Stroke

A stroke is a medical emergency that affects about 100,000 every year. It occurs when a part of the brain does not receive enough blood flow to function normally. 

There are two main types of stroke, based on what causes them:

1. Ischemic strokes are caused by some sort of blockage in a blood vessel. The cause of this blockage is often a blood clot that forms in the brain or travels to the brain from somewhere else in the body. An extreme narrowing of the blood vessels, usually from the buildup of plaque, can also cause it. 
2. Hemorrhagic strokes occur because there’s bleeding in the brain. This can happen if a blood vessel bursts in the brain. It can also happen with head trauma that results in bleeding. Less commonly, something like an aneurysm or a brain tumor can start to bleed. 

Ischemic strokes are much more common, and they make up about 85% of strokes. But hemorrhagic strokes have a higher risk of death. Altogether, strokes are deadly for 1 out of 3 people who have one.

Blood vessels carry oxygen and nutrition to the brain. Strokes occur when something gets in the way of blood flow to the brain.

This often happens when something damages blood vessel walls. Various conditions can do this:

• High blood pressure
• Diabetes
• High cholesterol
• Chemicals from smoking
• Alcohol use
• Diets high in saturated fats
• Conditions that lead to chronic inflammation (such as autoimmune disease, vasculitis, and Alzheimer’s dementia)

There are also many conditions that can increase your risk of forming blood clots:

• Diabetes
• Abnormal heart rhythms, especially atrial fibrillation
• Cancer
• Clotting disorders (such as Factor V Leiden or antiphospholipid syndrome)
• Sickle cell anemia
• Certain medications (particularly hormone therapy or estrogen-containing pills)
• Infections
• Autoimmune disorders
• Reduced physical activity
• Pregnancy

Conditions that may increase your risk of hemorrhagic strokes include:

• High blood pressure
• Bleeding disorders (such as von Willebrand’s disease and hemophilia)
• Anticoagulant medications (blood thinners like aspirin, clopidogrel, warfarin, apixaban, rivaroxaban)
• Head injury while taking a blood thinner

Stroke symptoms vary depending on the part of the brain that is affected. Some strokes are so small they go unnoticed, while others can cause a person to completely lose consciousness. But most strokes have one or more of the following sudden symptoms:

• Weakness on one side of the body
• Facial droop or asymmetry
• Slurred speech or difficulty speaking
• Numbness on one side of the body
• Severe dizziness that doesn’t change with head position
• Blindness, particularly in one eye
• Severe headache
• Confusion

A stroke diagnosis starts with a physical exam. Unlike some conditions, a healthcare provider can tell if someone is having a stroke based on a quick exam of their symptoms. But a stroke workup includes pictures of the brain — with a CT scan or MRI — to confirm the diagnosis. 

These tests show where the stroke is located, and whether it’s from lack of blood flow (ischemic) or bleeding (hemorrhagic). CT scans are best at picking up bleeding. They’re not as good at finding ischemic strokes, particularly if the stroke occurred within the last 24 hours. MRIs are better at showing ischemic and early strokes in more detail. They’re also better at showing the extent of the stroke’s effect on the brain. 

It’s important to know that these tests are a tool to help with stroke diagnosis, but they don’t always show the full extent of the stroke when it first happens. Sometimes repeat imaging is required (after time has passed) to see the damage more clearly. Treatment decisions are based on personal preferences, stroke type, as well as the severity and timing of stroke symptoms.

Treatments

Stroke treatment options depend on three main things:

1. Type of stroke
2. Severity of symptoms
3. How long ago the stroke started

For ischemic strokes, treatments include:

• Tissue plasminogen activator (tPA): This is a medication that a provider injects into the veins to break up any blood clots. It only works if someone gets it within several hours of stroke onset. It has a risk of causing unwanted, life-threatening bleeding. 
• Catheter-directed tPa: This makes tPA treatment a little safer, but it’s only possible for some blood clots. It uses a procedure to insert a catheter into the blood vessel and injects the medication directly on top of the clot.
• Thrombectomy: This also requires a procedure. It uses a catheter in the blood vessel to remove the blood clot. 
• Stent: If the cause of the stroke is the narrowing of a blood vessel, a provider can place a stent in the blood vessel to open it up.

For hemorrhagic strokes, treatment usually involves stopping the bleeding as soon as possible. This includes medications that reverse any blood thinning medications, intentionally reduce someone’s blood pressure, and decrease any pressure inside the brain. In certain cases, surgery can also help treat the bleeding.

Recovery

There are many factors that affect someone’s outcome and function after a stroke. Some examples include age, the severity of symptoms, and their other physical and mental health conditions. 

There’s a general rule for stroke recovery — 70% of recovery happens in the first 3 months after a stroke. Symptoms may continue to improve for up to 1 to 2 years, but early rehabilitation is the key to regaining function. Relearning how to dress, bathe, eat, walk, and read (for example) takes repetition with the help of professionals trained in stroke recovery.

When it comes to stroke rehab, research shows that a multi-specialist approach is best. This includes specialists like a rehabilitation physician and nurse, physical therapist, occupational therapist, and speech therapist. Dieticians and mental health professionals can also help support someone’s recovery. 

In the long term, if disabilities remain, assistance may be arranged with local caregivers, family, friends, and support services. Social workers are best able to coordinate ongoing services for stroke survivors.

Prevention

Although you can’t entirely prevent a stroke, there are ways to reduce some of the risks. These include:

• Treating medical conditions that can lead to stroke (such as diabetes, high blood pressure, and heart disease) 
• Taking any prescribed daily blood thinners, blood pressure-lowering medications, and cholesterol-lowering medications
• Eating a healthy diet that’s low in saturated fat
• Maintaining a healthy weight
• Engaging in regular exercise
• Taking steps to reduce daily stress

And if you have already had a stroke or transient ischemic attack (TIA), these prevention tips will also help lower your risk of a second stroke. It’s particularly important to take any medications your provider prescribes after a stroke. These will go a long way in keeping you healthy and free of strokes moving forward.