiver: Internal carotid artery
F Face drooping Does one side of the face droop, or is it numb?
Ask the person to smile. Is the smile uneven? Middle cerebral artery
A Arm weakness Is one arm weak or numb? Ask the person to raise Posterior
communicating artery
both arms. Does one arm drift downward?
S Speech difficulties Is speech slurred? Is the person unable to speak or Posterior cerebral artery
hard to understand? Ask the person to repeat
a simple sentence like “The sky is blue.” Is the Superior cerebellar artery
sentence repeated correctly?
Internal auditory artery
T Time Time is CRITICAL! If someone shows any of these
signs (even if they go away), call 911 and get Basilar artery
the person to the hospital. Note the time when Anterior inferior
the signs first appeared. cerebellar artery
In addition, report the sudden onset of the following: Posterior inferior
• Confusion cerebellar artery
• Numbness or weakness, especially in 1 side of the body Vertebral artery
• Severe headache with no known cause
Anterior spinal artery
• Trouble seeing in one or both eyes
Fig. 62.1 Cerebral arteries and the circle of Willis. The top of the tem-
• Trouble walking, dizziness, loss of balance or coordination
poral lobe has been removed to show the course of the middle cerebral
Source: ASA: FAST. Retrieved from www.strokeassociation.org/ artery.
STROKEORG/WarningSigns/Stroke-Warning-Signs-and-Symptoms_
UCM_308528_SubHomePage.jsp. 30 seconds, metabolism stops in 2 minutes, and cell death
occurs in 5 minutes.
and family. Be mindful of this impact when caring for patients
The brain is normally protected from changes in mean
who survive stroke.
systemic arterial BP over a range from 50 to 150 mm Hg by
PATHOPHYSIOLOGY OF STROKE a mechanism known as cerebral autoregulation. This involves
changes in the diameter of cerebral blood vessels in response
Anatomy of Cerebral Circulation to changes in pressure so that the blood flow to the brain stays
Blood is supplied to the brain by 2 major pairs of arteries: inter- constant. When cerebral ischemia occurs, autoregulation may
nal carotid arteries (anterior circulation) and vertebral arteries be impaired, making the brain dependent on systemic BP. CO2
(posterior circulation). The carotid arteries branch to supply is a potent cerebral vasodilator. Changes in arterial CO2 levels
most of the (1) frontal, parietal, and temporal lobes; (2) basal have a huge effect on cerebral blood flow (CBF). Increased CO2
ganglia; and (3) part of the diencephalon (thalamus and hypo- levels increase CBF. Decreased CO2 levels decrease CBF. Very
thalamus). The major branches of the carotid arteries are the low arterial oxygen (O2) levels (partial pressure of arterial O2
middle cerebral and anterior cerebral arteries. The vertebral less than 50 mm Hg) or increases in hydrogen ion concentration
arteries join to form the basilar artery, which branches to sup- also increase CBF.
ply the middle and lower parts of the temporal lobes, occipital Factors that affect blood flow to the brain include systemic
lobes, cerebellum, brainstem, and part of the diencephalon. The BP, cardiac output, and blood viscosity. During normal activity,
main branch of the basilar artery is the posterior cerebral artery. O2 requirements vary. Changes in cardiac output, vasomotor
The anterior and posterior communicating arteries connect the tone, and distribution of blood flow normally maintain ade-
anterior and posterior cerebral circulation at the circle of Willis quate blood flow to the brain. Cardiac output must be reduced
by (Fig. 62.1). Fig. 60.10 shows the arteries at the base of the by one-third before CBF is reduced. Changes in blood viscosity
brain. Genetic variations in this area are common. All connect- affect CBF, with decreased viscosity increasing blood flow.
