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When something happens to the blood flow in the central nervous system, a cerebral vascular accident (CVA) or stroke occurs. A CVA most often occurs in the brain but, very rarely, it can also occur in the spinal cord. A stroke occurs when there is a change to blood flow in the central nervous system (CNS) due to damage to a blood vessel, rupture to the blood vessel or something stopping blood flow like a clot or emboli (globule of fat or other material or bubble of air.) Slowing of blood flow in the CNS can also lead to a stroke.
A person with loss of blood flow to the heart is said to be having a heart attack. The same process can occur in the central nervous system in either the spinal cord, brain or both. A person with loss of blood flow to the spine or brain or sudden bleeding in the spine or brain can be said to be having a “spine attack” or “brain attack.”
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When a CVA occurs, nerve cells in the affected area of the CNS can’t function due to a lack of oxygen. Surrounding tissue can be affected by an increase in swelling of the area. The spinal cord and brain are contained in rigid bones so swelling is constricted. Therefore, pressure within the CNS will compress soft nerve tissue.
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Spinal cord CVA will result in complete (-plegia) or incomplete (-paresis) paralysis on both sides of the body depending on the level of injury in the spinal cord. Tetraplegia or tetraparesis (quadriplegia) involves the body and all four limbs. Paraplegia or paraparesis involves the lower part of the body. Effects of a spinal cord stroke can include alteration in mobility and function. Clot busting drugs do not seem to be effective in treating spinal cord stroke.
Brain CVA can affect the entire body, including paralysis or paresis (partial paralysis), cognitive and memory deficits, speech and visual issues, emotional difficulties, daily living challenges, and pain. Paralysis is a common outcome of stroke, often on one side of the body (hemiplegia). Paralysis may affect only the face, an arm or a leg, but most often, one entire side of the body and face is affected. A person who suffers a stroke in the left hemisphere (side) of the brain will show right-sided paralysis, or paresis. Likewise, a person with a stroke in the right hemisphere (side) will show deficits on the left side of the body.
Brainstem (the connection between the spinal cord and brain) CVA is a bit unique in that symptoms are vertigo and dizziness together with extreme imbalance. Double vision, slurred speech and decreased level of consciousness might be present. Brainstem stroke often mimics other neurological diseases. Diagnosis must be made early to take advantage of treatment.
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Stroke risk factors are divided by those you cannot control and those you can. If you have uncontrollable risk factors, do your best to control those you can to reduce risk.
Uncontrollable risk factors are those that are inherited and some pre-existing conditions. Included are age, gender, race, genetics and history of a prior TIA, stroke, or heart attack. People of all ages have strokes from newborns to the elderly, however as you get older, your risk of stroke increases due to changes in the body such as loss of artery elasticity (atherosclerosis). Women have a higher risk of stroke simply because they live longer than men. The stroke onset for women may be in these later years. Pregnancy complications, some birth control and post-menopausal hormones increase stroke risk. Genetics include family history of stroke or genetic diseases that can increase your risk of stroke. A person who has had a brain event such as TIA or stroke is at a much higher risk for a second one.
There are many factors that you can control to decrease your risk of stroke. You can greatly reduce your risk of stroke by controlling diseases that increase your risk. These diseases include high blood pressure, diabetes, obesity, high cholesterol, carotid artery disease, peripheral vascular disease, atrial fibrillation and other heart disease, and sickle cell disease. Many of these risk factors can be controlled by adopting a healthy diet and taking prescribed medication. Activity in your life will also help reduce your risk. Stopping smoking, alcohol and recreational drug use can significantly reduce the risk of a stroke.
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If you have a spinal cord stroke or other spinal cord injury, the complication of Autonomic Dysreflexia (AD) puts you at higher risk for a stroke in your brain. AD is a medical emergency where blood pressure becomes elevated to excessive levels compared to the individual’s normal pressure. Over time, an individual with spinal cord injury will experience low blood pressure as their normal. An elevation to a normal range can indicate high blood pressure for that person. Find out more about Autonomic Dysreflexia (AD).
Some medical procedures have a risk for a spinal cord or brain stroke such as heart bypass surgery, open abdominal aortic aneurism, spinal surgery, or clot removal in the spinal arteries. Stroke risk is increased with any surgery, test or procedure that can create or dislodge a blood clot.
Stroke in the spinal cord has unclear symptoms. The signs of a spinal cord stroke can be confused with other illnesses. Any or all the symptoms can appear. The symptoms of a stroke in the spinal cord are:
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Noticing a stroke in the spine can be difficult. You may have one, a combination or all the symptoms. It is important that you call 911 if your symptoms of a spinal cord stroke appear.
You might have one of these symptoms, a few or all of them. You might not realize you are having the symptoms of a stroke. Someone else might notice these symptoms. Be sure to note the time of onset of symptoms. Write ‘onset: XX:XX am or pm’ on your body in case the stroke advances and you are unable to recall or speak when emergency personnel arrive. This is critical for treatment.
Spinal cord stroke results in full or partial paralysis below the level of injury, bowel and bladder issues, sexual dysfunction, mobility and sensation difficulty. The result can be tetraplegia (quadriplegia), paraplegia, or one of the spinal cord syndromes. Abilities will vary depending on the location of the stroke in the spine.
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After a stroke in the spinal cord, some may experience pain, uncomfortable numbness, or strange sensations. These may be due to many factors including damage to the spine which may interrupt the communication of messages between the body from the brain. Spinal cord stroke disrupts these messages at the level of the stroke in the spinal cord.
A stroke in the spinal cord can lead to depression due to the challenges of chronic illness. Loss of mental or physical function can be daunting. Changes in lifestyle and family dynamics compound the issue.
Left Brain Stroke can result in full or partial paralysis on the right side of the body. There might be difficulty in understand speech or speaking words, word finding or unusual use of words or sounds. The individual is typically cautious or even sometimes timid in behavior. Memory loss can be present.
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Right Brain Stroke characteristics are full or partial paralysis on the left side of the body. There are often visual difficulties, quick and impulsive movements and thoughts. Memory loss can be present.
In left or right brain stroke, a visual field cut called hemianopsia can occur. The individual is not blind, but the visual field is reduced in both eyes. As a result, vision to one side is absent. The side of the visual field cut will be the same as side as paralysis in the body. The individual is unable to recognize that the visual field cut area is missing. This neglect can lead to injury to the neglected side even to the point that they do not recognize that body part as their own.
Brainstem stroke has the symptoms of vertigo and dizziness with imbalance. Functional abilities vary which can lead to locked in syndrome where the person understands what is happening but cannot physically or verbally respond. Memory loss can be present.
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Your mental wellbeing can be affected by a stroke. Depending on the location of a stroke in the brain, you might have difficulty in remembering, being careless, irritable or have some confusion. Some people will laugh or cry inappropriately.
The appropriate response to a stroke is emergency action. Call 911. Do not attempt to drive yourself or let someone drive you to the hospital. Emergency personnel can begin the process of recovery. Every minute lost, from the onset of symptoms to the time of emergency contact, cuts into the limited window of opportunity for intervention.
Stroke prevention measures should be undertaken to reduce your risk of both a spine or brain attack. This includes the main three preventions; diet, exercise, smoking cessation. Other risk factors that you can control should be modified. Medication can also help reduce stroke risk. Medications to reduce cholesterol, blood thinners and antiplatelet medications should be taken as your healthcare
