Stroke

Discusses ischemic stroke, hemorrhagic stroke, and TIA (transient ischemic attack). Describes stroke symptoms and importance of acting fast if symptoms develop. Covers stroke treatment and prevention.

Stroke

Topic Overview

What is a stroke?

A stroke occurs when a blood
vessel in the brain is
blocked or bursts. Without blood and the oxygen it carries, part of the brain
starts to die. The part of the body controlled by the damaged area of the brain
can't work properly.

Brain damage can begin within minutes. That's why it's so important to know the symptoms of stroke and to act fast. Quick treatment can
help limit damage to the brain and increase the chance of a full
recovery.

What are the symptoms?

Symptoms of a stroke happen
quickly. A stroke may cause:

  • Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
  • Sudden vision changes.
  • Sudden trouble speaking.
  • Sudden confusion or trouble understanding simple statements.
  • Sudden problems with walking or balance.
  • A sudden, severe headache that is
    different from past headaches.

If you have any of these symptoms, call 911 or other emergency services right away.

FAST is a simple way to remember the main symptoms of stroke. Recognizing these symptoms helps you know when to call for medical help. FAST stands for:

  • Face drooping.
  • Arm weakness.
  • Speech difficulty.
  • Time to call 911.

See your doctor if you have
symptoms that seem like a stroke, even if they go away quickly. You may have
had a
transient ischemic attack (TIA), sometimes called a
mini-stroke. A TIA is a warning that a stroke may happen soon. Getting early
treatment for a TIA can help prevent a stroke.

What causes a stroke?

There are two types of
stroke:

  • An
    ischemic (say
    "iss-KEE-mick") stroke happens when a blood clot blocks a
    blood vessel in the brain. The clot may form in the blood vessel or travel from
    somewhere else in the blood system. About 8 out of 10 strokes are ischemic strokes. They are the most common type of stroke in older
    adults.
  • A
    hemorrhagic (say "heh-muh-RAW-jick") stroke develops when an artery in the
    brain leaks or bursts. This causes bleeding inside the brain or near the
    surface of the brain. Hemorrhagic strokes are less
    common but more deadly than ischemic strokes.

How is a stroke diagnosed?

You need to see a doctor right away. If a stroke is diagnosed quickly—right after symptoms start—doctors may be able to use medicines that can help you recover better.

The first thing the doctor needs to find out
is what kind of stroke it is: ischemic or hemorrhagic. This is important,
because the medicine given to treat a stroke caused by a blood clot could be
deadly if used for a stroke caused by bleeding in the brain.

To
find out what kind of stroke it is, the doctor will do a type of X-ray called a
CT scan of the brain, which can show if there is
bleeding. The doctor may order other tests to find the location of the clot or
bleeding, check for the amount of brain damage, and check for other conditions
that can cause symptoms similar to a stroke.

How is it treated?

For an ischemic stroke, treatment focuses on restoring blood flow to
the brain. You may be given a clot-dissolving medicine called
tissue plasminogen activator (TPA). This medicine can improve recovery from a stroke, especially if given as soon as possible after the
stroke happens. Doctors try to give this medicine within 3 hours after symptoms start. Some people may be helped if they are able to get this medicine within 4½ hours of their first symptoms.footnote 1 Other medicines may be
given to prevent blood clots and control symptoms. A procedure may be done to remove the blood clot and restore blood flow.

For a
hemorrhagic stroke, treatment focuses on stopping the bleeding in the brain. Doctors may give you medicine or a transfusion with parts of blood, such as plasma. They may do
surgery to drain the blood or to reduce pressure on the brain.
Medicines may be used to control blood pressure, brain swelling, and other
problems.

After either kind of stroke and after your condition is stable, treatment shifts to
preventing other problems and future strokes. You may need to take a number of
medicines to control conditions that put you at risk for stroke, such as high
blood pressure or atrial fibrillation. Some people need to have a
surgery to remove
plaque buildup from the blood vessels that supply the
brain (carotid arteries).

