AHA News: The Brain Isn't the Only Place a Stroke Can Occur

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American Heart Association News

The sudden, painless loss in vision. Back pain that is burning. Aching legs Incontinence.

Some of these symptoms may not be recognized as stroke signs, since they are not common in the brain where the majority of strokes occur. Strokes can occur in other parts as well, according to Dr. Matthew Schrag. He is an assistant professor of Neurology and Vascular Neurologist at Vanderbilt University Medical Center, Nashville, Tennessee.

A stroke in the retina can cause sudden, total loss of vision in one eye. A stroke in the spinal cord can cause back pain, aching limbs, incontinence and paralysis. It may also lead to weakness, loss of pain and the inability to feel temperature. Schrag says that these strokes are just as serious as those in the brain and need immediate medical attention.

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He said that although they can be difficult to diagnose, the condition is theoretically treatable.

The American Heart Association defines stroke as a blockage of blood supply that results in cell death. Strokes in the brain can cause numbness, weakness, or difficulty speaking, particularly on one side, as well as vision problems, speech difficulties, and a sudden severe headache.

Blood supply can be blocked almost anywhere on the body, according to Dr. Lucia Sobrin of Harvard Medical School, Boston.

Central retinal artery obstruction (CRAO) is a stroke that occurs in the eye. It happens when plaque, which has built up on the carotid artery (the main artery that runs from each side of the neck to the brain and the eyes), breaks free and travels to retina. The same plaque could also travel to the brain, causing an ischemic attack. Sobrin stated that "it could go either direction."

She said that while it is common for a person to lose their vision in one eye, they may also only be losing partial vision in certain cases. They may still be able perceive light and motion.

If not treated in the first few days, vision loss may be permanent.

He said, "If you suddenly experience a loss of vision that is painless and sudden, go to an emergency room and think stroke." It's an urgent matter.

Sobrin, Schrag and other co-authors of the 2021 AHA Scientific Statement advocated for immediate screening and treatment with alteplase. This drug is used to dissolve blood clots that cause strokes in the head. People with CRAO treated with alteplase in the first 4 1/2 hours after vision loss have a 50% chance of recovering.

Schrag added that a CRAO can be a sign of a serious underlying condition. AHA urges screening for cardiovascular risk factors such as high blood cholesterol, high blood pressure and sleep apnea.

He said that CRAO was a good predictor of future strokes, heart attacks or deaths. "While this stroke may not be fatal, it is important to address the underlying issues.

Schrag noted that there is less knowledge about the treatment of strokes in the spine. This rare but dangerous condition is not well understood.

A blood clot can cause these symptoms. The treatment depends on the symptoms of each individual and may include blood thinners to reduce clotting.

Schrag explained that spinal strokes can also occur during medical procedures when blood pressure drops drastically or the heart stops, and there's not enough blood flow. The solution is to raise blood pressure before permanent damage occurs.

The same precautions are recommended for stroke prevention in the eyes or spine. They include a healthy eating plan, being physically active, maintaining an ideal weight, quitting smoking, keeping your blood pressure, cholesterol, and blood sugar within the target ranges, and getting 7 to 9 hours of sleep every night.