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.
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. If you get to the hospital right away after symptoms begin, 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 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 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. 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.
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.
Do activities that raise your heart rate. Get at least 30 minutes of exercise on most days of the week. Walking is a good choice. You also may want to do other activities, such as running, swimming, cycling, or playing tennis or team sports.
Eat a balanced diet that is low in cholesterol, saturated fats, and salt. These foods can make hardening of the arteries worse. Eat more fruits and vegetables. Eat fish at least once a month.
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.
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.
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
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:
Race. African Americans, Native Americans, and Alaskan Natives
have a higher risk than those of other races.
Gender. Stroke is more common in
men than women until age 75, when more women than men have strokes. Because
women live longer than men, more women have strokes each year.
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. 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.
Had a TIA or stroke and are taking
aspirin or other medicines that prevent blood clotting and you notice any
signs of bleeding.
Had a stroke and have a
choking episode from food going down your windpipe.
Had a stroke
and 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 had a stroke and notice that your affected arm or
leg is becoming increasingly stiff or you are not able to straighten it
(spasticity).
Have had a stroke and notice signs of a urinary tract
infection. Signs may include fever, pain with urination, blood in urine, and
low back (flank) pain.
Have had a stroke and you are having trouble keeping
your balance.
Who to see
Doctors who can diagnose and treat stroke
include:
Some hospitals have a stroke team made up of many
different health professionals, such as a physical therapist, an occupational
therapist, a speech therapist, a rehabilitation doctor (physiatrist), a nurse,
and a social worker.
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 to
find out the amount of damage to the brain and help predict recovery.
Other initial tests recommended for ischemic stroke include:
Blood tests to help your doctor make
choices about your treatment and to check for conditions that may cause
symptoms similar to a stroke. Tests may include:
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.
If your stroke is diagnosed soon enough after
the start of symptoms, you may be given a clot-dissolving medicine called
tissue plasminogen activator (t-PA), which can
increase your chances of survival and recovery.
You may also receive
aspirin or
another antiplatelet medicine.
Hemorrhagic stroke
Treatment includes efforts
to control bleeding, reduce pressure in the brain, and stabilize vital signs,
especially blood pressure.
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 that you try to keep
your blood sugar levels in a target range. To do this, you may
need to take oral medicines or insulin. 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 more active. For more information, see Prevention.
Get into a
stroke rehab program as soon as possible.
Rehabilitation
Starting a
rehabilitation (rehab) program as soon as possible after a
stroke increases your chances of regaining some of the abilities you
lost.
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.
Walking: People usually show the greatest progress in
being able to walk during the first 6 weeks. Most recovery occurs within the
first 3 months. But you may continue to improve slowly over the next few
years.
Speech, balance, daily skills: Speech, balance, and skills needed for day-to-day living
return more slowly and may continue to improve for up to a
year.
Communication, judgment: About half of the people who suffer a stroke have problems
with coordination, communication, judgment, or behavior that affect their work
and personal relationships.
If your doctor wants to find out how the stroke has affected your ability to reason, concentrate, or remember, you may have neuropsychological tests.
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. For more information, see the topic
Stroke Rehabilitation.
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.
Long-term care
If you get
worse, your loved ones may need to move you to a care facility
that can meet your needs, especially if your caregiver has his or her own
health problems that make it difficult to properly care for you.
It is common
for caregivers to neglect their own health when they are caring for a loved one
who has had a stroke. If your caregiver's health declines, the risk of injury
to you and your caregiver may increase.
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. This can help prevent a stroke.
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.
Do activities that raise your heart rate. Get at least 30 minutes of exercise on most days of the week. Walking is a good choice. You also may want to do other activities, such as running, swimming, cycling, or playing tennis or team sports.
Eat a balanced diet that is low in cholesterol, saturated fats, and salt. What kind of diet you use(What is a PDF document?) depends on your individual risks, your doctor's recommendation, and your preference.
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.
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:
Antiplatelet medicines.
Anticoagulant medicines.
Cholesterol-lowering and blood-pressure–lowering medicines are also used to prevent TIAs and strokes.
Aspirin (for example, Bayer) is most often used to prevent TIAs
and strokes.
Aspirin combined with dipyridamole (Aggrenox)
is a safe and effective alternative to aspirin.
Clopidogrel (Plavix) may be used
for people who cannot take aspirin.
Anticoagulants
Anticoagulants such as warfarin (for example, Coumadin) 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.
Statins
Statins lower cholesterol and can greatly reduce your risk of having another stroke. Statins even protect against stroke in people who do not have heart disease or high cholesterol.2
Blood pressure medicines
If you have high blood pressure, your doctor may want you to take medicines to lower it. Blood pressure medicines include:
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.
In an endovascular coil embolization, a
small coil 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.