The best way to get
better after a stroke is to start
stroke rehabilitation (rehab). The goal of stroke rehab is to help you
regain skills you lost or to make the most of your remaining abilities. Stroke
rehab can also help you take steps to prevent future strokes. You have the
greatest chance of regaining abilities during the first few months after a
stroke. So it is important to start rehab soon after a stroke and do a little
every day.

How can you prevent another stroke?

After you have had a
stroke, you are at risk for having another one. But you can make some important
lifestyle changes that can reduce your risk of stroke and improve your overall
health.

Treat any health problems you have

  • Manage high blood pressure or high cholesterol by working with your doctor.
  • Manage diabetes. Keep your blood sugar levels within a target range.
  • If your doctor recommends taking aspirin or a blood thinner, take it.
  • Take your medicine exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
  • Get the flu vaccine every year.

Adopt a healthy lifestyle

  • Don't smoke or allow others to smoke around you.
  • Limit alcohol to 2 drinks a day for men and 1 drink a day for women.
  • Stay at a healthy weight. Being overweight makes it more likely you will develop high blood pressure, heart problems, and diabetes. These conditions make a stroke more likely.
  • Be active. Ask your doctor what type and level of activity is safe for you. If you are in a stroke rehab program, your rehab team can make an exercise program that is right for you.
  • Eat heart-healthy foods. These include fruits, vegetables, high-fiber foods, fish, and foods that are low in sodium, saturated fat, and trans fat.

Frequently Asked Questions

Learning about stroke:

Being diagnosed:

Getting treatment:

Ongoing concerns:

Living with stroke:

End-of-life issues:

Health Tools

Health Tools help you make wise health decisions or take action to improve your health.

Cause

Causes of ischemic stroke

An
ischemic stroke is caused by a blood clot that blocks blood flow to the brain.

  • A blood clot can form in an artery that supplies blood to the brain.
    • Blood clots usually form in arteries damaged by plaque buildup, which is a process called atherosclerosis.
    • Long-term high blood pressure or diabetes may damage smaller blood vessels in the brain, causing a clot to form within the blood vessels and block blood flow.
  • A blood clot can form in another part of the body (often the heart) and travel through the bloodstream to the brain. For example, clots may form:

Low blood pressure may also cause an
ischemic stroke, although this is less common. Low blood pressure results in reduced
blood flow to the brain. It may be caused by narrowed or diseased
arteries, a heart attack, a large loss of blood, or a severe infection.

Some surgeries (such as endarterectomy) or other procedures (such as
carotid artery stenting) that are used to treat narrowed carotid arteries may cause a blood
clot to break loose, resulting in a stroke.

Causes of hemorrhagic stroke

A
hemorrhagic stroke is caused by bleeding in or around the
brain.

  • Bleeding inside the brain itself (intracerebral hemorrhage, or ICH) may be a
    result of long-term high blood pressure or use of blood thinner medicine, such as anticoagulants.
  • Bleeding in the space around the
    brain (subarachnoid hemorrhage, or SAH) may be caused by a ruptured
    aneurysm or uncontrolled high blood pressure.

Other less common causes include head or neck injuries, certain diseases, and radiation treatment for cancer in the neck or brain.

Symptoms

If you have symptoms of a stroke,
call 911 or other emergency services right away. General symptoms of a
stroke include:

  • Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
  • Sudden vision changes.
  • Sudden trouble speaking.
  • Sudden confusion or trouble understanding simple statements.
  • Sudden problems with walking or balance.
  • A sudden, severe headache that is
    different from past headaches.

FAST is a simple way to remember the main symptoms of stroke. Recognizing these symptoms helps you know when to call for medical help. FAST stands for:

  • Face drooping.
  • Arm weakness.
  • Speech difficulty.
  • Time to call 911.

Symptoms can vary depending on whether the stroke is caused by
a blood clot (ischemic stroke) or bleeding (hemorrhagic stroke), where the stroke occurs in the brain, and how bad it is.

A stroke usually happens suddenly but may occur over hours. For example, you may have mild weakness at first. Over time, you may not be able to move the arm and leg on one side of your body.

If several smaller strokes occur over time, you may
have a more gradual change in walking, balance, thinking, or behavior. This is called multi-infarct dementia.