ing vessels may not be present. Collateral circulation may develop over time to compen-
sate for a decrease in CBF. An area of the brain can potentially
Regulation of Cerebral Blood Flow receive blood supply from another blood vessel even if blood
The brain needs a continuous supply of blood to provide the supply from the original vessel has been cut off (e.g., because of
O2 and glucose that neurons need to function. Blood flow thrombosis). In other words, the vessels in the brain make an
must be maintained at 750 to 1000 mL/min (55 mL/100 g of “alternative route” for blood flow to reach damaged areas, thus
brain tissue), or 20% of the cardiac output, for optimal brain preventing a stroke.
function. If blood flow to the brain is totally interrupted Intracranial pressure (ICP) influences CBF. Increased ICP
(e.g., cardiac arrest), neurologic metabolism is altered in causes brain compression and reduced CBF. A major goal when
, CHAPTER 62 Stroke 1517
diabetes, smoking, obesity, sleep apnea, metabolic syndrome,
BOX 62.1 PROMOTING HEALTH
lack of physical exercise, poor diet, and drug and alcohol use.
EQUITY
We think modifiable risk factors cause 90% of strokes.6
Stroke Hypertension is the single most important modifiable risk
Blacks factor. It is often undetected and inadequately treated. Increases
• Have the highest incidence of strokes in systolic BP (SBP) and diastolic BP (DBP) independently
• Have a rate of first strokes that is twice that of any other ethnic group increase stroke risk. Treating hypertension reduces stroke risk
• Are 3 times more likely than Whites to have an ischemic stroke and 4 times up to 50%. New recommendations by the American Heart
more likely to have a hemorrhagic stroke Association (AHA) include home BP monitoring with a goal of
• Have increased rates of hypertension, diabetes, and sickle cell anemia, SBP less than 140 mm Hg.4
which may be related to the high incidence of strokes
Heart disease, including atrial fibrillation, myocardial infarc-
• Have high rates of smoking and obesity, 2 risk factors for stroke
• Are twice as likely to die from a stroke as Whites
tion (MI), cardiomyopathy, cardiac valve abnormalities, and
congenital heart defects, is a risk factor for stroke. Atrial fibrilla-
Other Ethnicities tion causes about 25% of strokes.6 People with atrial fibrillation
• Hispanics, Native Americans, and Asian Americans have a higher incidence are 5 times more likely to have a stroke than people with a reg-
of strokes than Whites ular heart rhythm. The incidence of atrial fibrillation increases
• Hispanics have a high incidence of diabetes, an important risk factor with age. Oral anticoagulants (e.g., warfarin, dabigatran) and
• Native Americans are more likely than Whites to have at least 2 risk factors adherence to their therapy play a key role in stroke prevention.
for stroke Diabetes is a significant risk factor for stroke. Stroke risk in peo-
ple with diabetes is 5 times higher than in those without diabetes.6
caring for a patient after a stroke is to reduce secondary injury Smoking nearly doubles the risk for ischemic stroke. Smokers
from increased ICP (see Chapter 61). are 4 times as likely to have a hemorrhagic stroke than non-
smokers.5 The risk from smoking decreases substantially over
time after the smoker quits. After 5 to 10 years of no tobacco use,
RISK FACTORS FOR STROKE former smokers have the same risk for stroke as nonsmokers.
