Stroke secondary to atherosclerosis

Definition

Stroke secondary to atherosclerosis refers to loss of neurologic functions (brain attack), which occurs because of atherosclerosis.

Causes, incidence, and risk factors

Stroke secondary to atherosclerosis affects about 2 out of 1,000 people, or approximately 50% of all those who have strokes.

Atherosclerosis (hardening of the arteries) occurs when sticky, fatty substances called plaque build up in the inner lining of the arteries. The plaque may slowly block or narrow an artery or trigger a clot (thrombus). Clots can lead to stroke.

Risks for stroke secondary to atherosclerosis include:

• History of high blood pressure (hypertension)
• Peripheral vascular disease
• Smoking
• Transient ischemic attacks or other cerebrovascular disease
• High cholesterol
• High levels of homocysteine
• Diabetes
• Obesity
• Sedentary lifestyle
• Kidney disease requiring dialysis

Symptoms

• Weakness or total inability to move a body part
• Numbness, loss of sensation
• Tingling or other abnormal sensations
• Decreased or loss of vision, which may be partial and/or temporary
• Language difficulties (aphasia)
• Inability to recognize or identify sensory stimuli (agnosia)
• Loss of memory
• Facial paralysis
• Eyelid drooping
• Vertigo (abnormal sensation of movement)
• Loss of coordination
• Swallowing difficulties
• Personality changes
• Mood and emotion changes
• Urinary incontinence (lack of control over bladder)
• Lack of control over the bowels
• Consciousness changes:
  • Sleepiness
  • Stupor 
  • Lethargy
  • Coma 
  • Unconsciousness

Signs and tests

Testing is the same as for stroke. Blood tests may show high cholesterol levels.

Other tests and procedures that may be performed include:

• Head CT scan
• Head MRI
• ECG (electrocardiogram)
• Echocardiogram (looks for a cardiac embolus)
• Carotid duplex (ultrasound)
• Transcranial Doppler (looks at blood vessels inside the brain)

Treatment

Go to the emergency room as quickly as possible if you believe you have had or may be having a stroke. Stroke is an acute, serious condition that should be treated immediately. The most important factor in effective treatment for stroke is arriving at the hospital as early as possible from the onset of symptoms.

The most effective treatment for stroke is intravenous rtPA. This medicine works to dissolve the clot causing the stroke. If received within 3 hours of the first stroke symptoms, the drug can help prevent permanent problems. There is risk of serious bleeding with this treatment so it cannot be used in all cases. 

Patients who can't be treated with clot-busting drugs will receive supportive treatments such as medicines to control blood pressure and high cholesterol, fluids, and medicines to prevent complications such as infections.

Patients may also need physical therapy following stroke. Diet changes may be recommended.

A carotid endarterectomy (removal of plaque from the carotid arteries) may be needed by some people to prevent new strokes.

Expectations (prognosis)

Twenty-five percent of people who have a stroke recover most or all of their function.

However, stroke and its complications can cause death.

Complications

• Pressure sores
• Permanent loss of movement or sensation of a part of the body
• Orthopedic complications, fractures, contractures, muscle spasticity
• Permanent loss of cognitive functions
• Disruption of communication, decreased social interaction
• Decreased ability to function or care for self
• Decreased life span
• Multi-infarct dementia
• Side effects of medications

Calling your health care provider

Go to the emergency room or call the local emergency number (such as 911) if symptoms occur indicating a stroke.

Prevention

The prevention of stroke secondary to atherosclerosis includes control of risk factors. Hypertension, diabetes, heart disease, and other risk factors should be treated as appropriate.

If you smoke, you should stop.

Treatment of TIA can prevent some strokes.

Aspirin therapy (81mg a day or 100mg every other day) is now recommended for stroke prevention in women under 65 as long as the benefits outweigh the risks. It should be considered for women over age 65 only if their blood pressure is controlled and the benefit is greater than the risk of gastrointestinal bleeding and brain hemorrhage.

References

Mosca L, Banka CL, Benjamin EJ, et al. Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update. Circulation. 2007; Published online before print February 19, 2007.