Stroke
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What is a stroke?
A stroke occurs when the blood supply to part of the brain is cut off or reduced, causing brain tissue to become deprived of oxygen and nutrients. Within minutes, brain cells begin to die.
A stroke is a medical emergency. Immediate treatment is crucial.
Early intervention can minimize brain damage and the risk of complications.
The good news is that strokes can be prevented.
What Are the Symptoms?
Be aware of the following signs and symptoms if you think you or someone else might be having a stroke.
Pay attention to when the signs and symptoms begin to appear.
The duration of your signs and symptoms may influence your treatment options:
01
Difficulty speaking and understanding speech.
You may feel confused.
Your speech may become slurred, or you may have trouble understanding what others are saying.
02
Paralysis or numbness in the face, arms, or legs.
You may experience sudden numbness, weakness, or paralysis in your face, arm, or leg. This often occurs on only one side of the body.
Try raising both arms above your head at the same time.
If one arm starts to droop, you may be having a stroke. In addition, one side of your mouth may droop when you try to smile.
03
Vision problems in one or both eyes.
Vision in one or both eyes may suddenly become blurry or go dark, or you may experience double vision.
04
Headache.
A sudden, severe headache—which may be accompanied by vomiting, dizziness, or changes in consciousness—may indicate that you are having a stroke.
05
Difficulty walking.
You may stumble or experience sudden dizziness, loss of balance, or loss of coordination.
Act Now: FAST
Seek medical help immediately if you notice any signs or symptoms of a stroke, even if the symptoms seem to come and go or disappear. Remember “FAST” and do the following:
F
Face — Face.
Ask that person to smile. Is one side of their face drooping?
A
Arms — Arms.
Ask the person to raise both arms. Does one arm drop? Or is one arm unable to be raised?
S
Speech — Speaking.
Ask the person to repeat a simple sentence. Does their speech sound slurred or strange?
T
Time — Time.
If you notice any of these signs, call 911 immediately, as indicated on the source page.
What Causes a Stroke?
A stroke can be caused by a blocked artery (ischemic stroke) or a leaking or ruptured blood vessel (hemorrhagic stroke). Some people may experience only a temporary disruption in blood flow to the brain (a transient ischemic attack, or TIA) that does not cause permanent damage.
About 80 percent of strokes are ischemic strokes.
Ischemic stroke
An ischemic stroke occurs when an artery leading to the brain narrows or becomes blocked, causing a significant reduction in blood flow (ischemia). The most common types of ischemic stroke include:
• Thrombotic stroke. A thrombotic stroke occurs when a blood clot (thrombus) forms in one of the arteries that supply blood to the brain. The clot may be caused by fatty deposits (plaque) that build up in the arteries and restrict blood flow (atherosclerosis), or by other arterial conditions.
• Embolic stroke. An embolic stroke occurs when a blood clot or other material forms far from the brain—usually in the heart—and is then carried by the bloodstream and becomes lodged in a narrower artery in the brain.
Hemorrhagic stroke
A hemorrhagic stroke occurs when a blood vessel in the brain leaks or bursts. Brain hemorrhage can be caused by various conditions that affect blood vessels, including:
• Uncontrolled high blood pressure (hypertension)
• Excessive use of anticoagulants (blood thinners)
• A weak spot in the wall of a blood vessel (aneurysm)
Transient ischemic attack (TIA)
A transient ischemic attack (TIA) is sometimes referred to as a “mini-stroke.” A temporary reduction in blood flow to part of the brain causes a TIA, which can last as little as five minutes.
Like an ischemic stroke, a TIA occurs when a clot or other material blocks blood flow to part of the nervous system. However, there is no permanent tissue damage and no lingering symptoms.
Seek emergency medical help even if your symptoms seem to have gone away.
Having a TIA puts you at greater risk of having a full-blown stroke that causes permanent damage later on.
What Are the Risk Factors?
Many factors can increase your risk of stroke.
Stroke risk factors that can potentially be managed include:
• Overweight or obesity
• Lack of physical activity
• Heavy or excessive alcohol consumption on a single occasion
• Use of illegal drugs, such as cocaine and methamphetamine
• Blood pressure readings higher than 120/80 millimeters of mercury (mmHg)
• Smoking or exposure to secondhand smoke
• High cholesterol
• Diabetes, Obstructive Sleep Apnea
• Cardiovascular diseases, including heart failure, heart defects, heart infections, or abnormal heart rhythms; a personal or family history of stroke, heart attack, or transient ischemic attack
Other factors associated with a higher risk of stroke include:
• Age. People aged 55 or older have a higher risk of stroke than younger people.
• Race. The source page states that African Americans have a higher risk of stroke than people of other races.
• Gender. Men are at a higher risk of stroke than women. Women are typically older when they have a stroke and are more likely to die from a stroke than men.
• Hormones. The use of birth control pills or hormone therapy containing estrogen, as well as increased estrogen levels resulting from pregnancy and childbirth.
