What is a stroke?
A stroke occurs when a blood vessel in the brain ruptures and bleeds, or when there’s a blockage in the blood supply to the brain. The rupture or blockage prevents blood and oxygen from reaching the brain’s tissues.
According to the Centers for Disease Control and Prevention (CDC), stroke is the fifth-leading Trusted Source cause of death in the United States. Every year, more than 795,000 Trusted Source U.S. people have a stroke.
Without oxygen, brain cells and tissue become damaged and begin to die within minutes.
The loss of blood flow to the brain damages tissues within the brain. Symptoms of a stroke show up in the body parts controlled by the damaged areas of the brain.
The sooner a person having a stroke gets care, the better their outcome is likely to be. For this reason, it’s helpful to know the signs of a stroke so you can act quickly. Stroke symptoms can include:
- numbness or weakness in the arm, face, and leg, especially on one side of the body
- trouble speaking or understanding speech
- slurring speech
- vision problems, such as trouble seeing in one or both eyes with vision blackened or blurred, or double vision
- trouble walking
- loss of balance or coordination
- severe, sudden headache with an unknown cause
A stroke requires immediate medical attention. If you think you or someone else is having a stroke, have someone call 911 right away. Prompt treatment is key to preventing the following outcomes:
- brain damage
- long-term disability
It’s better to be safe than sorry when dealing with a stroke, so don’t be afraid to call 911 if you think you recognize the signs of a stroke.
Symptoms of a stroke in women
Stroke is the fourth-leading Trusted Source cause of death in U.S. women. Women have a higher lifetime risk of having a stroke than men.
While some stroke signs are the same in women and men, some are more common in women.
Stroke signs that occur more often in women include:
- nausea or vomiting
- general weakness
- shortness of breath or trouble breathing
- fainting or losing consciousness
- confusion, disorientation, or lack of responsiveness
- sudden behavioral changes, especially increased agitation
Women are more likely than men to die from a stroke, so it’s important to be able to identify a stroke as soon as possible.
Symptoms of a stroke in men
Stroke is the fifth-leading Trusted Source cause of death in men. Men are more likely to have a stroke in their younger years than women, but they’re less likely to die from it, according to the National Institutes of Health Trusted Source.
Men and women can have some of the same signs and symptoms of stroke (see above). However, some stroke symptoms occur more often in men. These include:
- drooping on one side of the face or an uneven smile
- slurred speech, difficulty speaking, and trouble understanding other speech
- arm weakness or muscle weakness on one side of the body
While some symptoms may differ between men and women, it’s equally important for both to be able to spot a stroke early and get help.
Types of stroke
Strokes fall into three main categories: transient ischemic attack (TIA), ischemic stroke, and hemorrhagic stroke. These categories are further broken down into other types of strokes, including:
- embolic stroke
- thrombotic stroke
- intracerebral stroke
- subarachnoid stroke
The type of stroke you have affects your treatment and recovery process.
During an ischemic stroke, the arteries supplying blood to the brain narrow or become blocked. These blockages are caused by blood clots or blood flow that’s severely reduced. They can also be caused by pieces of plaque due to atherosclerosis breaking off and blocking a blood vessel.
The two most common types of ischemic strokes are thrombotic and embolic. A thrombotic stroke happens when a blood clot forms in one of the arteries supplying blood to the brain. The clot passes through the bloodstream and becomes lodged, which blocks blood flow. An embolic stroke is when a blood clot or other debris forms in another part of the body and then travels to the brain.
According to the CDC, 87 percentTrusted Source of strokes are ischemic strokes.
An embolic stroke is one of two types of ischemic strokes. It occurs when a blood clot forms in another part of the body — often the heart or arteries in the upper chest and neck — and moves through the bloodstream to the brain. The clot gets stuck in the brain’s arteries, where it stops the flow of blood and causes a stroke.
An embolic stroke may be the result of a heart condition. Atrial fibrillation, a common type of irregular heartbeat, can cause blood clots to develop in the heart. These clots may dislodge and travel through the bloodstream and into the brain.
Transient ischemic attack (TIA)
A transient ischemic attack, often called a TIA or ministroke, occurs when blood flow to the brain is blocked temporarily. Symptoms, which are similar to those of a full stroke, are typically temporary and disappear after a few minutes or hours.
A TIA is usually caused by a blood clot. It serves as a warning of a future stroke, so don’t ignore a TIA. Seek the same treatment you would for a major stroke.
According to the CDC, more than one-third Trusted Source of people who experience a TIA and don’t get treatment have a major stroke within a year. Up to 10 to 15 percent Trusted Source of people who experience a TIA have a major stroke within three months.
