Stroke

What is a stroke?

A stroke happens when there is a loss of blood flow to part of the brain. Your brain cells cannot get the oxygen and nutrients they need from blood, and they start to die within a few minutes. This can cause lasting brain damage, long-term disability, or even death.

If you think that you or someone else is having a stroke, call 911 right away. Immediate treatment may save someone's life and increase the chances for successful rehabilitation and recovery.

There are two types of stroke:

• Ischemic stroke is caused by a blood clot that blocks or plugs a blood vessel in the brain. This is the most common type; about 80% of strokes are ischemic.
• Hemorrhagic stroke is caused by a blood vessel that breaks and bleeds into the brain.

Another condition that's similar to a stroke is a transient ischemic attack (TIA). It's sometimes called a "mini-stroke." TIAs happen when the blood supply to the brain is blocked for a short time. The damage to the brain cells isn't permanent, but having a TIA puts you at much higher risk of having a stroke.

Certain factors can raise your risk of a stroke. The major risk factors include:

• High blood pressure. This is the primary risk factor for a stroke.
• Diabetes.
• Heart diseases. Atrial fibrillation and other heart diseases can cause blood clots that lead to stroke.
• Smoking. When you smoke, you damage your blood vessels and raise your blood pressure.
• A personal or family history of stroke or TIA
• Age. Your risk of stroke increases as you get older.
• Race and ethnicity. People who are African American or Hispanic have a higher risk of stroke.

There are also other factors that are linked to a higher risk of stroke, such as:

• Alcohol and illegal drug use
• Not getting enough physical activity
• High cholesterol
• Unhealthy diet
• Having obesity

The symptoms of a stroke often happen quickly. They include:

• Sudden numbness or weakness of the face, arm, or leg (especially on one side of the body)
• Sudden confusion, trouble speaking, or understanding speech
• Sudden trouble seeing in one or both eyes
• Sudden difficulty walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause

The F.A.S.T. test can help you remember what to look for if you think someone is having a stroke. Think "FAST" and look for:

• Face drooping on one side when smiling.
• Arm weakness occurs when the arms are raised, and one arm drifts downward.
• Speech is slurred or strange.
• Time to call 911.

If you think that you or someone else is having a stroke, call 911 right away. Every minute counts during a stroke.

To make a diagnosis, your health care provider will:

• Ask about your symptoms and medical history
• Do a physical exam, including a check of:
  • Your mental alertness
  • Your coordination and balance
  • Any numbness or weakness in your face, arms, and legs
  • Any trouble speaking and seeing clearly
• Run some tests, which may include:
  • Diagnostic imaging of the brain, such as a CT scan or MRI.
  • Heart tests, which can help detect heart problems or blood clots that may have led to a stroke. Possible tests include an electrocardiogram (EKG) and an echocardiography.

Treatments for stroke include medicines, surgery, and rehabilitation. Which treatments you get depend on the type of stroke and the stage of treatment. The different stages are:

• Acute treatment, to try to stop a stroke while it is happening
• Post-stroke rehabilitation, to overcome the disabilities caused by the stroke
• Prevention, to prevent a first stroke or, if you have already had one, prevent another stroke

Acute treatments for ischemic stroke are usually medicines:

• You may get tPA, (tissue plasminogen activator), a medicine to dissolve the blood clot. You can only get this medicine within 4 hours of when your symptoms started. The sooner you can get it, the better your chance of recovery.
• If you cannot get that medicine, you may get medicine that helps stop platelets from clumping together to form blood clots. Or you may get a blood thinner to keep existing clots from getting bigger.
• If you have carotid artery disease, you may also need a procedure to open your blocked carotid artery.

Acute treatments for hemorrhagic stroke focus on stopping the bleeding. The first step is to find the cause of bleeding in the brain. The next step is to control it:

• If high blood pressure is the cause of bleeding, you may be given blood pressure medicines.
• If an aneurysm is the cause, you may need aneurysm clipping or coil embolization. These are surgeries to prevent further leaking of blood from the aneurysm. They also can help prevent the aneurysm from bursting again.
• If an arteriovenous malformation (AVM) is the cause of a stroke, you may need an AVM repair. An AVM is a tangle of faulty arteries and veins that can rupture within the brain. An AVM repair may be done through:
• Surgery
• Injecting a substance into the blood vessels of the AVM to block blood flow
• Radiation to shrink the blood vessels of the AVM

Stroke rehabilitation can help you relearn skills you lost because of the damage. The goal is to help you become as independent as possible and have the best possible quality of life.

Prevention of another stroke is also important, since having a stroke increases the risk of getting another one. Prevention may include heart-healthy lifestyle changes and medicines.