It isn't always easy for people to recognize symptoms of a
small stroke. They may mistakenly think the symptoms can be attributed to
aging. Or the symptoms may be confused with those of other conditions that
cause similar symptoms.

What Happens

When you have an
ischemic stroke, the oxygen-rich blood supply to part of your brain is reduced.
With a
hemorrhagic stroke, there is bleeding in the
brain.

After about 4 minutes without blood and oxygen,
brain cells become damaged and may die. The body tries to restore
blood and oxygen to the cells by enlarging other blood vessels (arteries) near
the area.

If blood supply isn't restored, permanent damage
usually occurs. The body parts
controlled by those damaged cells cannot function.

This loss of function may be mild or
severe. It may be temporary or permanent. It depends on where and how much of the
brain is damaged and how fast the blood supply can be returned to the affected
cells. Life-threatening complications may also occur. This is why it's important to get treatment as soon as possible.

Recovery

Recovery
depends on the location and amount of brain damage caused by the stroke, the
ability of other healthy areas of the brain to take over for the
damaged areas, and
rehabilitation. In general, the less damage there is
to the brain tissue, the less disability results and the greater the chances of
a successful recovery.

Stroke is the most common nervous-system–related cause of physical
disability. Of people who survive a stroke, half will
still have some disability 6 months after the stroke.

You have the greatest chance of regaining
your abilities during the first few months after a stroke. Regaining some
abilities, such as speech, comes slowly, if at all. About half of all people
who have a stroke will have some long-term problems with talking,
understanding, and decision-making. They also may have changes in behavior that
affect their relationships with family and friends.

After a stroke, you (or a caregiver)
may also notice:

Long-term problems

Long-term
complications of a stroke, such as
depression and
pneumonia, may develop right away or months to years
after a stroke.

Some long-term problems may be prevented with proper home
treatment and medical follow-up. For more information, see Home Treatment.

What Increases Your Risk

A risk factor is anything that makes you more likely to have a particular health problem. Risk factors for stroke that you can treat or change include:

  • High blood pressure (hypertension).
  • Atrial fibrillation.
  • Diabetes.
  • Smoking.
  • High cholesterol.
  • Heavy use of
    alcohol
    .
  • Being overweight.
  • Physical
    inactivity.

Risk factors you cannot change
include:

  • Age. The risk of stroke increases with age.
  • Race. African Americans, Native Americans, and Alaskan Natives
    have a higher risk than those of other races.
  • Gender. Women have a higher risk of having a stroke compared to men. In people ages 55 to 75, about 2 out of 10 women will have a stroke and 1 or 2 out of 10 men will have a stroke.
  • Family history. The risk for stroke is greater if
    a parent, brother, or sister has had a stroke or
    transient ischemic attack (TIA).
  • History
    of stroke or TIA.

When To Call a Doctor

Call 911 or other emergency services now if you have signs of a stroke:

  • Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
  • Sudden vision changes.
  • Sudden trouble speaking.
  • Sudden confusion or trouble understanding simple statements.
  • Sudden problems with walking or balance.
  • A sudden, severe headache that is
    different from past headaches.

Signs of a transient ischemic attack (TIA) are similar to signs of a stroke. But TIA symptoms usually disappear after 10 to 20 minutes, although they may last longer. There is no way to tell whether the symptoms are caused by a stroke or by TIA, so emergency medical care is needed for both conditions.

Call your doctor right away if you:

  • Have had recent symptoms of a TIA or stroke, even if
    the symptoms have disappeared.
  • Are taking
    aspirin or other medicines that prevent blood clotting and you notice any
    signs of bleeding.
  • Have a
    choking episode from food going down your windpipe.
  • Have signs of a blood clot in a
    deep blood vessel, which include redness, warmth, and
    pain in a specific area of your arm or leg.

Call your doctor for an appointment if you:

  • Think you have had a TIA in the past and have
    not talked with your doctor about it.
  • Have a
    pressure injury.
  • Notice that your affected arm or
    leg is becoming increasingly stiff or you are not able to straighten it
    (spasticity).
  • Notice signs of a urinary tract
    infection
    . Signs may include fever, pain with urination, blood in urine, and
    low back (flank) pain.
  • Are having trouble keeping
    your balance.

