Stroke

A stroke occurs when the blood supply to part of the brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients. Brain cells begin to die within minutes. Stroke is a medical emergency; prompt treatment is crucial to minimize brain damage and potential complications.

There are two main types of stroke: ischemic (caused by a blocked artery — about 87 % of strokes) and hemorrhagic (caused by a leaking or burst blood vessel). A transient ischemic attack (TIA), sometimes called a ministroke, is a temporary period of symptoms similar to those of a stroke and is a warning sign that should be taken seriously.

Stroke is a leading cause of death and long-term disability. Many strokes can be prevented through control of risk factors, and outcomes are greatly improved by rapid recognition and treatment.

Stroke symptoms appear suddenly and may include:

• Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body
• Sudden confusion, trouble speaking, or difficulty understanding speech
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance, or lack of coordination
• Sudden severe headache with no known cause

The acronym FAST is a useful reminder:

• Face — Ask the person to smile. Does one side droop?
• Arms — Ask the person to raise both arms. Does one arm drift downward?
• Speech — Ask the person to repeat a simple phrase. Is speech slurred or strange?
• Time — If you observe any of these signs, call emergency services immediately.

Additional symptoms can include sudden vision loss, difficulty swallowing, or sudden behavioral changes.

Ischemic stroke occurs when a blood clot blocks or narrows an artery leading to the brain. The clot may form in the brain’s blood vessels (thrombotic) or travel from elsewhere, often the heart (embolic). Atherosclerosis is a major underlying factor.

Hemorrhagic stroke occurs when a blood vessel in the brain leaks or ruptures. Causes include uncontrolled high blood pressure, aneurysms, arteriovenous malformations, and anticoagulant medications.

Transient ischemic attack (TIA) is caused by a temporary decrease in blood supply to part of the brain; symptoms resolve within 24 hours (usually much sooner) but signal a high risk of future stroke.

Modifiable risk factors include:

• High blood pressure — the most important controllable risk factor
• Smoking and secondhand smoke exposure
• Diabetes
• High cholesterol
• Obesity and physical inactivity
• Cardiovascular disease, including heart failure, heart defects, and atrial fibrillation
• Obstructive sleep apnea
• Heavy alcohol use or illicit drug use
• Certain medications (e.g., hormonal contraceptives in higher-risk individuals)

Non-modifiable factors include age, race (higher risk in African Americans), sex, family history, and prior stroke or TIA.

Depending on the stroke’s type, severity, and location, complications may include:

• Paralysis or loss of muscle movement (often on one side of the body)
• Difficulty talking or swallowing
• Memory loss or thinking difficulties
• Emotional problems and depression
• Pain, numbness, or other sensory changes
• Changes in behavior and self-care ability
• Secondary medical complications (blood clots, infections, pressure sores)

Rehabilitation can help many people regain function and independence.

The most effective stroke prevention strategies are:

• Control blood pressure to target levels
• Do not smoke and avoid secondhand smoke
• Manage diabetes and cholesterol
• Maintain a healthy weight and exercise regularly
• Eat a diet rich in fruits, vegetables, and whole grains and low in saturated fat and sodium
• Limit alcohol
• Treat atrial fibrillation and other heart conditions
• Take prescribed antiplatelet or anticoagulant medicines when indicated
• Seek immediate care for TIA symptoms

Rapid diagnosis is essential. Evaluation typically includes:

• Physical and neurological examination
• CT scan or MRI of the brain to distinguish ischemic from hemorrhagic stroke and rule out other conditions
• CT angiography or MR angiography to visualize blood vessels
• Carotid ultrasound
• Echocardiogram to look for heart sources of emboli
• Blood tests

The goal is to determine the type of stroke and eligibility for time-sensitive treatments as quickly as possible.

Call emergency medical services immediately if you or someone else experiences any stroke symptoms, even if they seem to fluctuate or disappear. Do not wait to see if symptoms go away and do not drive yourself to the hospital. Emergency medical personnel can begin treatment on the way and alert the hospital to prepare for rapid evaluation.

Time is critical: clot-busting medication for ischemic stroke is most effective when given within 4.5 hours of symptom onset, and mechanical clot removal can be performed in selected patients up to 24 hours in some cases.

Ischemic stroke

• Intravenous thrombolysis with alteplase (tPA) if within the time window and criteria are met
• Mechanical thrombectomy (catheter-based clot removal) for large-vessel occlusions in eligible patients
• Antiplatelet therapy, blood-pressure management, and treatment of contributing factors

Hemorrhagic stroke

• Blood-pressure control
• Reversal of anticoagulation if applicable
• Surgical or endovascular treatment of aneurysms or vascular malformations in selected cases
• Supportive care and management of intracranial pressure

After the acute phase, secondary prevention (risk-factor control and antithrombotic therapy) and rehabilitation (physical, occupational, and speech therapy) are essential.

After a stroke or TIA:

• Take all prescribed medicines (antiplatelets/anticoagulants, blood-pressure medicines, statins) consistently
• Participate fully in rehabilitation therapies
• Adopt and maintain heart-healthy lifestyle habits
• Monitor blood pressure at home if advised
• Attend all follow-up appointments
• Seek support for emotional changes and caregiver needs
• Learn to recognize recurrent stroke symptoms and call emergency services immediately if they occur

In an emergency, there is no time for preparation—call emergency services right away. For follow-up visits after a stroke or TIA, bring:

• Complete medication list
• Records of recent hospital stays or test results
• Blood-pressure and blood-sugar logs if applicable
• Notes about residual symptoms and progress in rehabilitation
• Questions about secondary prevention, driving, return to work, and long-term prognosis