If you have already had a stroke or are at risk of having a stroke, you can make some heart-healthy lifestyle changes to try to prevent a future stroke:

• Eating a heart-healthy diet
• Aiming for a healthy weight
• Managing stress
• Getting regular physical activity
• Quitting smoking
• Managing your blood pressure and cholesterol levels

If these changes aren't enough, you may need medicine to control your risk factors.

NIH: National Institute of Neurological Disorders and Stroke

Ischemic Stroke

What is an ischemic stroke?

A stroke happens when there is a loss of blood flow to part of the brain. Your brain cells cannot get the oxygen and nutrients they need from blood, and they start to die within a few minutes. This can cause lasting brain damage, long-term disability, or even death.

There are two main types of strokes, ischemic and hemorrhagic. Ischemic stroke is the more common type. An ischemic stroke happens when a blood clot blocks a blood vessel in the brain. Quick treatment can save a life and improve the chances of recovery.

Ischemic strokes are usually caused by one or more of the following:

• A blood clot. A clot can form in an artery that supplies the brain (thrombosis), or it can travel from another part of the body (embolism).
• Atherosclerosis. A disease in which plaque, a sticky substance made up of cholesterol, fat, and other substances, builds up inside your arteries.
• Irregular heart rhythms. Conditions like atrial fibrillation can cause clots to form in the heart, which may travel to the brain.
• Other heart and blood conditions. Such as heart valve diseases or sickle cell disease.

A transient ischemic attack (TIA) is caused by a brief blockage of blood flow to the brain. It usually lasts a few minutes. Having a TIA can mean you are at risk for having a more serious stroke.

Symptoms of stroke often happen suddenly. They include:

• Sudden numbness or weakness of the face, arm or leg (especially on one side of the body)
• Sudden confusion, trouble speaking or understanding speech
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause

If you think someone is having a stroke, the F.A.S.T. test can help you remember what to look for. Think "FAST" and look for:

• Face drooping on one side when smiling.
• Arm weakness that occurs when the arms are raised, and one arm drifts downward.
• Speech is slurred or strange.
• Time to call 911.

To make a diagnosis, your health care provider may do a physical exam, ask about your symptoms and medical history, and use imaging tests. Other heart tests may be done to help find the cause of the stroke.

It is important to treat strokes as quickly as possible. The most common treatments include:

• Medicines such as blood thinners or thrombolytics (which break up and dissolve existing clots) may be used to prevent or treat ischemic stroke.
• Surgery or stenting may be used to open narrowed arteries or remove plaque build-up from the carotid arteries, which supply blood to the brain.

After treatment, rehabilitation can help you regain lost skills and independence. Your provider may also order other medicines to manage your blood pressure,cholesterol, or other health problems such as diabetes that may increase your risk for stroke.

The best way to prevent stroke is by making heart-healthy lifestyle changes to lower your risk. If lifestyle changes aren't enough, your provider may prescribe medicine to help manage your risk factors.

NIH: National Institute of Neurological Disorders and Stroke

Hemorrhagic Stroke

What is a hemorrhagic stroke?

A stroke happens when there is a loss of blood flow to part of the brain. Your brain cells cannot get the oxygen and nutrients they need from blood, and they start to die within a few minutes. This can cause lasting brain damage, long-term disability, or even death.

There are two main types of strokes, ischemic and hemorrhagic. A hemorrhagic stroke is less common but often more severe. It occurs when a blood vessel in the brain bursts, causing bleeding (hemorrhage) in or around the brain. This bleeding increases pressure inside the skull and damages brain tissue. Within minutes, brain cells begin to die.

Hemorrhagic strokes are classified by where the bleeding happens:

• Intracerebral hemorrhage. Bleeding occurs directly into the brain tissue. This is the most common type of hemorrhagic stroke.
• Subarachnoid hemorrhage. Bleeding occurs in the space between the brain and the thin layers of tissues covering it. This often happens when a weak spot in an artery (called an aneurysm) bursts on the brain's surface.

Common causes include:

• Aneurysm. A bulge or "ballooning" in a weakened artery wall that can burst.
• Arteriovenous malformation (AVM). A tangled group of abnormal blood vessels that can rupture inside the brain.
• High blood pressure (hypertension). Over time, it can weaken blood vessel walls and increase the risk of them breaking open.
• Head trauma. Brain injury can cause bleeding.

Stroke symptoms often happen suddenly. They include:

• Sudden numbness or weakness of the face, arm or leg (especially on one side of the body)
• Sudden confusion, trouble speaking, or understanding speech
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause

The F.A.S.T. test can help you remember what to look for if you think someone is having a stroke. Think "FAST" and look for:

• Face drooping on one side when smiling.
• Arm weakness occurs when the arms are raised, and one arm drifts downward.
• Speech is slurred or strange.
• Time to call 911.