How can it be prevented?
Knowing your stroke risk factors, following your doctor’s recommendations, and adopting a healthy lifestyle are the best steps you can take to prevent a stroke.
Many stroke prevention strategies are the same as those for preventing heart disease.
In general, recommendations for a healthy lifestyle include:
01
Controlling high blood pressure (hypertension).
This is one of the most important things you can do to reduce your risk of stroke. If you’ve ever had a stroke, lowering your blood pressure can help prevent a TIA or another stroke. In addition to recommending lifestyle changes, your doctor may prescribe medication to treat high blood pressure.
02
Reduce the amount of cholesterol and saturated fat in your diet.
Eating less cholesterol and fat—especially saturated and trans fats—can reduce plaque in the arteries. If you can’t control your cholesterol through dietary changes alone, your doctor may prescribe cholesterol-lowering medication.
03
Stop using tobacco.
Smoking increases the risk of stroke in smokers and nonsmokers exposed to secondhand smoke. Quitting tobacco use reduces the risk of stroke.
04
Managing diabetes.
You can manage diabetes through diet, exercise, weight control, and medication.
05
Maintain a healthy weight.
Being overweight contributes to other stroke risk factors, such as high blood pressure, cardiovascular disease, and diabetes. Losing just 10 pounds—about 4.5 kg—can lower blood pressure and improve cholesterol levels.
06
Eat a diet rich in fruits and vegetables.
A diet that includes five or more servings of fruits or vegetables each day can reduce the risk of stroke. Following a Mediterranean diet—which emphasizes olive oil, fruits, nuts, vegetables, and whole grains—can help.
07
Exercise regularly.
Aerobic exercise, or “cardio,” reduces the risk of stroke in several ways. Exercise can lower blood pressure, increase high-density lipoprotein (HDL) cholesterol levels, and improve overall heart and blood vessel health. Exercise also helps with weight loss, managing diabetes, and reducing stress. Gradually increase your activity to 30 minutes—such as walking, jogging, swimming, or biking—most days, or even every day, of the week.
08
Consume alcohol in moderation, if you choose to drink at all.
The source page explains that alcohol can be both a risk factor and a protective factor against stroke. Heavy alcohol consumption increases the risk of high blood pressure, ischemic stroke, and hemorrhagic stroke. However, according to the source, consuming small to moderate amounts of alcohol—such as one drink a day—may help prevent ischemic stroke and reduce the blood’s tendency to clot. Alcohol can also interact with other medications you’re taking. Talk to your doctor about what’s right for you.
09
Managing obstructive sleep apnea (OSA).
The source page states that doctors may recommend an overnight oxygen test to screen for OSA, a sleep disorder that causes oxygen levels to drop periodically during the night. The source also notes that OSA treatment includes supplemental oxygen at night or the use of a small oral device to aid breathing.
10
Avoiding illegal drugs.
Certain street drugs, such as cocaine and methamphetamine, are known risk factors for TIA or stroke. Cocaine reduces blood flow and can narrow the arteries.
Preventive Medication
If you have ever had an ischemic stroke or a TIA, your doctor may recommend medication to help reduce your risk of another stroke.
Diagnosis
01
Physical examination.
In addition to taking a complete medical history through an interview, the doctor will check your blood pressure and use a stethoscope to listen to your heart and for murmurs in the neck arteries (carotid arteries), which may indicate atherosclerosis.
02
Blood test.
The doctor will check your blood clotting, blood sugar, and important blood chemicals.
03
Computed tomography (CT scan).
A CT scan uses a series of X-rays to produce detailed images of the brain. A CT scan can reveal bleeding, tumors, strokes, and other conditions. A doctor may inject a contrast agent into the bloodstream to view the blood vessels in the neck and brain in greater detail (CT angiography).
04
Magnetic resonance imaging (MRI).
MRI uses radio waves and a strong magnetic field to produce detailed images of the brain. MRI can detect brain tissue damaged by ischemic stroke as well as brain hemorrhage. Doctors can inject a contrast agent into a blood vessel to visualize arteries and veins and clarify blood flow (magnetic resonance angiography or magnetic resonance venography).
05
Carotid ultrasound.
During this test, sound waves produce detailed images of the inside of the carotid arteries in the neck. This test shows the buildup of fatty deposits (plaque) and blood flow in the carotid arteries.
06
Cerebral angiogram.
During this procedure, the doctor inserts a thin, flexible tube (catheter) through a small incision, usually in the groin, and guides it through a major artery to the carotid or vertebral artery. The doctor then injects a contrast agent into the blood vessel so that it appears on X-ray images. This procedure provides a detailed view of the arteries in the brain and neck.
07
Echocardiogram.
An echocardiogram uses sound waves to produce detailed images of the heart. An echocardiogram can detect blood clots in the heart that may travel from the heart to the brain and cause a stroke.
Lifestyle and Home Care
Lifestyle changes can help you manage and prevent high blood pressure, even if you’re currently taking blood pressure medication.