The most effective way to decrease the burden of stroke is pre- The effect of alcohol on stroke risk depends on the amount
vention and teaching, especially about risk factors. We divide consumed. Women who drink more than 1 alcoholic drink per
risk factors into nonmodifiable and modifiable. Stroke risk day and men who drink more than 2 alcoholic drinks per day are
increases with multiple risk factors. Thus, primary prevention at higher risk for hypertension, which increases their chance of
focuses on reducing modifiable risk factors. This can dramati- stroke. Illicit drug use, especially cocaine use, increases stroke risk.6
cally reduce the chance of stroke.5 A waist circumference to hip circumference ratio equal to
or above the mid-value for the population increases the risk
Nonmodifiable Risk Factors for ischemic stroke 3-fold. Obesity is associated with hyperten-
Nonmodifiable risk factors include age, gender, ethnicity or race, sion, high blood glucose, and increased blood lipid levels, all of
and family history or heredity. Stroke risk increases with age, which increase stroke risk.6 Physical inactivity increases stroke
doubling each decade after 55 years of age. Two-thirds of all risk. Benefits of physical activity can occur with even light to
strokes occur in persons older than 65 years. Strokes are more moderate regular activity. The AHA recommends 150 minutes
common in men, but more women die from stroke than men. of moderate-intensity exercise or 75 minutes of vigorous-inten-
Because women tend to live longer than men, they have more sity exercise per week to reduce stroke risk.4 Nutrition teaching
opportunity to have a stroke.2 is important. A diet high in fat and low in fruits and vegetables
Blacks have twice the incidence of stroke and a higher death may increase stroke risk.
rate from stroke compared to any other ethnic group (Box 62.1). The early forms of birth control pills that had high levels of
This may be related in part to higher rates of hypertension, obe- progestin and estrogen increased a woman’s chance of having a
sity, and diabetes.2 stroke, especially if the woman smoked. Newer, low-dose oral
Genetic risk factors are important in the development of vas- contraceptives have lower risks for stroke except in those who
cular disease, including stroke. A person with a family history have hypertension and smoke. The AHA recommends smok-
of stroke has an increased risk of having a stroke. We think that ing cessation and alternatives to estrogen oral contraceptives for
genes encoding products involved in lipid metabolism, throm- those women to reduce their risk of stroke.4
bosis, and inflammation are genetic factors for stroke. People Women who have migraines with aura have an increased
who have at least 2 first-degree relatives with a history of sub- risk for stroke. Other conditions that may increase stroke risk
arachnoid hemorrhage (SAH) or aneurysm should be screened include inflammatory conditions (e.g., rheumatoid arthritis),
to rule out anomalies in their cerebral vasculature.5 sickle cell disease, and blood clotting disorders, such as factor
V Leiden mutation.5
Modifiable Risk Factors
Modifiable risk factors are those that can potentially be altered Transient Ischemic Attack
through lifestyle changes and medical treatment, thus reducing Another risk factor associated with stroke is a history of a
the risk for stroke. They include hypertension, heart disease, transient ischemic attack (TIA). A TIA is a transient episode
Stroke
Michelle Bussard
http://evolve.elsevier.com/Lewis/medsurg/
CONCEPTUAL FOCUS
Family Dynamics Mobility
Functional Ability Safety
Intracranial Regulation Sensory Perception
LEARNING OUTCOMES
1. Describe the incidence of and risk factors for stroke. 7. Describe the acute nursing management of a patient with a
2. Explain mechanisms that affect cerebral blood flow. stroke.
3. Compare and contrast the etiology and pathophysiology of 8. Describe the rehabilitative nursing management of a patient
ischemic and hemorrhagic strokes. with a stroke.
4. Correlate the clinical manifestations of stroke with the 9. Explain the psychosocial impact of a stroke on the patient,
underlying pathophysiology. caregiver, and family.
5. Identify diagnostic studies done for patients with strokes.
6. Distinguish the interprofessional care for patients with
ischemic strokes and hemorrhagic strokes.
