A stroke occurs due to a decrease in oxygen to the brain. Symptoms can include facial drooping, speech problems, and arm weakness. It is a medical emergency.

A stroke occurs when a blockage or bleed of the blood vessels either interrupts or reduces the supply of blood to the brain. When this happens, the brain does not receive enough oxygen or nutrients, and brain cells start to die.

Stroke is a cerebrovascular disease. This means that it affects the blood vessels that feed the brain oxygen. If the brain does not receive enough oxygen, damage may start to occur.

This is a medical emergency. Although many strokes are treatable, some can lead to disability or death.

Read on to learn more about strokes, including the symptoms and causes, treatment options, and more.

There are three main types of stroke:

  • Ischemic stroke: Ischemic stroke is the most common type of stroke, making up 87% of all cases. A blood clot prevents blood and oxygen from reaching an area of the brain.
  • Hemorrhagic stroke: Hemorrhagic stroke occurs when a blood vessel ruptures. This is usually the result of aneurysms or arteriovenous malformations (AVMs).
  • Transient ischemic attack (TIA): TIA occurs when blood flow to a part of the brain is inadequate for a brief period of time. Normal blood flow resumes after a short amount of time, and the symptoms resolve without treatment. Some people call this a “ministroke.”

The symptoms of a stroke often appear without warning. Some of the main symptoms include:

  • confusion, including difficulty speaking and understanding speech
  • a headache, possibly with altered consciousness or vomiting
  • numbness or an inability to move parts of the face, arm, or leg, particularly on one side of the body
  • vision problems in one or both eyes
  • difficulty walking, including dizziness and a lack of coordination

Symptoms vary and may range in severity.

Learning the acronym “FAST” is a good way to remember the symptoms of stroke. This can help a person seek prompt treatment. FAST stands for:

  • Face drooping: If the person tries to smile, does one side of their face droop?
  • Arm weakness: If the person tries to raise both their arms, does one arm drift downward?
  • Speech difficulty: If the person tries to repeat a simple phrase, is their speech slurred or unusual?
  • Time to act: If any of these symptoms are occurring, contact the emergency services immediately.

Each type of stroke has a different set of potential causes. Generally, however, stroke is more likely to affect a person if they:

  • have overweight or obesity
  • are aged 55 years or older
  • have a personal or family history of stroke
  • have high blood pressure
  • have diabetes
  • have high cholesterol
  • have heart disease, carotid artery disease, or another vascular disease
  • do not get enough physical activity or exercise
  • regularly consume alcohol
  • smoke

Ischemic stroke

ischemic stroke occurs due to blockages or narrowing in the arteries that provide blood to the brain. This causes ischemia, or a severely reduced blood flow, which damages brain cells.

Blood clots often cause ischemic stroke. Clots can form in the brain arteries and other blood vessels in the body. The bloodstream carries these into narrower arteries in the brain.

Fatty plaque deposits within the arteries can also cause clots that result in ischemia.

Hemorrhagic stroke

Leaky or burst arteries in the brain can give rise to hemorrhagic strokes.

Leaked blood puts pressure on brain cells and damages them. It also reduces the blood supply that can reach the brain tissue after the hemorrhage.

Blood vessels can burst and spill blood into the brain or near the surface of the brain. This may also send blood into the space between the brain and the skull.

Conditions that increase the likelihood of hemorrhagic stroke include:

Intracerebral hemorrhage is a type of hemorrhagic stroke. This occurs when brain tissue floods with blood after an artery bursts.

Subarachnoid hemorrhage is another type of hemorrhagic stroke. In a subarachnoid hemorrhage, bleeding occurs in the area between the brain and the thin tissues that cover it.

TIA

TIA only briefly interrupts the flow of blood to the brain. It is similar to ischemic strokes, in that they occur due to clots.

People should treat them as medical emergencies, even if the symptoms are temporary. They serve as warning signs for future strokes and indicate a partially blocked artery or clot source in the heart.

According to the Centers for Disease Control and Prevention (CDC), over a third of people who experience a TIA have a major stroke within a year if they do not receive any treatment. Around 10% to 15% of people will have a major stroke within 3 months of experiencing a TIA.

Stroke begins rapidly. For the best outcome, a person should receive a diagnosis and treatment as soon as possible. As some communities have integrated stroke treatment teams in their emergency medical services, it is better to call 911 than drive somebody to the hospital.

The doctor may begin by performing a physical examination and asking questions about symptoms. There are several different diagnostic tests a doctor may then use to determine the type of stroke. These can include:

  • CT scan: A series of X-rays can show hemorrhages, strokes, tumors, and other conditions within the brain.
  • MRI scan: MRIs use radio waves and magnets to create an image of the brain, which a doctor can use to detect damaged brain tissue.
  • Digital subtraction angiography (DSA): A doctor may inject a dye into the brain’s blood vessels to make them visible under X-ray or MRI. This provides a detailed view of the blood vessels in the brain.
  • Electrocardiogram (EKG): This creates a detailed image of the heart, which doctors can use to check for any sources of clots that could have traveled to the brain.
  • Blood tests: A doctor may perform blood tests to determine if there is a high risk of bleeding or blood clots, measuring levels of particular substances in the blood, including clotting factors, and checking whether or not an infection is present.

