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.
Symptoms of a stroke happen quickly. A stroke may cause:
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.
There are two types of stroke:
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.
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.
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.
Learning about stroke:
Living with stroke:
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An ischemic stroke is caused by a blood clot that blocks blood flow to the brain.
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.
A hemorrhagic stroke is caused by bleeding in or around the brain.
Other less common causes include head or neck injuries, certain diseases, and radiation treatment for cancer in the neck or brain.
If you have symptoms of a stroke, call 911 or other emergency services right away. General symptoms of a stroke include:
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.
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 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.
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:
Risk factors you cannot change include:
Call 911 or other emergency services now if you have signs of a stroke:
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:
Call your doctor for an appointment if you:
Doctors who can diagnose and treat stroke include:
If you need surgery or have other health problems, other specialists may be consulted, such as a:
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.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
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:
If it seems that you may have a narrowing of a carotid artery, your doctor may want you to have:
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.
Measures will be taken to stabilize your vital signs, including giving you medicines.
Treatment includes efforts to control bleeding, reduce pressure in the brain, and stabilize vital signs, especially blood pressure.
Your treatment will also focus on preventing another stroke. This may include:
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.
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.
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.
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.
You can help prevent a stroke if you control risk factors and treat other medical conditions that can lead to a stroke.
These are some of the common risk factors for stroke:
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:
Cholesterol-lowering and blood-pressure–lowering medicines are also used to prevent TIAs and strokes.
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.
If you have high blood pressure, your doctor may want you to take medicines to lower it. Blood pressure medicines include:
Medicines used to treat depression and pain may also be prescribed after a stroke.
When surgery is being considered after a stroke, your age, prior overall health, and current condition are major factors in the decision.
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.
Treatment for hemorrhagic stroke may include surgery to:
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.
Carotid artery stenting is not as common as carotid endarterectomy, a type of surgery.
|National Institute of Neurological Disorders and Stroke|
|NIH Neurological Institute|
|P.O. Box 5801|
|Bethesda, MD 20824|
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|
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|
|7500 Security Boulevard|
|Baltimore, MD 21244-1850|
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|
|San Francisco, CA 94104|
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|
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.
Other Works Consulted
- Abbott AL (2009). Medical (nonsurgical) intervention alone is now best for prevention of stroke associated with asymptomatic severe carotid stenosis. Stroke, 40(10): e573–e583.
- Adams RJ, et al. (2003). Coronary risk evaluation in 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 evidence-based practice guidelines (8th ed.). Chest, 133(6, Suppl): 630S–669S.
- 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.
- Goldstein LB, et al. (2010). Guidelines for the primary prevention of stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. Published online December 2, 2010 (doi: 10.1161/STR.0b013e3181fcb238).
- Hirsch J, et al. (2008). Executive summary: American College of Chest Physicians evidence-based clinical practice guidelines (8th ed.). Chest, 133(6): 71S–109S.
- International Carotid Stenting Study investigators (2010). Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): An interim analysis of a randomized controlled trial. Lancet, 375(9719): 985–997.
- Latchaw RE, et al. (2003). Guidelines and recommendations for perfusion imaging in cerebral ischemia. Stroke, 34(4): 1084–1104.
- Morgenstern LB, et al. (2010). Guidelines for the management of spontaneous intracerebral hemorrhage. Stroke, 41(9): 2108–2129.
- Skinner JS, Cooper A (2009). Secondary prevention of ischaemic cardiac events, search date October 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
- Smith SC, et al. (2011). AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: A guideline from the American Heart Association and American College of Cardiology Foundation. Circulation, 124(22): 2458–2473.
- Spence JD, et al. (2010). Effects of intensive medical therapy on microemboli and cardiovascular risk in asymptomatic carotid stenosis. Archives of Neurology, 67(2): 180–186.
- U.S. Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans (ODPHP Publication No. U0036). Washington, DC: U.S. Government Printing Office. Available online: http://www.health.gov/paguidelines/pdf/paguide.pdf.
- U.S. Preventive Services Task Force (2007). Screening for carotid artery stenosis. Available online: http://www.ahrq.gov/clinic/uspstf/uspsacas.htm.
- Wahlgren N, et al. (2008). Thrombolysis with alteplase 3-4.5 h after acute ischemic stroke (SITS-ISTR): An observational study. Lancet. Published online September 15, 2008 (doi:10.1016/S0140-6736(08)61339-2).
|Primary Medical Reviewer||E. Gregory Thompson, MD - Internal Medicine|
|Specialist Medical Reviewer||Richard D. Zorowitz, MD - Physical Medicine and Rehabilitation|
|Last Revised||April 4, 2012|
Last Revised: April 4, 2012
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