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, so it is important to know the symptoms of stroke and 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, paralysis, or weakness in your face, arm, or leg, especially on only one side of your body.
• New problems with walking or balance.
• Sudden vision changes.
• Drooling or slurred speech.
• New problems speaking or understanding simple statements, or feeling confused.
• 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.

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 stroke develops 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 (say “iss-KEE-mick”) strokes. They are the most common type of stroke in older adults.
• A hemorrhagic 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 (say “heh-muh-RAH-jick”) strokes are less common but more deadly than ischemic strokes.

How is a stroke diagnosed?

Seeing a doctor right away is very important. If a stroke is diagnosed quickly—within the first 3 hours of when symptoms start—doctors may be able to use medicines that can lead to a better recovery.

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. If less than 3 hours have passed since your symptoms began, doctors may use a medicine that dissolves blood clots. Research shows that this medicine can improve recovery from a stroke, especially if given within 90 minutes of the first symptoms.¹ Other medicines may be given to prevent blood clots and control symptoms.

A hemorrhagic stroke can be hard to treat. Doctors may do surgery or other treatments to stop bleeding or reduce pressure on the brain. Medicines may be used to control blood pressure, brain swelling, and other problems.

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, high cholesterol, and diabetes. 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 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.

Can you prevent a stroke?

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

• Don't smoke. Smoking can more than double your risk of stroke. Avoid secondhand smoke too.
• Eat a heart-healthy diet that includes plenty of fish, fruits, vegetables, beans, high-fiber grains and breads, and olive oil. Eat less salt too.
• Try to do moderate activity at least 2½ hours a week. It's fine to be active in blocks of 10 minutes or more throughout your day and week. Your doctor can suggest a safe level of exercise for you.
• Stay at a healthy weight.
• Control your cholesterol and blood pressure.
• If you have diabetes, keep your blood sugar as close to normal as possible.
• Limit alcohol. Having more than 1 drink a day (if you are female) or more than 2 drinks a day (if you are male) increases the risk of stroke.
• Take a daily aspirin or other medicines if your doctor advises it.
• Avoid getting sick from the flu. Get a flu shot every year.

Work closely with your doctor. Go to all your appointments, and take your medicines just the way your doctor says to.

Frequently Asked Questions

Learning about stroke:	What is a stroke? What causes a stroke? Can I prevent a stroke? What are the symptoms of a stroke? How does a stroke progress? What increases my risk for stroke? Are there different types of stroke? Who is affected by stroke?
Being diagnosed:	How is a stroke diagnosed? Who can diagnose a stroke?
Getting treatment:	How is a stroke treated? What medicines are used to treat a stroke? Will I need surgery? Should I have a carotid endarterectomy?
Ongoing concerns:	What are the chances that I'll have another stroke? What complications can develop? Should I put my loved one who has had a stroke in a nursing home?
Living with stroke:	What kind of help will I need after a stroke? What lifestyle changes will I need to make after a stroke? How can I eat a heart-healthy diet? Do I need to change the way I eat when I'm taking warfarin (Coumadin)? What life-threatening complications can develop?
End-of-life issues:	How can I prepare for end-of-life issues?

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Author:	Monica Rhodes	Last Updated: January 8, 2009
Medical Review:	Anne C. Poinier, MD - Internal Medicine Richard D. Zorowitz, MD - Physical Medicine and Rehabilitation
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