It is only possible to confirm the type of stroke using a brain scan in a hospital environment.

Because ischemic and hemorrhagic strokes have different causes and effects on the body, they require different treatments.

Rapid diagnosis is important for reducing brain damage and enabling the doctor to treat the stroke using a suitable method for the type.

The sections below cover the treatment options a stroke, as well as some general rehabilitation tips.

Ischemic stroke

Treatments for ischemic stroke include:

  • an injection of tissue plasminogen activator (tPA) within 4.5 hours after the onset of symptoms to break down blood clots and prevent others from forming
  • aspirin if tPA is uinsuitable
  • possible thrombectomy to remove blood clots
  • carotid endarterectomy if the stroke is due to carotid artery disease

Terms explained

Tissue plasminogen activator (tPA) is a protein. The injectable medication converts plasminogen to plasmin, an enzyme that helps dissolve blood clots that are blocking blood flow to the brain.

tPA is generally more effective if a person receives it within 4.5 hours after they first expereince symptoms of an ischemic stroke. It is essential to receive a diagnosis and treatment as early as possible.

Hemorrhagic stroke

Treatment for a hemorrhagic stroke focuses on controlling the bleeding and reducing the pressure on the brain.

Treatment often begins with taking drugs that reduce pressure in the brain and control overall blood pressure, as well as preventing seizures and any sudden constrictions of blood vessels.

If a person is taking blood-thinning anticoagulants or antiplatelet medication, such as warfarin or clopidogrel, they can receive medications to counter the effects of the blood thinners.

Surgeons can repair some of the problems with blood vessels that have led or could lead to hemorrhagic strokes. Doctors may recommend a procedure such as:

  • aneurysm clipping to stop blood flow and shrink the aneurysm
  • coil embolization to block blood flow to the aneurysm
  • surgery to temporarily remove part of the skull if there is a lot of fluid
  • surgery or radiation to shrink or remove an AVM
  • blood transfusion to replace lost blood

TIA

If a person has a TIA, treatment will be necessary to help prevent another TIA or stroke.

Following a TIA, a doctor may recommend:

  • taking aspirin or other antiplatelet medication
  • taking anticoagulants
  • taking blood pressure medication to manage high blood pressure
  • taking statins to manage high cholesterol
  • carotid endarterectomy in some cases

It will also be important to:

  • consume a heart healthy diet
  • get enough regular physical activity or exercise
  • quitting smoking if applicable
  • avoiding alcohol

Rehabilitation

Stroke is a potentially life changing event that can have lasting physical and emotional effects.

Successful recovery from a stroke will often involve specific therapies and support systems, including:

  • Speech therapy: This helps with problems producing or understanding speech. Practice, relaxation, and changing communication style can all make communicating easier.
  • Physical therapy: This can help a person relearn movement and coordination. It is important to stay active, even though this may be difficult at first.
  • Occupational therapy: This can help a person improve their ability to carry out daily activities, such as bathing, cooking, dressing, eating, reading, and writing.
  • Support groups: Joining a support group can help a person cope with common mental health issues that can occur after a stroke, such as depression. Many find it useful to share common experiences and exchange information.
  • Support from friends and family: Close friends and relatives should try to offer practical support and comfort after a stroke. Letting friends and family know what they can do to help is very important.

Rehabilitation is an important and ongoing part of stroke treatment. With the right assistance and the support of loved ones, regaining a normal quality of life is usually possible, depending on the severity of the stroke.

The best way to prevent a stroke is to address the underlying causes. People can do this by making lifestyle changes such as:

  • consuming penty of fruits and vegetbles
  • maintaining a moderate weight
  • getting enough regular physical activity or exercise
  • avoiding smoking
  • avoiding alcohol, or only drinking moderately

Other measures a person can take to help reduce the risk of stroke include:

  • managing their blood pressure levels
  • managing diabetes if applicable
  • treating heart disease if applicab le

As well as making these lifestyle changes, taking anticoagulant or antiplatelet medications can also reduce the risk of experiencing another stroke.

Undergoing cardiac artery, carotid artery, or brain aneurysm surgery can also lower the risk of additional strokes, as can some other surgical options still under investigation.

There are three main types of stroke: ischemic stroke, hemorrhagic stroke, and transient ischemic stroke. They happen when there is a decrease in oxygen to the brain.

Some of the main symptoms of a stroke include a drooping face, weakness of the arm, and speech difficulties. It is important to seek immediate medical help if a person suspects a stroke.

Treatment for a stroke can depend on the type and cause, but may include tissue plasminogen activator (tPA), antiplatelets, anticoagulants, and surgery.

Speak with a doctor if there are concerns about the risk factors for a stroke. Managing some underlying conditions, consuming a balanced diet with plenty of fruits and vegetables, maintaining a moderate weight, and avoiding smoking and alcohol can help reduce the likelihood of a stroke.