Stroke: MedlinePlus Medical Encyclopedia
A stroke occurs when blood flow to a part of the brain stops. A stroke is sometimes called a "brain attack."
If blood flow is cut off for longer than a few seconds, the brain cannot get nutrients and oxygen. Brain cells can die, causing lasting damage.
A stroke can also occur if a blood vessel inside the brain bursts, leading to bleeding inside the head.
There are two major types of stroke:
Ischemic stroke
Hemorrhagic stroke
Ischemic stroke occurs when a blood vessel that supplies blood to the brain is blocked by a blood clot. This may happen in two ways:
A clot may form in an artery that is already very narrow. This is called a thrombotic stroke.
A clot may break off from another place in the blood vessels of the brain, or from some other part of the body, and travel up to the brain. This is called cerebral embolism, or an embolic stroke.
Ischemic strokes may also be caused by a sticky substance called plaque that can clog arteries.
A hemorrhagic stroke occurs when a blood vessel in part of the brain becomes weak and bursts open. This causes blood to leak into the brain. Some people have defects in the blood vessels of the brain that make this more likely. These defects may include:
(weak area in the wall of a blood vessel that causes the blood vessel to bulge or balloon out)
(AVM; abnormal connection between the arteries and veins)
(CAA; condition in which proteins called amyloid build up on the walls of the arteries in the brain)
Hemorrhagic strokes may also occur when someone is taking blood thinners, such as dabigatran, rivaroxaban, apixaban, edoxaban and warfarin or has a bleeding disorder. Very high blood pressure may cause blood vessels to burst, leading to hemorrhagic stroke.
An ischemic stroke can develop bleeding and become a hemorrhagic stroke.
is the main
. Other major risk factors are:
Irregular heartbeat, called
Smoking
Family history of stroke
Being male
Increasing age, especially after age 55
Ethnicity (African Americans are more likely to die of a stroke)
Obesity
History of prior stroke or
(occurs when blood flow to a part of the brain stops for a brief time)
Stroke risk is also higher in:
People who have heart disease or
caused by narrowed arteries
People who have
habits such as excessive use of alcohol, use of recreational drugs, a high-fat diet, or lack of exercise
People who have a hereditary tendency to develop blood clots
Women who take birth control pills (especially those who smoke and are older than 35)
Women who are pregnant
Women who take hormone replacement therapy
, a hole between the left and right atria (upper chambers) of the heart
People who have sleep disorders (such as
)
Symptoms of stroke depend on which part of the brain is damaged. In some cases, a person may not know that a stroke has occurred.
Most of the time, symptoms develop suddenly and without warning. But symptoms may occur on and off for the first day or two. Symptoms are usually most severe when the stroke first happens, but they may slowly get worse.
A headache may occur if the stroke is caused by bleeding in the brain. The headache:
Starts suddenly and may be severe
May be worse when you are lying flat
May wake you up from sleep
May get worse when you change positions or when you bend, strain, or cough
Other symptoms depend on how severe the stroke is, and what part of the brain is affected. Symptoms may include:
(including sleepiness, unconsciousness, and coma)
Changes in hearing or taste
Changes that affect touch and the ability to feel pain, pressure, or different temperatures
or loss of memory
Problems writing or reading
or abnormal feeling of movement (vertigo)
Eyesight problems, such as decreased vision, double vision, or total loss of vision
Lack of control over the bladder or bowels
Loss of balance or coordination, or trouble walking
Muscle weakness in the face, arm, or leg (usually just on one side)
Numbness or tingling on one side of the body
Personality, mood, or emotional changes
Trouble speaking or understanding others who are speaking
Your health care provider will do a physical exam to:
Check for problems with vision, movement, feeling, reflexes, understanding, and speaking. Your provider and nurses will repeat this exam over time to see if your stroke is getting worse or improving.
Listen to the carotid arteries in the neck with a stethoscope for an abnormal sound, called a bruit, which is caused by abnormal blood flow.