KEY TERMS
aneurysm intracerebral hemorrhage
aphasia ischemic stroke
cerebrovascular accident (CVA) stroke
dysarthria subarachnoid hemorrhage (SAH)
dysphasia thrombotic stroke
embolic stroke transient ischemic attack (TIA)
hemorrhagic strokes
Stroke occurs when there is (1) ischemia (inadequate blood in the United States have had a stroke.1 With an aging pop-
flow) to a part of the brain or (2) hemorrhage (bleeding) into the ulation, we can expect these numbers to increase. However,
brain that results in the death of brain cells. In a stroke, func- stroke can occur at any age. 34% of strokes occur in people
tions such as movement, sensation, thinking, talking, or emo- younger than 65 years old.2
tions that were controlled by the affected area of the brain are Stroke is currently the fifth most common cause of death in
lost or impaired. The severity of the loss of function varies based the United States.1 More than 150,000 deaths occur each year
on the location and extent of the brain damage. from stroke.3 While deaths due to stroke have declined, stroke
The terms brain attack and cerebrovascular accident (CVA) is the leading cause of serious long-term disability. 15% to 30%
are also used to describe stroke. The term brain attack com- have a permanent disability.4
municates the urgency of recognizing the warning signs of a Common long-term disabilities include hemiparesis (partial
stroke and treating it as a medical emergency, as we do with a paralysis on 1 side), inability to walk, complete or partial depen-
heart attack (Table 62.1). After the onset of a stroke, immediate dence for activities of daily living (ADLs), aphasia (dysfunction
medical attention is crucial to decrease disability and the risk in communication), and depression. In addition to the physical,
of death. cognitive, and emotional impact of the stroke on the survivor,
Stroke is a major public health concern. About 800,000 the stroke affects the lives of the stroke patient’s caregiver and
people have a stroke each year.1 An estimated 7 million adults family. A stroke is a lifelong change for both the stroke survivor
1515
,1516 SECTION 12 Problems Related to Movement and Coordination
Optic chiasm
TABLE 62.1 PATIENT & CAREGIVER Circle of Willis
TEACHING
Anterior
FAST Warning Signs of Stroke communicating artery
FAST is an easy way to remember the signs of stroke. Include the following Anterior cerebral artery
information in the teaching plan for a patient at risk for stroke and the
patient’s caregiver: Internal carotid artery
F Face drooping Does one side of the face droop, or is it numb?
Ask the person to smile. Is the smile uneven? Middle cerebral artery
A Arm weakness Is one arm weak or numb? Ask the person to raise Posterior
communicating artery
both arms. Does one arm drift downward?
S Speech difficulties Is speech slurred? Is the person unable to speak or Posterior cerebral artery
hard to understand? Ask the person to repeat
a simple sentence like “The sky is blue.” Is the Superior cerebellar artery
sentence repeated correctly?
Internal auditory artery
T Time Time is CRITICAL! If someone shows any of these
signs (even if they go away), call 911 and get Basilar artery
the person to the hospital. Note the time when Anterior inferior
the signs first appeared. cerebellar artery
In addition, report the sudden onset of the following: Posterior inferior
• Confusion cerebellar artery
• Numbness or weakness, especially in 1 side of the body Vertebral artery
• Severe headache with no known cause
Anterior spinal artery
• Trouble seeing in one or both eyes
Fig. 62.1 Cerebral arteries and the circle of Willis. The top of the tem-
• Trouble walking, dizziness, loss of balance or coordination
poral lobe has been removed to show the course of the middle cerebral
Source: ASA: FAST. Retrieved from www.strokeassociation.org/ artery.
STROKEORG/WarningSigns/Stroke-Warning-Signs-and-Symptoms_
UCM_308528_SubHomePage.jsp. 30 seconds, metabolism stops in 2 minutes, and cell death
occurs in 5 minutes.
and family. Be mindful of this impact when caring for patients
The brain is normally protected from changes in mean
who survive stroke.
systemic arterial BP over a range from 50 to 150 mm Hg by
PATHOPHYSIOLOGY OF STROKE a mechanism known as cerebral autoregulation. This involves
changes in the diameter of cerebral blood vessels in response
Anatomy of Cerebral Circulation to changes in pressure so that the blood flow to the brain stays
Blood is supplied to the brain by 2 major pairs of arteries: inter- constant. When cerebral ischemia occurs, autoregulation may
nal carotid arteries (anterior circulation) and vertebral arteries be impaired, making the brain dependent on systemic BP. CO2
(posterior circulation). The carotid arteries branch to supply is a potent cerebral vasodilator. Changes in arterial CO2 levels
most of the (1) frontal, parietal, and temporal lobes; (2) basal have a huge effect on cerebral blood flow (CBF). Increased CO2
ganglia; and (3) part of the diencephalon (thalamus and hypo- levels increase CBF. Decreased CO2 levels decrease CBF. Very
thalamus). The major branches of the carotid arteries are the low arterial oxygen (O2) levels (partial pressure of arterial O2
middle cerebral and anterior cerebral arteries. The vertebral less than 50 mm Hg) or increases in hydrogen ion concentration
arteries join to form the basilar artery, which branches to sup- also increase CBF.