Who to see

Doctors who can diagnose and treat stroke
include:

If you need surgery or have other health problems, other
specialists may be consulted, such as a:

Some hospitals have a stroke team made up of many
different health professionals, such as a neurologist, a neuroradiologist, a physical therapist, an occupational
therapist, a speech therapist, a rehabilitation doctor (physiatrist), a nurse,
and a social worker.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

Tests in the emergency room

The first test after a stroke is
typically a
CT scan, a
series of X-rays that can show whether there is bleeding in the brain. This
test will show whether the stroke is ischemic or hemorrhagic.
You may also have an MRI.

Other initial tests recommended for ischemic stroke include:

Tests you may have later

If it seems that you may have a narrowing of
a
carotid artery, your doctor may want you to have a:

If your doctor
believes that the stroke may have been caused by a problem with your heart, an
echocardiogram or
Holter monitoring or telemetry test may be done.

Guidelines recommend that risk factors for heart disease also be
assessed after a stroke to prevent disability or death from a future heart
problem. This is because many people who have had a stroke also have
coronary artery disease.

Treatment Overview

Emergency treatment

Ischemic stroke

Measures will be taken to stabilize your vital signs,
including giving you medicines.

  • You may be given a clot-dissolving medicine called
    tissue plasminogen activator (TPA). This medicine can improve recovery from a stroke, especially if given as soon as possible after the
    stroke happens. Doctors try to give this medicine within 3 hours after symptoms start. Some people may be helped if they are able to get this medicine within 4½ hours of their first symptoms.footnote 1
  • You may also receive
    aspirin or
    another antiplatelet medicine.
  • In some cases, a procedure may be done to restore blood flow. The doctor uses a thin, flexible tube (catheter) and a tiny cage to remove the blood clot that caused the stroke.

Hemorrhagic stroke

Treatment includes efforts
to control bleeding, reduce pressure in the brain, and stabilize vital signs,
especially blood pressure.

  • To stop the bleeding, you may be given medicine or a transfusion of parts of blood, such as plasma. These are given through an IV.
  • You will be
    closely monitored for signs of increased pressure on the brain. These signs include
    restlessness, confusion, trouble following commands, and headache. Other
    measures will be taken to keep you from straining from excessive coughing,
    vomiting, or lifting, or straining to pass stool or change
    position.
  • If the bleeding is due to a ruptured
    brain aneurysm, surgery to repair the aneurysm may be
    done. For more information, see Surgery.
  • In some cases, medicines may be given to control blood
    pressure
    , brain swelling, blood sugar levels, fever, and seizures.
  • If a large amount of bleeding
    has occurred and symptoms are quickly getting worse, you may need surgery to
    remove the blood that has built up inside the brain and to lower pressure
    inside the head.

Preventing another stroke

Your treatment will also focus on
preventing another
stroke. This may include:

  • Reducing
    high blood pressure, the most common risk factor for
    stroke, by making changes to your diet and taking medicines that lower blood pressure.
  • Taking aspirin or another antiplatelet medicine to
    prevent strokes. For more information, see Medications.
  • Controlling
    diabetes. Your doctor will advise you to try to keep
    your blood sugar levels in a target range. To do this, you may
    need to take insulin or other diabetes medicine. A healthy diet and plenty of exercise will also help.
  • Getting a flu shot every year to
    help you avoid getting sick from the
    flu.

You may also need to make lifestyle changes such
as quitting smoking, eating heart-healthy foods, and being active. For more information, see Prevention.

If your
carotid arteries are significantly blocked, you may
need a procedure to reopen the narrowed arteries. For more information, see Surgery and Other Treatment.

