One of my neighbors recently suffered a stroke. What exactly is a stroke? What are the symptoms? Can a stroke be prevented?

There are three types of strokes. A subarachnoid hemorrhage occurs when a blood vessel at the base of the brain ruptures. A cerebral hemorrhage results from the rupture of a damaged artery that creates a blood clot within the brain itself. The third and most common type of stoke, cerebral infarction, occurs when an artery becomes blocked and prevents the flow of blood to the brain. In all three types of strokes, brain cells deprived of oxygen and nourishment become damaged and may die.

A stroke is a serious emergency. Medical attention should be sought as soon as symptoms appear if vital brain cells are to be saved. Stroke onset may begin with sudden weakness, clumsiness, numbness or tingling in an arm, leg, or in the face. Vision in one or both eyes may become blurred or lost completely.

Speech may become garbled, slurred or difficult. He or she may become dizzy or fall. Sometimes, warning symptoms called transient ischemic attacks occur. They are painless and last only minutes, but they must not be ignored for they may lead to a major stroke. There are many therapies for strokes, but prevention is the best treatment. High blood pressure, the single most important risk factor for stroke, can be treated. Other treatable risk factors include a high red blood cell count, elevated blood cholesterol and lipids, cigarette smoking, excessive alcohol use, diabetes mellitus and obesity.
Stroke and Balance

Following a stroke two years ago, I lost my sense of balance. Will it ever come back?

Your sense of balance is very complex and depends on signals between the brain and parts of the body that are responsible for spatial orientation. For example, signals from the middle ear, where the body’s “gyroscope” is located, keep us from feeling dizzy when we turn our heads; receptors in the feet and legs signal contact with the ground; and the eyes provide additional spatial orientation. These signals are transmitted to the brain along nervous system pathways. An interruption at any point in any of these pathways can cause loss of balance. During a stroke, the blood supply is blocked to a portion of the brain, and the loss of blood damage that part of the brain. Since your sense of balance was affected, your stroke may have damaged the part of the brain that receives and processes information from the inner ear. Or, the stroke may have damaged the pathways between those “receiving areas” and other centers in the brain. Your body can compensate for some of this damage, but compensation may take up to 18 months. Unfortunately, brain tissue cannot be replaced once it has been damaged, so it is possible to have some degree of permanent impairment.

A careful assessment by your physician will ensure that other factors are not contributing to your loss of balance. Walking aids such as a cane will increase your stability and allow you to walk safely and with more confidence.
Stress and Stroke

My 58–year–old husband had a stroke, but he has never had hypertension, atherosclerosis, obesity, heart disease or any other problems we thought caused stroke. Could stress have caused this? How can we prevent a recurrence?

There are no clear answers about a relationship between stress and stroke. Some prominent researchers have found that stroke is more likely to occur during periods of stress, but other well–respected investigators have found no association.

At your husband’s age, atherosclerosis, or hardening of the arteries, might have developed recently; and arteriogram, which examines the interior of certain blood vessels, may show whether atherosclerosis is present. Tests that employ sound–wave analysis also may provide important information regarding the arteries between the heart and the brain. His heart also should be investigated. Your husband is relatively young to have had a stroke and in such patients, the heart is likely to be the source of trouble. Undiagnosed heart disease could cause a blood clot to travel to the brain, resulting in a stroke; an irregular heart beat, called an arrhythmia, also could cause a stroke. You are right to be concerned about recurrence and finding the cause of your husband’s stroke. I would recommend that you ask your doctor to arrange for a complete analysis of your husband’s blood vessels and heart.