Check for high blood pressure and an irregular heartbeat.
You may have the following tests to help find the type, location, and cause of the stroke and check for other problems:
or
of the brain to determine the location of the stroke, and if there is a mass, or any bleeding
to look for a blood vessel that is blocked or bleeding
(ultrasound) to see if the carotid arteries in your neck have narrowed
to see if the stroke could have been caused by a blood clot from the heart
Magnetic resonance angiography
(MRA) or CT angiography to check for abnormal blood vessels in the brain
Other tests include:
Blood tests
(EEG) to determine if there are seizures
(ECG) and
A stroke is a medical emergency. Quick treatment is needed. Call 911 or the local emergency number right away or seek urgent medical care at the first signs of a stroke.
People who are having stroke symptoms need to get to a hospital as quickly as possible.
If the stroke is caused by a blood clot, a clot-busting medicine may be given to dissolve the clot (also called thrombolytic therapy).
To be effective, this treatment must be started within 4 1/2 hours of when the symptoms first started. However, the sooner this treatment is started, the better the chance of a good outcome.
Endovascular thrombectomy may be needed. This is when a catheter is inserted into your arteries. Dye is injected while images of your brain's blood vessels are reviewed. A clot, if found, could be removed through the catheter.
Other treatments given in the hospital depend on the cause of the stroke. These may include:
Blood thinners such as heparin, warfarin, direct acting oral anticoagulants (DOACs), aspirin, or clopidogrel (Plavix)
Medicine to control risk factors for stroke, such as high blood pressure, diabetes, and high cholesterol
Special procedures or surgery to relieve symptoms or prevent more strokes
Nutrients and fluids
Physical therapy, occupational therapy, speech therapy, and swallowing therapy will all begin in the hospital. If the person has severe swallowing problems, a feeding tube in the stomach (gastrostomy tube) will likely be needed.
The goal of treatment after a stroke is to help you recover as much function as possible and prevent future strokes.
from your stroke will begin while you are still in the hospital or at a rehab center. It will continue when you go home from the hospital or center. Be sure to follow up with your provider after you go home.
How well a person does after a stroke depends on:
The type of stroke
How much brain tissue is damaged
What body functions have been affected
How quickly treatment is given
Problems moving, thinking, and talking often start to improve in the days to weeks after a stroke.
Many people develop
after a stroke. This can slow down recovery but is also a very treatable complication of a stroke.
Many people who have had a stroke will keep improving in the months or years after their stroke.
Over half of people who have a stroke are able to function and live at home. Others are not able to care for themselves.
If treatment with clot-busting medicines is successful, the symptoms of a stroke may go away. However, people often do not get to the hospital soon enough to receive these medicines, or they cannot take these medicines because of a health condition.
People who have a stroke from a blood clot (ischemic stroke) have a better chance of surviving than those who have a stroke from bleeding in the brain (hemorrhagic stroke).
The risk for a second stroke is highest during the weeks or months after the first stroke. The risk begins to decrease after this period.
Stroke is a medical emergency that needs to be treated right away. The acronym F.A.S.T. is an easy way to remember signs of stroke and what to do if you think a stroke has occurred. The most important action to take is to call 911 or the local emergency number right away for emergency assistance.
F.A.S.T. stands for:
FACE. Ask the person to smile. Check if one side of the face droops.
ARMS. Ask the person to raise both arms. See if one arm drifts downward.
SPEECH. Ask the person to repeat a simple sentence. Check if words are slurred and if the sentence is repeated correctly.
TIME. If a person shows any of these symptoms, time is essential. It is important to get to the hospital as quickly as possible. Call 911 or the local emergency number. Act F.A.S.T.
Reducing your stroke
lessens your chance of having a stroke.
Cerebrovascular disease; CVA; Cerebral infarction; Cerebral hemorrhage; Ischemic stroke; Stroke - ischemic; Cerebrovascular accident; Stroke - hemorrhagic; Carotid artery - stroke
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Updated by: Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School at Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.