Tips for a successful recovery

  • Be as involved as possible in your care. You may feel like letting a caregiver take charge. But the
    more you can participate, the better.
  • Recognize symptoms of depression and ask for help. Symptoms include feeling sad or hopeless all the time, or losing interest in activities that used to make you happy. Depression is common in people who have had a stroke. The sooner you know if you are depressed, the sooner you can get treatment. Treatment can help you feel better.
  • Get into a
    stroke rehabilitation (rehab) program
    as soon as possible.

Rehab

Starting a
rehab program as soon as possible after a
stroke increases your chances of regaining some of the abilities you
lost.

Your
rehab will be based on the physical abilities that were lost, your
general health before the stroke, and your ability to participate.
Rehab begins with helping you resume activities of daily living, such
as eating, bathing, and dressing. Rehab can also help you make changes in your lifestyle, at
home, at work, and in relationships. The changes you make will depend on how the stroke affected you.

Rehab can help you to:

  • Do as well as you can and be as independent as
    possible.
  • Learn to live with the changes to your brain and body
    caused by the stroke.
  • Adjust to living within your home, family,
    and community.

If you are someone whose loved one has had a stroke, you can play an important role in that person's recovery by providing support and encouragement.

It's not
possible to predict how much ability you will regain. The
more ability you retain immediately after a stroke, the more independent you
are likely to be when you are discharged from the hospital. For more information, see the topic
Stroke Rehabilitation.

Long-term care

Some people move to a care facility that can meet their needs. There are several kinds of long-term care. Each provides different levels of care, assistance, and services. The quality and costs of care and services at long-term care facilities vary
widely, and options vary from one community to another. Your doctor or rehab team can help you find which type of long-term care would be best for you.

Palliative care

Palliative care is a kind of care for people who have a serious illness. It's different from care to cure your illness. Its goal is to improve your quality of life—not just in your body but also in your mind and spirit.

You can have this care along with treatment to cure your illness. You can also have it if treatment to cure your illness no longer seems like a good choice.

Palliative care providers will work to help control pain or side effects. They may help you decide what treatment you want or don't want. And they can help your loved ones understand how to support you.

If you're interested in palliative care, talk to your doctor.

For more information, see
the topic
Palliative Care.

End-of-life care

A time may come when treatment for your illness no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief. But you can still get treatment to make you as comfortable as possible during the time you have left. You and your doctor can decide when you may be ready for hospice care.

For more information, see
the topics:

Prevention

You can help prevent a stroke if you
control risk factors and treat other medical conditions that can lead to a
stroke. You can help prevent a TIA or stroke by taking steps toward a heart-healthy lifestyle.

Know your stroke risk

Your doctor can help you know your risk. These are some of the common risk factors for stroke:

  • You have atrial fibrillation.
  • You smoke.
  • You have high blood pressure.
  • You have high cholesterol.
  • You have diabetes.
  • You are overweight.
  • You do not exercise on a regular basis.
  • You drink large amounts of alcohol.

Treat any health problems you have

  • Manage high blood pressure or high cholesterol by working with your doctor.
  • Manage diabetes. Keep your blood sugar levels within a target range.
  • If your doctor recommends that you take aspirin or a blood thinner, take it.
  • Take your medicine exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.

Adopt a healthy lifestyle

  • Don't smoke or allow others to smoke around you. For more information, see the topic Quitting Smoking.
  • Limit alcohol to 2 drinks a day for men and 1 drink a day for women.
  • Stay at a healthy weight. Being overweight makes it more likely you will develop high blood pressure, heart problems, and diabetes. These conditions make a stroke more likely.
  • Try to do at least 2½ hours a week of
    moderate exercise. One way
    to do this is to be active 30 minutes a day, at least 5 days a week. Or try to do
    vigorous activity at least 1¼ hours a week.
  • Eat heart-healthy foods. These include fruits, vegetables, high-fiber foods, and foods that are low in sodium, saturated fat, and trans fat. Eat fish at least 2 times each week. Oily fish, which contain omega-3 fatty acids, are best. These fish include salmon, mackerel, lake trout, herring, and sardines.

