What Is a Stroke?

A stroke—or brain attack—occurs when blood flow to the brain gets disrupted. Disruption in blood flow is caused when either a blood clot blocks one of the vital blood vessels in the brain (ischemic stroke), or when a blood vessel in the brain bursts, spilling blood into surrounding tissues (hemorrhagic stroke).

The brain needs a constant supply of oxygen and nutrients to properly function. Even a brief interruption in blood supply can cause serious problems, as brain cells begin to die after just a few minutes without blood or oxygen. A loss of brain function occurs with brain cell death. When this happens, symptoms of a stroke may include impaired ability with movement, speech, thinking and memory, bowel and bladder, eating, emotional control and other vital body functions. Recovery from stroke and the specific ability affected depends on the size and location of the stroke. A small stroke may result in problems such as weakness in an arm or leg, whereas larger strokes may cause paralysis (inability to move part of the body), loss of speech or even death.

What Causes a Stroke?

A stroke occurs when a blood clot limits the flow of blood and oxygen to the brain or when a blood vessel bursts or leaks. A blood clot can have many causes, including poor diet, smoking or excessive alcohol use. A blood vessel can burst due to conditions like diabetes or high blood pressure, which can damage or weaken the arteries and make them more susceptible to rupturing.

What Are the Different Types of Strokes?

The two most common types of stroke are ischemic and hemorrhagic. Each type of stroke has a different cause:

• Ischemic stroke: When blood clots or fatty plaque deposits greatly narrow or completely block a blood vessel, it reduces blood flow to the brain
• Hemorrhagic stroke: When an artery in the brain leaks or ruptures, the pressure from the leaked blood causes damage to brain cells
• Transient ischemic attack (TIA): Known as a mini stroke, a TIA is like an ischemic stroke, but the blockage is temporary, often less than five minutes. While a TIA may not lead to lasting complications, any blockage may require treatment to prevent a full stroke

What Are the Risk Factors for Stroke?

A number of factors can contribute to your risk of having a stroke. Risk factors that can be controlled through lifestyle changes or medical treatment include:

• Diabetes can damage blood vessels over time because of high blood sugar
• Excessive alcohol use. The more alcohol you consume, the greater your risk
• Heart disease can increase your risk of plaque buildup and clots
• Heart rhythm disorders can cause blood clots that can lead to stroke
• High blood pressure can damage or weaken blood vessels
• High red blood cell count thickens the blood and can cause clots
• High cholesterol causes plaque buildup and hardening of the arteries
• Obesity contributes to an increased risk of stroke
• A sedentary lifestyle and lack of exercise can increase risk
• Smoking doubles your risk for stroke

Other risk factors for stroke that can't be controlled include:

• Age: As people get older, their risk of stroke increases
• Gender: Men are more likely to have a stroke
• Previous stroke: Once you have a stroke, you are at much higher risk of having another one
• Genetics: A family history of strokes increases your risk

What Are the Signs and Symptoms of a Stroke?

Signs of a stroke may be sudden—although they could be either mild stroke symptoms or aggressive—and include:

• Weakness or numbness of the face, arms or legs, especially on one side of the body
• Confusion or difficulty speaking or understanding
• Problems with vision, such as dimness or loss of vision in one or both eyes
• Dizziness or problems with balance or coordination
• Problems with movement or walking
• Loss of consciousness or seizure
• Severe headaches with no other known cause, especially if sudden onset

All of the above warning signs may not occur with each stroke, so do not ignore any of these symptoms. Even if the symptoms go away, take action immediately.

Other, less common, symptoms of stroke may include the following:

• Sudden nausea or vomiting not caused by a viral illness
• Brief loss or change of consciousness, such as fainting, confusion, seizures or coma

Are the Symptoms the Same for Ischemic and Hemorrhagic Strokes?