ply the middle and lower parts of the temporal lobes, occipital Factors that affect blood flow to the brain include systemic
lobes, cerebellum, brainstem, and part of the diencephalon. The BP, cardiac output, and blood viscosity. During normal activity,
main branch of the basilar artery is the posterior cerebral artery. O2 requirements vary. Changes in cardiac output, vasomotor
The anterior and posterior communicating arteries connect the tone, and distribution of blood flow normally maintain ade-
anterior and posterior cerebral circulation at the circle of Willis quate blood flow to the brain. Cardiac output must be reduced
by (Fig. 62.1). Fig. 60.10 shows the arteries at the base of the by one-third before CBF is reduced. Changes in blood viscosity
brain. Genetic variations in this area are common. All connect- affect CBF, with decreased viscosity increasing blood flow.
ing vessels may not be present. Collateral circulation may develop over time to compen-
sate for a decrease in CBF. An area of the brain can potentially
Regulation of Cerebral Blood Flow receive blood supply from another blood vessel even if blood
The brain needs a continuous supply of blood to provide the supply from the original vessel has been cut off (e.g., because of
O2 and glucose that neurons need to function. Blood flow thrombosis). In other words, the vessels in the brain make an
must be maintained at 750 to 1000 mL/min (55 mL/100 g of “alternative route” for blood flow to reach damaged areas, thus
brain tissue), or 20% of the cardiac output, for optimal brain preventing a stroke.
function. If blood flow to the brain is totally interrupted Intracranial pressure (ICP) influences CBF. Increased ICP
(e.g., cardiac arrest), neurologic metabolism is altered in causes brain compression and reduced CBF. A major goal when
, CHAPTER 62 Stroke 1517
diabetes, smoking, obesity, sleep apnea, metabolic syndrome,
BOX 62.1 PROMOTING HEALTH
lack of physical exercise, poor diet, and drug and alcohol use.
EQUITY
We think modifiable risk factors cause 90% of strokes.6
Stroke Hypertension is the single most important modifiable risk
Blacks factor. It is often undetected and inadequately treated. Increases
• Have the highest incidence of strokes in systolic BP (SBP) and diastolic BP (DBP) independently
• Have a rate of first strokes that is twice that of any other ethnic group increase stroke risk. Treating hypertension reduces stroke risk
• Are 3 times more likely than Whites to have an ischemic stroke and 4 times up to 50%. New recommendations by the American Heart
more likely to have a hemorrhagic stroke Association (AHA) include home BP monitoring with a goal of
• Have increased rates of hypertension, diabetes, and sickle cell anemia, SBP less than 140 mm Hg.4
which may be related to the high incidence of strokes
Heart disease, including atrial fibrillation, myocardial infarc-
• Have high rates of smoking and obesity, 2 risk factors for stroke
• Are twice as likely to die from a stroke as Whites
tion (MI), cardiomyopathy, cardiac valve abnormalities, and
congenital heart defects, is a risk factor for stroke. Atrial fibrilla-
Other Ethnicities tion causes about 25% of strokes.6 People with atrial fibrillation
• Hispanics, Native Americans, and Asian Americans have a higher incidence are 5 times more likely to have a stroke than people with a reg-
of strokes than Whites ular heart rhythm. The incidence of atrial fibrillation increases
• Hispanics have a high incidence of diabetes, an important risk factor with age. Oral anticoagulants (e.g., warfarin, dabigatran) and
• Native Americans are more likely than Whites to have at least 2 risk factors adherence to their therapy play a key role in stroke prevention.