Home Treatment

Tips for dealing with the effects of a stroke

  • Use a cane or a walker to help prevent falls.
  • Manage getting dressed. Talk with an
    occupational therapist about devices—such as reachers, sock aids, and buttonhooks—that
    can help you get dressed.
  • Manage vision problems. After a stroke, some people have problems seeing to one side. For example, people with right-sided paralysis may have difficulty seeing to the right.
  • Don't neglect your affected side. It's natural to favor the side of your body that wasn't affected by stroke. But it's important to pay attention to the rest of your body too.
  • Manage eating problems. You may not be able to feel
    food on one or both sides of your mouth. This increases your risk for choking.
    You may need further tests or an evaluation by a speech therapist.

  • Manage bladder problems, such as emptying your bladder regularly.
    Some people suffer loss of bladder control after a stroke. But this is usually temporary.

Tips for family members and caregivers

  • Provide support and encouragement. Strong support from the family can be a big help in stroke recovery.
  • Help
    with speech problems
    . Your loved one may have trouble communicating, which can be very frustrating. You can help by speaking slowly
    and directly and listening carefully.

Medications

Your doctor will probably prescribe several medicines after you have had a stroke. Medicines to prevent blood clots are typically used, because blood clots can cause TIAs and strokes.

The types of medicines that prevent clotting are:

  • Anticoagulant medicines.
  • Antiplatelet medicines.

Cholesterol-lowering and blood-pressure–lowering medicines are also used to prevent TIAs and strokes.

Anticoagulant medicines

Anticoagulants prevent blood clots from forming and keep existing blood clots from getting bigger.

You may need to take this type of medicine after a stroke if you have atrial fibrillation or another condition that makes you more likely to have another stroke. For more information, see the topic Atrial Fibrillation.

Antiplatelet medicines

Antiplatelet medicines keep
platelets in the blood from sticking together.

These medicines include:

  • Aspirin (for example, Bayer).
  • Aspirin combined with dipyridamole (Aggrenox).
  • Other antiplatelet medicines, such as clopidogrel (Plavix).

Statins

Statins lower cholesterol and your risk for another stroke.

Blood pressure medicines

If you have high blood pressure, your doctor may want you to take medicines to lower it. Blood pressure medicines include:

Other medicines

Medicines used to treat depression and pain may also be
prescribed after a stroke.

Surgery

When surgery is being considered after a
stroke, your age, prior overall health, and current
condition are major factors in the decision.

Surgery for ischemic stroke

If you have serious blockage in the carotid arteries in your neck, you may need a carotid endarterectomy. During this surgery, a surgeon removes plaque buildup in the carotid arteries. The benefits and risks of this surgery must be carefully weighed, because the surgery itself may cause a stroke.

Surgery for hemorrhagic stroke

Treatment for hemorrhagic stroke may include surgery to:

  • Drain or remove blood that is in or around the brain.
  • Repair a brain aneurysm.
    • In an endovascular embolization, soft metal coils or mesh is inserted into the aneurysm to block it off and stop or prevent bleeding.
    • In a craniotomy, a small metal clip is placed around the base of the aneurysm to block it off. This stops the bleeding in the brain.
  • Remove or
    block off abnormally formed blood vessels (arteriovenous malformation) that
    have caused bleeding in the brain.

Other Treatment

Carotid artery stenting (also called carotid angioplasty and stenting) is sometimes done as an alternative to surgery to prevent stroke.

In this procedure, a doctor threads a thin tube called a catheter through an artery in the groin and up to the carotid artery in your neck. The doctor then uses a tiny balloon to enlarge the narrowed portion of the artery and places a stent to keep the artery open.

Carotid artery stenting is not as common as carotid endarterectomy, a type of surgery.

Other Places To Get Help

Organizations

American College of Cardiology: CardioSmart
www.cardiosmart.org
National Stroke Association (U.S.)
www.stroke.org

American Stroke Association
www.strokeassociation.org

References

Citations

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Credits

ByHealthwise StaffPrimary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine Martin J. Gabica, MD - Family Medicine Kathleen Romito, MD - Family Medicine Adam Husney, MD - Family Medicine Specialist Medical Reviewer Richard D. Zorowitz, MD - Physical Medicine and Rehabilitation

Current as ofDecember 19, 2017