A hemorrhagic stroke happens when an artery in the brain breaks open or leaks blood. The blood from that artery creates excess pressure in the skull and swells the brain, damaging brain cells and tissues.
The two types of hemorrhagic strokes are intracerebral and subarachnoid. An intracerebral hemorrhagic stroke, the most common type of hemorrhagic stroke, happens when the tissues surrounding the brain fill with blood after an artery bursts. The subarachnoid hemorrhagic stroke is less common. It causes bleeding in the area between the brain and the tissues that cover it.
According to the American Heart Association, about 13 percent of strokes are hemorrhagic.
What causes a stroke?
The cause of a stroke depends on the type of stroke. The three main types of stroke are transient ischemic attack (TIA), ischemic stroke, and hemorrhagic stroke.
A TIA is caused by a temporary blockage in an artery that leads to the brain. The blockage, typically a blood clot, stops blood from flowing to certain parts of the brain. A TIA typically lasts for a few minutes up to a few hours, and then the blockage moves and blood flow is restored.
Like a TIA, an ischemic stroke is caused by a blockage in an artery that leads to the brain. This blockage may be a blood clot, or it may be caused by atherosclerosis. With this condition, plaque (a fatty substance) builds up on the walls of a blood vessel. A piece of the plaque can break off and lodge in an artery, blocking the flow of blood and causing an ischemic stroke.
A hemorrhagic stroke, on the other hand, is caused by a burst or leaking blood vessel. Blood seeps into or around the tissues of the brain, causing pressure and damaging brain cells.
There are two possible causes of a hemorrhagic stroke. An aneurysm (a weakened, bulging section of a blood vessel) can be caused by high blood pressure and can lead to a burst blood vessel. Less often, a condition called an arteriovenous malformation, which is an abnormal connection between your veins and arteries, can lead to bleeding in the brain.
Risk factors for stroke
Certain risk factors make you more susceptible to stroke. According to the National Heart, Lung, and Blood Institute Trusted Source, the more risk factors you have, the more likely you are to have a stroke. Risk factors for stroke include:
An unhealthy diet that increases your risk of stroke is one that’s high in:
- saturated fats
- trans fats
Inactivity, or lack of exercise, can also raise your risk for stroke.
Regular exercise has a number of health benefits. The CDC recommends that adults get at least 2.5 hours Trusted Source of aerobic exercise every week. This can mean simply a brisk walk a few times a week.
Your risk for stroke also increases if you drink too much alcohol. Alcohol consumption should be done in moderation. This means no more than one drink per day for women, and no more than two for men. More than that may raise blood pressure levels as well as triglyceride levels, which can cause atherosclerosis.
Using tobacco in any form also raises your risk for stroke, since it can damage your blood vessels and heart. This is further increased when smoking, because your blood pressure rises when you use nicotine.
There are certain personal risk factors for stroke that you can’t control. Stroke risk can be linked to your:
- Family history. Stroke risk is higher in some families because of genetic health issues, such as high blood pressure.
- Sex. According to the CDC Trusted Source, while both women and men can have strokes, they’re more common in women than in men in all age groups.
- Age. The older you are, the more likely you are to have a stroke.
- Race and ethnicity. Caucasians, Asian Americans, and Hispanics are less likely to have a stroke than African-Americans, Alaska Natives, and American Indians.
Certain medical conditions are linked to stroke risk. These include:
- a previous stroke or TIA
- high blood pressure
- high cholesterol
- heart disorders, such as coronary artery disease
- heart valve defects
- enlarged heart chambers and irregular heartbeats
- sickle cell disease
To find out about your specific risk factors for stroke, talk to your doctor.
Diagnosis of stroke
Your doctor will ask you or a family member about your symptoms and what you were doing when they arose. They’ll take your medical history to find out your stroke risk factors. They’ll also:
- ask what medications you take
- check your blood pressure
- listen to your heart
You’ll also have a physical exam, during which the doctor will evaluate you for:
- numbness in your arms, face, or legs
- signs of confusion
- vision issues
Your doctor will then do certain tests. A variety of tests are used to aid in diagnosis of a stroke. These tests can help doctors determine:
- if you had a stroke
- what may have caused it
- what part of the brain is impacted
- whether you have bleeding in the brain
These tests can also determine if your symptoms are being caused by something else.