for stroke Diabetes is a significant risk factor for stroke. Stroke risk in peo-
ple with diabetes is 5 times higher than in those without diabetes.6
caring for a patient after a stroke is to reduce secondary injury Smoking nearly doubles the risk for ischemic stroke. Smokers
from increased ICP (see Chapter 61). are 4 times as likely to have a hemorrhagic stroke than non-
smokers.5 The risk from smoking decreases substantially over
time after the smoker quits. After 5 to 10 years of no tobacco use,
RISK FACTORS FOR STROKE former smokers have the same risk for stroke as nonsmokers.
The most effective way to decrease the burden of stroke is pre- The effect of alcohol on stroke risk depends on the amount
vention and teaching, especially about risk factors. We divide consumed. Women who drink more than 1 alcoholic drink per
risk factors into nonmodifiable and modifiable. Stroke risk day and men who drink more than 2 alcoholic drinks per day are
increases with multiple risk factors. Thus, primary prevention at higher risk for hypertension, which increases their chance of
focuses on reducing modifiable risk factors. This can dramati- stroke. Illicit drug use, especially cocaine use, increases stroke risk.6
cally reduce the chance of stroke.5 A waist circumference to hip circumference ratio equal to
or above the mid-value for the population increases the risk
Nonmodifiable Risk Factors for ischemic stroke 3-fold. Obesity is associated with hyperten-
Nonmodifiable risk factors include age, gender, ethnicity or race, sion, high blood glucose, and increased blood lipid levels, all of
and family history or heredity. Stroke risk increases with age, which increase stroke risk.6 Physical inactivity increases stroke
doubling each decade after 55 years of age. Two-thirds of all risk. Benefits of physical activity can occur with even light to
strokes occur in persons older than 65 years. Strokes are more moderate regular activity. The AHA recommends 150 minutes
common in men, but more women die from stroke than men. of moderate-intensity exercise or 75 minutes of vigorous-inten-
Because women tend to live longer than men, they have more sity exercise per week to reduce stroke risk.4 Nutrition teaching
opportunity to have a stroke.2 is important. A diet high in fat and low in fruits and vegetables
Blacks have twice the incidence of stroke and a higher death may increase stroke risk.
rate from stroke compared to any other ethnic group (Box 62.1). The early forms of birth control pills that had high levels of
This may be related in part to higher rates of hypertension, obe- progestin and estrogen increased a woman’s chance of having a
sity, and diabetes.2 stroke, especially if the woman smoked. Newer, low-dose oral
Genetic risk factors are important in the development of vas- contraceptives have lower risks for stroke except in those who
cular disease, including stroke. A person with a family history have hypertension and smoke. The AHA recommends smok-
of stroke has an increased risk of having a stroke. We think that ing cessation and alternatives to estrogen oral contraceptives for
genes encoding products involved in lipid metabolism, throm- those women to reduce their risk of stroke.4
bosis, and inflammation are genetic factors for stroke. People Women who have migraines with aura have an increased
who have at least 2 first-degree relatives with a history of sub- risk for stroke. Other conditions that may increase stroke risk
arachnoid hemorrhage (SAH) or aneurysm should be screened include inflammatory conditions (e.g., rheumatoid arthritis),
to rule out anomalies in their cerebral vasculature.5 sickle cell disease, and blood clotting disorders, such as factor
V Leiden mutation.5
Modifiable Risk Factors
Modifiable risk factors are those that can potentially be altered Transient Ischemic Attack
through lifestyle changes and medical treatment, thus reducing Another risk factor associated with stroke is a history of a
the risk for stroke. They include hypertension, heart disease, transient ischemic attack (TIA). A TIA is a transient episode
