Stroke

What is a stroke?

A stroke is a medical emergency when blood flow to the brain is blocked or sudden bleeding occurs in the brain. Individuals may either have an ischemic stroke or a hemorrhagic stroke. Strokes can cause lasting brain damage, long-term disability, or the death of someone if it is severe or left untreated.

Just under 90% of strokes are due to blocked blood vessels (ischemic). The remaining cases involve internal bleeding (hemorrhagic).

Every minute counts during a stroke. If you think that you or a loved one is having a stroke, call 911 for immediate assistance. Medical personnel can begin lifesaving treatment while they bring a patient to the hospital.

What are the symptoms of a stroke?

Always pay attention to the warning signs that you or someone you know may be having a stroke. Make sure to make note of the time that symptoms first appear. Receiving treatment promptly is extremely important for stroke patients. Symptoms may include:

• Trouble speaking or slurred words

• Difficulty understanding speech

• Numbness, weakness, or paralysis (in the face, arm, or leg) on one side of the body

• One-sided droopy mouth when you try to smile

• Blurred or blackened vision in one or both eyes

• Seeing double

• A sudden, severe headache

• Vomiting, dizziness, or a change in consciousness (with a headache)

• Loss of balance/coordination

Do not wait to see if stroke symptoms stop over time. If you are with someone who is having a stroke, closely monitor their symptoms until medical personnel arrive. If you’re unsure whether someone is having a stroke, remember the term “FAST”:

• Face. Ask them to smile and check if one side of the face droops.

• Arms. Ask the person to raise both of their arms. Notice if one arm drifts downward or is incapable of rising.

• Speech. Ask the person to repeat an easy phrase. Pay attention to whether their speech is slurred or any different than usual.

• Time. If you identify any symptoms, call 911 for immediate medical assistance.

What causes a stroke?

The two main causes of a stroke are ischemic and hemorrhagic. If someone has a temporary disruption of blood flow to the brain, they are experiencing a transient ischemic attack (TIA). A TIA should not cause lasting symptoms in patients.

Ischemic Stroke

An ischemic stroke is the most common type of stroke. Reduced blood flow, known as ischemia, is caused by the brain’s blood vessels becoming narrowed or blocked. The blocked or narrowed blood vessels can be results of:

• Fatty deposits building up in your blood vessels

• Blood clots (or other debris) traveling through the bloodstream

An ischemic stroke is often the consequence of debris lodging themselves in the brain’s blood vessels. Early research has also suggested that the COVID-19 infection may increase the risk of having an ischemic stroke.

Hemorrhagic Stroke

Blood vessels in the brain that leak or rupture lead to hemorrhagic strokes. Contributing factors for having a hemorrhagic stroke can include:

• Uncontrolled high blood pressure

• Head trauma

• Bulges by weaker spots of blood vessel walls (aneurysms)

• Protein deposits that weaken blood vessel walls (cerebral amyloid angiopathy)

• Overtreatment of blood thinners (anticoagulants)

• A previous ischemic stroke that causes a brain hemorrhage

Bleeding in the brain can also occur when there is a rupture of an arteriovenous malformation, or an irregular tangle of thin-walled blood vessels. An AVM is a rare cause of bleeding. Speak with your doctor about any questions or concerns that you may have regarding brain bleeds.

Transient Ischemic Attack

A TIA is sometimes referred to as a ministroke. The decrease in blood supply to part of the brain may last as briefly as five minutes. It is important to seek emergency medical assistance, even if you think that it was a TIA rather than a stroke. A TIA can mean:

• There is partial blockage of an artery leading to the brain

• There is a narrowed artery

• There is an increased risk of having a stroke later

Taking care of yourself or a loved one experiencing stroke symptoms can be scary, especially if you’ve never witnessed one. Going to the hospital for a comprehensive diagnosis and to receive care can help address any questions and concerns.

How is a stroke diagnosed?

A doctor will diagnose a stroke after going over your symptoms and medical history, performing a physical exam, and reviewing the test results. If you did end up suffering a TIA, the doctor will discuss your options and how to best prevent a future stroke.

A diagnostic imaging test allows a doctor to see the blood vessels in your brain. It will determine the type of stroke that you had and where it occurred in the brain. Imaging test options include:

• Computed tomography (CT): Performed immediately after a suspected stroke for clear, detailed pictures of the brain

• Magnetic resonance imaging (MRI): Used instead of, or in addition to, a CT scan to identify any changes in brain tissue and/or damage to brain cells

• Digital subtraction angiography (DSA) or positron emission tomography (PET): To detect narrowed blood vessels in the neck, any aneurysms, or any tangled blood vessels in the brain

Your doctor may order additional, non-imaging tests to thoroughly examine you before offering a specific stroke diagnosis.