Tests to diagnose strokes
You may go through various tests to further help your doctor determine if you’ve had a stroke, or to rule out another condition. These tests include:
Your doctor might draw blood for several blood tests. Blood tests can determine:
- your blood sugar levels
- if you have an infection
- your platelet levels
- how fast your blood clots
MRI and CT scan
You may undergo either or both a magnetic resonance imaging (MRI) scan and a computerized tomography (CT) scan.
The MRI will help see if any brain tissue or brain cells have been damaged. A CT scan will provide a detailed and clear picture of your brain that shows any bleeding or damage in the brain. It may also show other brain conditions that could be causing your symptoms.
Your doctor may order an electrocardiogram (EKG), too. This simple test records the electrical activity in the heart, measuring its rhythm and recording how fast it beats. It can determine if you have any heart conditions that may have led to stroke, such as a prior heart attack or atrial fibrillation.
Another test your doctor may order to determine if you’ve had a stroke is a cerebral angiogram. This offers a detailed look at the arteries in your neck and brain. The test can show blockages or clots that may have caused symptoms.
A carotid ultrasound, also called a carotid duplex scan, can show fatty deposits (plaque) in your carotid arteries, which supply the blood to your face, neck, and brain. It can also show whether your carotid arteries have been narrowed or blocked.
An echocardiogram can find sources of clots in your heart. These clots may have traveled to your brain and caused a stroke.
Proper medical evaluation and prompt treatment are vital to recovering from a stroke. According to the American Heart Association, “Time lost is brain lost.” Call 911 as soon as you realize you may be having a stroke, or if you suspect a loved one is having a stroke.
Treatment for stroke depends on the type of stroke:
Ischemic stroke and TIA
These stroke types are caused by a blood clot or other blockage in the brain. For that reason, they’re largely treated with similar techniques, which include:
Antiplatelet and anticoagulants
Over-the-counter aspirin is often a first line of defense against stroke damage. Anticoagulant and antiplatelet drugs should be taken within 24 to 48 hours after stroke symptoms begin.
Thrombolytic drugs can break up blood clots in your brain’s arteries, which still stop the stroke and reduce damage to the brain.
One such drug, tissue plasminogen activator (tPA), or Alteplase IV r-tPA, is considered the gold standard in ischemic stroke treatment. It works by dissolving blood clots quickly, if delivered within the first 3 to 4.5 hours after symptoms of your stroke began. People who receive a tPA injection are more likely to recover from a stroke, and less likely to have any lasting disability as a result of the stroke.
During this procedure, the doctor inserts a catheter into a large blood vessel inside your head. They then use a device to pull the clot out of the vessel. This surgery is most successful if it’s performed 6 to 24 hours after the stroke begins.
If your doctor finds where artery walls have weakened, they may perform a procedure to inflate the narrowed artery and support the walls of the artery with a stent.
In the rare instances that other treatments don’t work, your doctor may perform surgery to remove a blood clot and plaques from your arteries. This may be done with a catheter, or if the clot is especially large, your doctor may open an artery to remove the blockage.
Strokes caused by bleeds or leaks in the brain require different treatment strategies. Treatments for hemorrhagic stroke include:
Unlike with an ischemic stroke, if you’re having a hemorrhagic stroke, the treatment goal is to make your blood clot. Therefore, you may be given medication to counteract any blood thinners you take.
You may also be prescribed drugs that can reduce blood pressure, lower the pressure in your brain, prevent seizures, and prevent blood vessel constriction.
During this procedure, your doctor guides a long tube to the area of hemorrhage or weakened blood vessel. They then install a coil-like device in the area where the artery wall is weak. This blocks blood flow to the area, reducing bleeding.
During imaging tests, your doctor may discover an aneurysm that hasn’t started bleeding yet or has stopped. To prevent additional bleeding, a surgeon may place a tiny clamp at the base of the aneurysm. This cuts off blood supply and prevents a possible broken blood vessel or new bleeding.
If your doctor sees that an aneurysm has burst, they may do surgery to clip the aneurysm and prevent additional bleeding. Likewise, a craniotomy may be needed to relieve the pressure on the brain after a large stroke.
In addition to emergency treatment, healthcare providers will advise you on ways to prevent future strokes.
Several medications are used to treat strokes. The type your doctor prescribes depends largely on the type of stroke you had. The goal of some medications is to prevent a second stroke, while others aim to prevent a stroke from happening in the first place.
The most common stroke medications include:
- Tissue plasminogen activator (tPA). This emergency medication can be provided during a stroke to break up a blood clot causing the stroke. It’s the only medication currently available that can do this, but it must be given within 3 to 4.5 hours after symptoms of a stroke begin. This drug is injected into a blood vessel so the medication can start to work as quickly as possible, which reduces the risk of complications from the stroke.