Here are some things you can do:
1. Eat healthy foods. Put this into practice healthy eating habits.
Try the DASH (Dietary Approaches to Stop Hypertension) diet, which emphasizes fruits, vegetables, whole grains, poultry, fish, and low-fat dairy products.
• Get enough potassium, which can help prevent and control high blood pressure.
• Reduce your intake of saturated and trans fats.
• Reduce the amount of salt in your diet.
2. Maintain a healthy weight.
Maintaining a healthy weight—or losing weight if you are overweight or obese—can help control high blood pressure and reduce the risk of related health problems.
If you are overweight, losing just 5 pounds (2.3 kilograms) can lower your blood pressure.
3. Improve physical activity.
Regular physical activity can help lower blood pressure, manage stress, reduce the risk of certain health problems, and keep weight under control.
For most healthy adults, the Department of Health and Human Services recommends at least 150 minutes of moderate-intensity aerobic activity per week or 75 minutes of vigorous-intensity aerobic activity per week, or a combination of moderate- and vigorous-intensity activities.
Try to do strength training at least two days a week.
4. Limit your alcohol intake.
Even if you're healthy, alcohol can raise your blood pressure.
If you choose to drink alcohol, do so in moderation.
For healthy adults, this means up to one standard drink per day for women of all ages and men over 65, and up to two standard drinks per day for men 65 or younger.
5. Do not smoke or quit smoking
Tobacco damages the walls of blood vessels and accelerates the hardening of the arteries. If you smoke, ask your doctor for help to quit.
6. Manage stress.
Reduce stress as much as possible.
Practice healthy stress-management techniques, such as muscle relaxation, deep breathing, or meditation. Regular physical activity and getting enough sleep can also help. Read more on the page stress management.
Monitor your blood pressure at home. Monitoring your blood pressure at home can help you keep a closer eye on it, show whether your medication is working, and even alert you and your doctor to potential complications. Home blood pressure monitoring is not a substitute for a doctor’s visit, and home blood pressure monitors may have some limitations. Even if your readings are normal, do not stop or change your medication or alter your diet without first consulting your doctor.
If your blood pressure is under control, you may be able to reduce the frequency of your doctor visits by monitoring your blood pressure at home.
Practice relaxation or slow, deep breathing. Practice taking deep, slow breaths to help calm yourself. There are several devices that can help with slow, deep breathing. However, it remains unclear whether these devices have a significant effect on lowering blood pressure.
Manage your blood pressure during pregnancy. If you are a woman with high blood pressure, talk to your doctor about how to manage your blood pressure during pregnancy.
Treatment
Emergency treatment for a stroke depends on whether you are experiencing an ischemic stroke, which blocks an artery—the most common type—or a hemorrhagic stroke, which involves bleeding into the brain.
Ischemic stroke
To treat an ischemic stroke, doctors must immediately restore blood flow to the brain.
Emergency treatment with medication. Treatment with clot-busting medication must begin within 4.5 hours if administered intravenously, and the sooner the better. Prompt treatment not only improves the chances of survival but can also reduce complications. You may be given:
• Intravenous injection of tissue plasminogen activator (tPA).
An injection of recombinant tissue plasminogen activator (tPA), also known as alteplase, is referred to as the gold standard for treating ischemic stroke on the source page. The tPA injection is usually administered through a vein in the arm. This powerful clot-busting medication should ideally be administered within three hours. In some cases, tPA can be administered up to 4.5 hours after stroke symptoms first appear.
Emergency endovascular procedures. Doctors sometimes treat ischemic strokes with procedures performed directly inside the blocked blood vessel. These procedures must be performed as soon as possible, depending on the characteristics of the blood clot.
Several large, recent studies cited on the source page indicate that, depending on the location of the clot and other factors, endovascular therapy may be the most effective treatment. Endovascular therapy has been shown to significantly improve outcomes and reduce long-term disability following an ischemic stroke.
Other procedures. To reduce the risk of a future stroke or transient ischemic attack, your doctor may recommend a procedure to open an artery that has narrowed due to plaque buildup.
Hemorrhagic stroke
Emergency treatment for hemorrhagic stroke focuses on controlling bleeding and reducing pressure in the brain.
You may also need surgery to help reduce future risks.
Emergency measures. If you are taking warfarin (Coumadin, Jantoven) or an antiplatelet medication such as clopidogrel (Plavix) to prevent blood clots, you may be given medication or a blood product transfusion to counteract the blood-thinning effects of these medications.
You may also be prescribed medication to reduce pressure in the brain (intracranial pressure), lower blood pressure, prevent vasospasm, or prevent seizures.
Once the bleeding in the brain has stopped, treatment typically involves supportive medical care while the body absorbs the blood. The recovery process is similar to that of a severe bruise healing. If the area of bleeding is extensive, a doctor may perform surgery to remove the blood and reduce pressure on the brain.