A stroke happens when blood flow to a part of the brain stops. A stroke is sometimes called a "brain attack."
Cerebrovascular disease; CVA; Cerebral infarction; Cerebral hemorrhage; Ischemic stroke; Stroke - ischemic; Cerebrovascular accident; Stroke - hemorrhagic
Causes, incidence, and risk factors
If blood flow is stopped for longer than a few seconds, the brain cannot get blood and oxygen. Brain cells can die, causing permanent damage.There are two major types of stroke: ischemic stroke and 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 be caused by clogged arteries. Fat, cholesterol, and other substances collect on the artery walls, forming a sticky substance called plaque.A hemorrhagic stroke occurs when a blood vessel in part of the brain becomes weak and bursts open, causing blood to leak into the brain. Some people have defects in the blood vessels of the brain that make this more likely.See also:AneurysmArteriovenous malformation (AVM)STROKE RISK FACTORSHigh blood pressure is the number one risk factor for strokes. The other major risk factors are:Atrial fibrillationDiabetesFamily history of strokeHigh cholesterolIncreasing age, especially after age 55Race (black people are more likely to die of a stroke)People who have heart disease or poor blood flow in their legs caused by narrowed arteries are also more likely to have a stroke.The chance of stroke is higher in people who live an unhealthy lifestyle by:Being overweight or obeseDrinking heavilyEating too much fat or saltSmokingTaking cocaine and other illegal drugsBirth control pills can increase the chances of having blood clots. The risk is highest in woman who smoke and are older than 35.For more information, see: Stroke risk factors
The symptoms of stroke depend on what part of the brain is damaged. In some cases, a person may not know that he or she has had a stroke.Symptoms usually develop suddenly and without warning. Or, 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, especially if the stroke is caused by bleeding in the brain. The headache:Starts suddenly and may be severeOccurs when you are lying flatWakes you up from sleepGets worse when you change positions or when you bend, strain, or coughOther symptoms depend on how severe the stroke is and what part of the brain is affected. Symptoms may include:Change in alertness (including sleepiness, unconsciousness, and coma)Changes in hearingChanges in tasteChanges that affect touch and the ability to feel pain, pressure, or different temperaturesClumsinessConfusion or loss of memoryDifficulty swallowingDifficulty writing or readingDizziness or abnormal feeling of movement (vertigo)Lack of control over the bladder or bowelsLoss of balanceLoss of coordinationMuscle weakness in the face, arm, or leg (usually just on one side)Numbness or tingling on one side of the bodyPersonality, mood, or emotional changesProblems with eyesight, including decreased vision, double vision, or total loss of visionTrouble speaking or understanding others who are speakingTrouble walking
Signs and tests
A complete exam should be done. Your doctor will:Check for problems with vision, movement, feeling, reflexes, understanding, and speaking. Your doctor and nurses will repeat this exam over time to see if your stroke is getting worse or improving.Listen for an abnormal sound, called a "bruit," when using a stethoscope to listen to the carotid arteries in the neck. A bruit is caused by abnormal blood flow.Check your blood pressure, which may be high.Tests can help your doctor find the type, location, and cause of the stroke and rule out other disorders.Angiogram of the head can show which blood vessel is blocked or bleedingCarotid duplex (ultrasound) can show if the carotid arteries in your neck have narrowedCT scan of the brain is often done soon after symptoms of a stroke begin. An MRI scan of the brain may be done instead or afterwardsEchocardiogram may be done if the stroke could have been caused by a blood clot from the heartMagnetic resonance angiography (MRA) or CT angiography may be done to check for abnormal blood vessels in the brainOther tests include:Lab tests will include:
Bleeding timeBlood cholesterol and sugarBlood clotting tests (prothrombin time or partial thromboplastin time)Complete blood count (CBC)Electrocardiogram (ECG) and heart rhythm monitoring -- to show whether an irregular heartbeat (such as atrial fibrillation) caused the stroke