- Anticoagulants. These drugs reduce your blood’s ability to clot. The most common anticoagulant is warfarin (Jantoven, Coumadin). These drugs can also prevent existing blood clots from growing larger, which is why they may be prescribed to prevent a stroke, or after an ischemic stroke or TIA has occurred.
- Antiplatelet drugs. These medications prevent blood clots by making it more difficult for the blood’s platelets to stick together. The most common antiplatelet drugs include aspirin and clopidogrel (Plavix). They can be used to prevent ischemic strokes and are especially important in preventing secondary stroke. If you’ve never had a stroke before, you should only use aspirin as a preventive medication if you have a high risk of atherosclerotic cardiovascular disease (e.g., heart attack and stroke) and a low risk of bleeding.
- Statins. Statins, which help lower high blood cholesterol levels, are among the most commonly prescribed Trusted Source medications in the United States. These drugs prevent the production of an enzyme that can turn cholesterol into plaque — the thick, sticky substance that can build up on the walls of arteries and cause strokes and heart attacks. Common statins include rosuvastatin (Crestor), simvastatin (Zocor), and atorvastatin (Lipitor).
- Blood pressure drugs. High blood pressure can cause pieces of plaque buildup in your arteries to break off. These pieces can block arteries, causing a stroke. As a result, controlling high blood pressure can help prevent a stroke.
Your doctor may prescribe one or more of these drugs to treat or prevent a stroke, depending on factors such as your health history and your risks.
Recovering from a stroke
Stroke is a leading cause of long-term disability in the United States. However, the National Stroke Association reports that 10 percent of stroke survivors make an almost-complete recovery, while another 25 percent recover with only minor impairments.
It’s important that recovery and rehabilitation from a stroke start as soon as possible. In fact, stroke recovery should begin in the hospital. There, a care team can stabilize your condition, assess the effects of the stroke, identify underlying factors, and begin therapy to help you regain some of your affected skills.
Stroke recovery focuses on four main areas:
A stroke can cause speech and language impairment. A speech and language therapist will work with you to relearn how to speak. Or, if you find verbal communication difficult after a stroke, they’ll help you find new ways of communication.
After a stroke, many survivors have changes to their thinking and reasoning skills. This can cause behavioral and mood changes. An occupational therapist can help you work to regain your former patterns of thinking and behavior and to control your emotional responses.
Relearning sensory skills
If the part of your brain that relays sensory signals is affected during the stroke, you may find that your senses are “dulled” or no longer working. That may mean that you don’t feel things well, such as temperature, pressure, or pain. A therapist can help you learn to adjust to this lack of sensation.
Muscle tone and strength may be weakened by a stroke, and you may find you’re unable to move your body as well as you could before. A physical therapist will work with you to regain your strength and balance, and find ways to adjust to any limitations.
Rehabilitation may take place in a rehabilitation clinic, a skilled nursing home, or your own home.
How to prevent a stroke
You can take steps to help prevent stroke by living a healthy lifestyle. This includes the following measures:
- Quit smoking. If you smoke, quitting now will lower your risk for stroke.
- Consume alcohol in moderation. If you drink excessively, try to reduce your intake. Alcohol consumption can raise your blood pressure.
- Keep weight down. Keep your weight at a healthy level. Being obese or overweight increases your stroke risk. To help manage your weight:
- Eat a diet that’s full of fruits and vegetables.
- Eat foods low in cholesterol, trans fats, and saturated fats.
- Stay physically active. This will help you maintain a healthy weight and help reduce your blood pressure and cholesterol levels.
- Get checkups. Stay on top of your health. This means getting regular checkups and staying in communication with your doctor. Be sure to take the following steps to manage your health:
- Get your cholesterol and blood pressure checked.
- Talk to your doctor about modifying your lifestyle.
- Discuss your medication options with your doctor.
- Address any heart problems you may have.
- If you have diabetes, take steps to manage it.
Taking all these measures will help put you in better shape to prevent stroke.
If you suspect you’re experiencing symptoms of a stroke, it’s vital that you seek emergency medical treatment. Clot-busting medication can only be provided in the first hours after the signs of a stroke begin, and early treatment is one of the most effective ways to reduce your risk for long-term complications and disability.
Prevention is possible, whether you’re preventing a first stroke or trying to prevent a second. Medications can help reduce the risk of blood clots, which lead to strokes. Work with your doctor to find a prevention strategy that works for you, including medical intervention and lifestyle changes.