National Institute of Neurological Disorders and
Stroke
NIH Neurological Institute
P.O. Box 5801
Bethesda, MD 20824
Phone:
1-800-352-9424
Phone:
(301) 496-5751
TDD:
(301) 468-5981
Web Address:
www.ninds.nih.gov
The National Institute of Neurological Disorders and
Stroke (NINDS), a part of the National Institutes of Health, is the leading
U.S. federal government agency supporting research on brain and nervous system
disorders. It provides the public with educational materials and information
about these disorders.
American Stroke Association
7272 Greenville Avenue
Dallas, TX 75231
Phone:
1-888-4-STROKE (1-888-478-7653)
Web Address:
www.strokeassociation.org
This association provides information and referrals to
local self-help groups for people who have had a stroke and for their families.
Pamphlets and other information can be obtained by calling the Dallas office (toll-free).
Centers for Medicare and Medicaid Services (CMS): Nursing Home Compare
7500 Security Boulevard
Baltimore, MD 21244-1850
Phone:
1-877-267-2323 toll-free
Phone:
(410) 786-3000
TDD:
(410) 786-0727
Web Address:
www.medicare.gov/NHCompare/home.asp
Nursing Home Compare is a website with information about every Medicare- and Medicaid-certified nursing home in the country. The site allows you to search for nursing homes by name, city, county, state, or ZIP code. It also allows you to compare the quality of nursing homes using a five-star rating. The site also has information on alternatives to nursing homes, such as home care or assisted living.
The Centers for Medicare and Medicaid Services (CMS) is a
federal agency within the U.S. Department of Health and Human Services. CMS
administers Medicare, Medicaid, and the Children's Health Insurance Program
(CHIP). CMS also has other responsibilities, such as overseeing the health
insurance portability standards, which include the Health Insurance Portability
and Accountability Act of 1996 (HIPAA), and ensuring quality care standards in
long-term care facilities and clinical laboratories.
Family Caregiver Alliance
180 Montgomery Street
Suite 900
San Francisco, CA 94104
Phone:
1-800-445-8106 (415) 434-3388
Email:
info@caregiver.org
Web Address:
www.caregiver.org
This organization supports and assists
people who are providing long-term care at home. It also provides education,
research, services, and advocacy.
National Stroke Association
9707 East Easter Lane, Building B
Centennial, CO 80112
Phone:
1-800-STROKES (1-800-787-6537)
Fax:
(303) 649-1328
Email:
info@stroke.org
Web Address:
www.stroke.org
This association provides education, information,
referrals, and research on stroke. Information specific to survivors,
caregivers, family, women, and children is included.
Adams HP Jr, et al. (2007). Guidelines for the early
management of adults with ischemic stroke: A guideline from the American Heart
Association/American Stroke Association Stroke Council, Clinical Cardiology
Council, Cardiovascular Radiology and Intervention Council, and the
Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in
Research Interdisciplinary Working Groups: The American Academy of Neurology
affirms the value of this guideline as an educational tool for neurologists.
Stroke, 38(5): 1655–1711.
Adams RJ (2008). AHA/ASA science advisory: Update to
the AHA/ASA recommendations for the prevention of stroke in patients with
stroke and transient ischemic attack. Stroke, 39(5):
1647–1652.
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patients with transient ischemic attack and ischemic stroke: A scientific
statement for healthcare professionals from the Stroke Council and the Council
on Clinical Cardiology of the American Heart Association/American Stroke
Association. Circulation, 108(10): 1278–1290.
Albers GW, et al. (2008). Antithrombotic and
thrombolytic therapy for ischemic stroke: American College of Chest Physicians
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Bederson JB, et al. (2009). Guidelines for the management of aneurysmal subarachnoid hemorrhage. Stroke, 40(3): 994–1025.
Brott TG, et al. (2010). Stenting versus endarterectomy for treatment of carotid-artery stenosis. New England Journal of Medicine, 363(1): 11–23.
Ederle J, et al. (2009). Randomized controlled trials comparing endarterectomy and endovascular treatment for carotid artery stenosis: A Cochrane systematic review. Stroke, 40(4): 1373–1380.
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Credits
By
Healthwise Staff
Primary Medical Reviewer
E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer
Richard D. Zorowitz, MD - Physical Medicine and Rehabilitation
Adams HP Jr, et al. (2007). Guidelines for the early
management of adults with ischemic stroke: A guideline from the American Heart
Association/American Stroke Association Stroke Council, Clinical Cardiology
Council, Cardiovascular Radiology and Intervention Council, and the
Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in
Research Interdisciplinary Working Groups: The American Academy of Neurology
affirms the value of this guideline as an educational tool for neurologists.
Stroke, 38(5): 1655–1711.
Adams RJ (2008). AHA/ASA science advisory: Update to
the AHA/ASA recommendations for the prevention of stroke in patients with
stroke and transient ischemic attack. Stroke, 39(5):
1647–1652.
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