• Blood tests will reveal if your red blood cell and platelet count, plus your glucose levels, are stable. Blood tests help rule out medications that will not effectively treat your stroke. Make sure to discuss with your doctor if they think that it is necessary to run blood tests to see if there is muscle damage or how well the blood clots.

• Electrocardiograms (EKG) can detect heart problems, like atrial fibrillation or a prior heart attack, that may have caused a stroke.

• Lumbar punctures (spinal taps) can detect hemorrhagic strokes if imaging scans do not find bleeding in the brain.

It is best to schedule an appointment with your doctor to run these tests sooner rather than later. Receiving the results sooner will allow your doctor to more effectively diagnose and treat you.

What are stroke risk factors?

There are a number of lifestyle and medical risk factors that can influence a person’s likelihood of having a stroke.

Lifestyle Risk Factors

• Physical inactivity
• Obesity or being overweight
• Use of illegal drugs (cocaine, methamphetamine)
• Heavy or binge drinking

Medical Risk Factors

• High cholesterol
• Diabetes
• High blood pressure
• Cigarette smoking
• Secondhand smoke exposure
• Cardiovascular disease
• Obstructive sleep apnea
• Personal or family history (of stroke, heart attack, TIA)
• COVID-19 infection

There are other risk factors that can contribute to an increased likelihood of having a stroke, including if you are:

• Aged 55 or older
• Black or Latino
• Taking birth control pills
• Undergoing hormone therapies that include estrogen

A person’s sex assigned at birth can influence their likelihood of a stroke and its severity. Men are more likely to have a stroke than women. Women are generally older if they have strokes and their strokes are commonly more severe.

What are the treatment options for a stroke?

Treatment that you receive for a stroke will depend on whether it was ischemic or hemorrhagic. A doctor or a team of specialists will determine your stroke treatment plan based on how much time has passed since your symptoms began and if you have any other medical conditions.

The most common medicine options for treating an ischemic stroke are:

• Tissue plasminogen activator (tPA) to break up blood clots

• Blood-thinning medicine (anticoagulant) like aspirin or clopidogrel

A doctor may determine that a medical procedure is needed to open any blocked arteries or restore adequate blood flow to the brain. Possible medical procedures include:

• Thrombectomy to remove a clot from a blood vessel

• Angioplasty and stenting to open a blocked artery

• Carotid endarterectomy to remove plaque in the neck (carotid artery disease can cause strokes)

Treating a hemorrhagic stroke is time-sensitive. Effective treatment requires knowing what part of the brain is bleeding and how much it bleeds. A healthcare provider may recommend:

• Taking blood pressure medicine

• Stopping any anticoagulant or blood-thinning medicines

• Taking Vitamin K to help stop any bleeding

Medical procedures differ for patients who have had a hemorrhagic stroke. After speaking with a doctor, the best treatment procedure for you or a loved one may involve:

• Aneurysm clipping

• Blood transfusion

• Coil embolization

• Draining excess fluid in the brain

• Temporary and partial removal of the skull to allow unimpeded brain swelling

• Surgery or radiation to treat AVM

• Surgery to remove pooled blood

A medical provider in many instances will only elect to use surgery if the patient shows signs of getting worse. Speaking with them, or having someone speak on your behalf, is the best way to ensure that you receive the most comprehensive and effective treatment.

What are common stroke complications?

There are different temporary and permanent disabilities that are consequences of strokes. The chances of certain complications depend on how long the brain is without adequate blood flow.

• Loss of muscle movement (paralysis)

• Trouble talking

• Difficulty swallowing

• Memory loss

• Cognitive decline

• Difficulty controlling emotions or depression

• Pain, numbness, or tingling in affected areas

• Changes in behavior (becoming withdrawn)

• Needing assistance with grooming and/or daily tasks

What is the outlook for a stroke patient?

A patient’s life expectancy and quality of life after having a stroke will depend upon a variety of factors, including:

• Age
• Type of stroke
• Medical history

A 2022 population-wide study in Australia and New Zealand found that a stroke can be linked to a five-and-a-half year reduction in a person’s life expectancy. That is why it is important to seek medical attention as soon as you suspect that something might be wrong. Even if it just ends up being preventative that first time, a healthcare provider can offer a much fuller picture of your healthcare needs and discuss the best next steps.