The signs for ischemic stroke symptoms and hemorrhagic stroke symptoms can be similar but there can also be slight differences. Those experiencing an ischemic stroke may have numbness or weakness on one side of the body or face and difficulty with balance, vision and speaking. Often a key hemorrhagic stroke symptom is a sudden and severe headache, which doesn't always occur in other types of strokes.

Are the Symptoms of Stroke in Women the Same as in Men?

The risk of stroke increases with age. Because women generally live longer than men, more women experience strokes. While the main symptoms of a stroke in women are the same as in men, women more commonly report these symptoms of a stroke:

• Difficulty breathing
• Feeling weak or fainting
• Hiccups
• Seizures
• Hallucinations
• Sudden behavioral changes
• Vomiting or nausea

What to do When you See Signs of Stroke

Time matters for a patient suffering a stroke. Get immediate medical attention at the first sign or symptom of a stroke, even if the symptoms appear to fade. The FAST acronym can help you tell if someone may be experiencing a stroke:

• Face: Does the face droop when you ask the patient to smile?
• Arms: Is the patient able to raise both arms equally well?
• Speech: Is the patient's speech slurred or strange when asked to repeat a basic phrase?
• Time: Getting medical attention quickly is imperative, so call 911 immediately

How is a Stroke Diagnosed?

A healthcare provider will conduct a physical exam as part of diagnosing a potential stroke. From there, doctors can use imaging tests to measure blood flow in the brain. Those tests include:

• CT scan: An X-ray image to show bleeding in the brain or damaged brain cells
• MRI: The magnetic fields of magnetic resonance imaging create images that show minor changes in brain tissue
• CTA: A computed tomographic angiography is an X-ray of blood vessels
• MRA: A magnetic resonance angiography uses MRI technology to better understand arterial blood flow
• Doppler sonography: Also known as a carotid ultrasound, the sound waves can provide an image of if plaque has built up inside arteries

What Is the Treatment for a Stroke?

There are several options for treating a stroke. The best stroke treatment will depend on the patient’s age, health and medical history as well as the severity, location, cause and type of stroke. In some cases, surgery may be necessary. Several types of stroke surgery may be performed to help treat a stroke, or to help prevent a stroke from occurring. Those surgeries include:

• Simple and complex intracranial bypass procedures
• Craniectomy and hemispheric decompression for stroke patients with a large area of brain affected
• Carotid endarterectomy, skull base approaches to aneurysm clipping, and AVM resection to prevent stroke or stroke recurrence while minimizing disturbance of normal brain tissue
• Stereotactic radiosurgery to treat AVMs inaccessible by other means
• Endovascular surgery to treat intracranial aneurysms, AVMs, and extracranial and intracranial obstructions (angioplasty, stenting)

Surgical stroke treatment options may differ based on the type of stroke. Ischemic stroke treatment clears the blockage, which can be done via endovascular surgeries. In a hemorrhagic stroke, surgeons may need to relieve the pressure on the brain and repair the blood vessel.

Stroke treatment may also include medications, both in an emergency setting and following initial stroke treatment. Drugs that can break up blood clots, such as a recombinant tissue plasminogen activator (TSA), are a common ischemic stroke treatment. In the case of a hemorrhagic stroke, patients may be prescribed medicines to thin the blood or lower blood pressure.

For patients who suffer a stroke, specialists at our Center for Cerebrovascular Diseases deliver rapid, accurate and advanced assessment and treatment. A stroke is an emergency, and the greatest chance for recovery from stroke occurs when treatment is started immediately.

Recovering from a Stroke

Stroke recovery starts with recuperation from any emergency procedures followed by stroke rehabilitation. After a stroke, the patient is closely monitored until the emergency portion of the stroke has passed. A healthcare team will assess the impact of the stroke, which may have damaged brain tissue and require rehabilitation. Stroke recovery usually goes through seven stages as patients gradually recover motor skills and normal brain function. A patient's stroke rehabilitation program is

based on their individual needs and abilities and can include range of motion exercises, sensory reeducation, mirror therapy and complex movement exercises.

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