To make a diagnosis, your health care provider may do a physical exam, ask about your symptoms and medical history, and use imaging tests to check for bleeding in your brain.

It is important to treat strokes as quickly as possible. For a hemorrhagic stroke, the first step is to find the cause of bleeding in the brain and stop it. Treatment may involve medicines or, in some cases, surgery to stop the bleeding or relieve pressure on the brain.

After the stroke, rehabilitation can help people recover lost abilities and regain independence.

The best way to prevent stroke is by making heart-healthy lifestyle changes to lower your risk. If lifestyle changes aren't enough, your provider may prescribe medicine to help manage your risk factors.

NIH: National Institute of Neurological Disorders and Stroke

Stroke Rehabilitation

What is stroke rehabilitation?

Stroke rehabilitation is a program for people who have had a stroke. A stroke happens when there is a loss of blood flow to part of the brain. Your brain cells cannot get the oxygen and nutrients they need from blood, and they start to die within a few minutes. This can cause lasting brain damage, long-term disability, or even death.

Stroke rehabilitation can help you relearn skills you lost because of the damage. It can help with movement, speech, strength, and daily living skills. The goal is to help you become as independent as possible.

Rehabilitation is for people who have lost abilities needed for daily life. Stroke rehabilitation is recommended for anyone affected by stroke. Most people who take part in a treatment program recover better than those who don't.

The effects of a stroke depend on the parts of your brain that were affected. Your health care provider may recommend care based on your needs.

The types of disabilities a stroke can cause include:

• Paralysis or problems controlling movement
• Pain or other problems with your senses
• Problems using or understanding language
• Problems with thinking and memory
• Difficulty with controlling or expressing emotions

The sooner you begin rehabilitation, the more likely you are to regain lost skills and abilities. Treatment may start while you're still in the hospital. Most likely it will begin within 24 to 48 hours after the stroke.

The goal of rehabilitation is to help you get your abilities back and regain independence. But the specific goals vary for each person. Your treatment plan will depend on what part of your body or type of ability was affected by the stroke. It may include teaching you new ways to work with disabilities, such as using assistive devices to make it easier to do your usual activities.

A plan for stroke rehabilitation can involve many kinds of health professionals. They will work with you to figure out your needs, goals, and make a treatment plan. The types of treatments can include:

• Speech-language therapy. To help with speaking, understanding, reading, writing, and swallowing.
• Physical therapy. To help you relearn movement and coordination skills, regain strength, and stretch your muscles.
• Occupational therapy. To help improve your ability to perform daily living skills such as eating, drinking, bathing, and dressing.
• Cognitive therapy. To help you relearn or improve skills such as thinking, learning, memory, planning, and decision making.
• Mental health counseling. Therapy, medicine, or joining a patient support group may be recommended to help you cope with emotional or behavioral issues.
• Medicine. To treat pain, other health issues, or to help with depression or other mental health conditions following a stroke.
• Vocational rehabilitation. To help you build skills for going to school or working at a job.

Rehabilitation may start while you're in the hospital. Once you're ready for discharge, you and your family will work with your provider to determine the best setting for your specific needs. These can include:

• An inpatient rehabilitation clinic
• A home-based program
• An outpatient unit
• A skilled nursing facility

A stroke can cause various complications, and each person may recover at a different pace. The length of rehabilitation will depend on how bad the stroke was and any related complications.

Some people recover quickly after a stroke, but most people need some type of long-term rehabilitation. This can change as you progress and your needs change. Your willingness to work toward improvement and the support of your family and health care team will help you get the best results.

NIH: National Institute of Neurological Disorders and Stroke

Transient Ischemic Attack

A transient ischemic attack (TIA) is a stroke that lasts only a few minutes. It happens when the blood supply to part of the brain is briefly blocked. Symptoms of a TIA are like other stroke symptoms, but do not last as long. They happen suddenly, and include:

• Numbness or weakness, especially on one side of the body
• Confusion or trouble speaking or understanding speech
• Trouble seeing in one or both eyes
• Difficulty walking
• Dizziness
• Loss of balance or coordination

Most symptoms of a TIA disappear within an hour, although they may last for up to 24 hours. Because you cannot tell if these symptoms are from a TIA or a stroke, you should go to the hospital right away.

TIAs are often a warning sign for future strokes. Taking medicine, such as blood thinners, may reduce your risk of a stroke. Your doctor might also recommend surgery. You can also help lower your risk by having a healthy lifestyle. This includes not smoking, not drinking too much, eating a healthy diet, and exercising. It is also important to control other health problems, such as high blood pressure and cholesterol.

NIH: National Institute of Neurological Disorders and Stroke