🧠 Stroke - Everything Explained Simply

What is a Stroke?

Types of Stroke

1. 🔴 Ischemic Stroke (most common - 87% of all strokes)

• Thrombotic - a clot forms directly in a brain artery (often due to narrowed arteries from cholesterol build-up)
• Embolic - a clot forms somewhere else (like the heart) and travels to the brain

2. 🩸 Hemorrhagic Stroke (about 10-13%)

• Intracerebral hemorrhage - bleeding inside the brain
• Subarachnoid hemorrhage (SAH) - bleeding in the space around the brain (less than 5% of strokes)

3. ⚡ TIA - Transient Ischemic Attack ("Mini-Stroke")

How to Recognize a Stroke - BE FAST

Other symptoms may include:

• Sudden severe headache "like the worst of your life" (classic for bleeding stroke)
• Sudden numbness or weakness on one side of the body (face, arm, or leg)
• Sudden confusion or trouble understanding
• Sudden dizziness or difficulty walking

What Happens in the Brain During a Stroke?

• Left side of brain - controls right side of body, language, speech
• Right side of brain - controls left side of body, spatial awareness
• Brainstem - controls breathing, heart rate, consciousness
• Cerebellum - controls balance and coordination

Risk Factors

Things you CANNOT change:

• Age - risk increases sharply after 65; 75% of strokes occur in people over 75
• Sex - men have strokes more often, but women have worse outcomes
• Race - Black and Native American people have significantly higher rates
• Family history / genetics
• Previous stroke or TIA

Things you CAN change:

• High blood pressure (hypertension) - the single biggest risk factor
• Diabetes - damages blood vessels over time
• High cholesterol - causes artery narrowing
• Smoking - damages blood vessels, thickens blood
• Atrial fibrillation (irregular heartbeat) - a major cause of blood clot emboli to the brain
• Obesity and physical inactivity
• Excessive alcohol use
• Poor diet

Treatment

For Ischemic Stroke (Clot) - Act Within Hours

• tPA (clot-busting drug) - Given intravenously, this drug dissolves the clot. Must be given within 4.5 hours of symptoms starting. Works best the earlier it is given.
• Mechanical Thrombectomy - A catheter is inserted through a blood vessel to physically pull out the clot. Can be effective up to 24 hours in selected patients. This has been a major recent advance in stroke care.

For Hemorrhagic Stroke (Bleeding)

• The goal is to stop the bleeding and reduce pressure on the brain
• Blood pressure is tightly controlled
• Surgery may be needed to repair a burst aneurysm or remove the blood clot pressing on the brain
• clot-busting drugs are contraindicated - they would make bleeding worse

Hospital Care (Both Types)

• Monitoring in a dedicated stroke unit (shown to significantly improve survival)
• Blood pressure management
• Preventing complications like pneumonia, blood clots in the legs, and pressure sores
• Swallowing assessment - up to 65% of stroke patients develop difficulty swallowing (dysphagia), which can lead to food going into the lungs

Recovery and Rehabilitation

• Physical therapy - relearning movement, walking, strength
• Occupational therapy - relearning daily tasks (dressing, cooking)
• Speech therapy - for language and swallowing problems
• Psychological support - post-stroke depression is very common

Prevention

• Control blood pressure (most important of all)
• Control blood sugar in diabetes
• Lower cholesterol (statins are commonly prescribed)
• Stop smoking
• Anticoagulant drugs (like warfarin or newer blood thinners) for people with atrial fibrillation
• Antiplatelet drugs (like aspirin or clopidogrel) after a TIA or ischemic stroke
• Regular exercise, healthy diet, maintain healthy weight
• Limit alcohol

Key Numbers to Remember

A Helpful Video

🩸 Hemoglobin Ranges and Treatment - Simple Guide

First: What is Normal?

PART 1: Low Hemoglobin (Anemia) - By Severity

🟡 Mild Anemia — Hb 10 - 12 g/dL (women) / 10 - 13 g/dL (men)

• Find the cause first - the treatment depends entirely on WHY the Hb is low
• Iron Deficiency (most common cause): Oral iron tablets (ferrous sulfate) daily for 3-6 months. Continue even after Hb normalizes to replenish iron stores.
• B12/Folate Deficiency: Oral folic acid (0.4-1 mg daily) or B12 supplements/injections
• Anemia of Chronic Disease: Treat the underlying disease (e.g., infection, inflammation, cancer)
• No transfusion needed at this level unless symptomatic or surgery planned

🟠 Moderate Anemia — Hb 8 - 10 g/dL

• Continue finding and treating the root cause
• Iron deficiency: Oral iron still works, but IV (intravenous) iron may be preferred if:
  • Patient can't tolerate oral iron (stomach upset, constipation)
  • Absorption is poor (e.g., gut disease)
  • Need faster correction (e.g., pre-surgery, third trimester of pregnancy)
• Folate/B12 deficiency: Oral or injectable replacement
• Erythropoietin (EPO) injections - used in anemia due to kidney disease or cancer chemotherapy
• In pregnancy (Hb 9-10.5 g/dL): oral iron is first line (ACOG guidelines)
• Blood transfusion still generally NOT needed unless patient is symptomatic with cardiac disease

🔴 Severe Anemia — Hb 6 - 8 g/dL

• IV iron preferred over oral at this stage for faster correction
• Blood transfusion (packed red blood cells - PRBCs) is now considered:
  • Transfuse if Hb < 7 g/dL in most stable adult patients (AABB guideline)
  • Transfuse if Hb < 8 g/dL in patients with heart disease, orthopedic or cardiac surgery
  • 1 unit of blood raises Hb by ~1 g/dL
• In severe pregnancy anemia (Hb < 9 g/dL): IV iron is treatment of choice
• Treat the underlying cause urgently

🆘 Very Severe / Life-Threatening Anemia — Hb < 6 g/dL

• Emergency blood transfusion - urgent and potentially life-saving
• In actively bleeding patients: transfusion is guided by clinical signs (shock, poor perfusion), NOT just the Hb number - because Hb can appear falsely normal right after acute blood loss
• ICU-level monitoring
• Treat the cause (stop bleeding, treat hemolysis, etc.)
• Target: raise Hb to at least 7-8 g/dL, then continue investigating and treating the cause

PART 2: Transfusion Thresholds - Summary (AABB Guidelines)

One unit of blood raises Hb by ~1 g/dL in adults.

PART 3: High Hemoglobin (Polycythemia) — Hb > 17.5 g/dL (men) / > 16 g/dL (women)

• Dehydration (most common - false elevation)
• Living at high altitude
• Polycythemia Vera (a bone marrow disease)
• Smoking, lung disease (low oxygen)
• Anabolic steroids / EPO misuse

Quick Visual Summary

Hb (g/dL):   <6     6-8       8-10       10-12      12-16     >16-17.5
              🆘      🔴        🟠          🟡         ✅         ⚠️
           EMERGENCY  SEVERE   MODERATE    MILD      NORMAL    TOO HIGH
           Urgent    Consider  IV Iron/   Oral iron/  Watch &   Check
           transfuse transfuse EPO/treat  vitamins   treat     polycythemia