A stroke is a medical emergency. Immediate treatment can save lives and reduce disability. Call 911 or your local emergency number or seek urgent medical care at the first signs of a stroke.It is very important for people who are having stroke symptoms to get to a hospital as quickly as possible. If the stroke is caused by a blood clot, a clot-busting drug may be given to dissolve the clot.Most of the time, patients must reach a hospital within 3 hours after symptoms begin. Some people may be able to receive these drugs for up to 4 - 5 hours after symptoms begin.Treatment depends on how severe the stroke was and what caused it. Most people who have a stroke need to stay in a hospital.TREATMENT IN THE HOSPITALClot-busting drugs (thrombolytic therapy) may be used if the stroke is caused by a blood clot. This medicine breaks up blood clots and helps bring back blood flow to the damaged area. However, not everyone can get this type of medicine.For these drugs to work, a person must be seen and treatment must begin within 3 hours of when the symptoms first started. A CT scan must be done to see whether the stroke is from a clot or from bleeding.If the stroke is caused by bleeding instead of clotting, clot-busting drugs (thrombolytics) can cause more bleeding.Other treatments depend on the cause of the stroke:Blood thinners such as heparin or warfarin (Coumadin) may be used to treat strokes due to blood clots. Aspirin or clopidogrel (Plavix) may also be used.Other medicine may be needed to control symptoms such as high blood pressure.In some situations, a special stroke team and skilled radiologists may be able to use angiography to highlight the clogged blood vessel and open it up.If bleeding occurred, surgery is often needed to remove blood from around the brain and to fix damaged blood vessels.Surgery on the carotid artery may be needed.See also:Carotid artery diseaseCarotid artery surgeryNutrients and fluids may be needed, especially if the person has trouble swallowing. These may be given through a vein (intravenously) or a feeding tube in the stomach (gastrostomy tube). Swallowing trouble may be temporary or permanent.Physical therapy, occupational therapy, speech therapy, and swallowing therapy will all begin in the hospital.LONG-TERM TREATMENTThe goal of treatment after a stroke is to help the patient recover as much function as possible and prevent future strokes.The recovery time and need for long-term treatment is different for each person. Problems moving, thinking, and talking often improve in the weeks to months after a stroke. A number of people who have had a stroke will keep improving in the months or years after the stroke.See: Stroke recovery for information about:Bladder and bowel problemsLiving at home instead of a nursing facilityMuscle and nerve problemsSpeech problemsStroke rehabilitationSwallowing and eating problemsThinking and memory problems
Support and resources are available from the American Stroke Association -- www.strokeassociation.org.
The outlook depends on:The type of strokeHow much brain tissue is damagedWhat body functions have been affectedHow quickly you get treated You may recover completely, or have some permanent loss of function.Over half of people who have a stroke are able to function and live at home. Other people are not able to care for themselves.If treatment with clot-busting drugs is successful, the symptoms of a stroke may go away. However, patients often do not get to the hospital soon enough to receive these drugs, or they cannot take these drugs because of a health condition.People who have a stroke due to a blood clot (ischemic stroke) have a better chance of surviving than those who have a stroke due to bleeding in the brain (hemorrhagic stroke).The risk for a second stroke is highest during the weeks or months after the first stroke. Then the risk begins to decrease.
Breathing food into the airway (aspiration)DementiaFallsLoss of mobilityLoss of movement or feeling in one or more parts of the bodyMuscle spasticityPoor nutritionPressure soresProblems speaking and understandingProblems thinking or focusing
Calling your health care provider
Stroke is a medical emergency that needs to be treated right away. Call your local emergency number (such as 911) if someone has symptoms of a stroke.
See: Stroke risk factors and prevention
Latchaw RE, Alberts MJ, Lev MH, Connors JJ, Harbaugh RE, Higashida RT, et al. Recommendations for imaging of acute ischemic stroke: a scientific statement from the American Heart Association. Stroke. 2009;40:3646-3678. Epub 2009 Sep 24.Del Zoppo GJ, Saver JL, Jauch EC, Adams HP Jr: American Heart Association Stroke Council, Expansion of the time window for treatment of acute ischemic stroke with intravenous tissue plasminogen activator: a science advisory from the American Heart Association/American Stroke Association. Stroke. 2009;40:2945-2948. Epub 2009 May 28.Chung CS, Caplan LR. Stroke and other neurovascular disorders. In: Goetz, CG, eds. Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 45.Furie KL, Kasner SE, Adams RJ, Albers GW, Bush RL, Fagan SC, et al. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:227-276.Goldstein LB, Bushnell CD, Adams RJ, Appel LJ, Braun LT, Chaturvedi S, et al. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:517-584.Morgenstern LB, Hemphill JC 3rd, Anderson C, Becker K, Broderick JP, Connolly ES Jr, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2010;41:2108-2129.