Stroke : Causes-Symptoms-Diagnosis-Treatment

  

What is Stroke?

A stroke occurs when the blood supply to part of the brain is interrupted or reduced. This causes brain cells to die quickly.

If you see a stroke happening, get help right away. If you don't receive treatment right away, the brain can be damaged and other complications can occur.


What is Stroke?
Stroke


Stroke is less common in the United States now than in the past. People who are affected can receive effective treatments, which can also help prevent disability from stroke.

  1. Nervous system

Medical terms

  • A stroke, from time to time called a brain attack, takes place when something blocks blood supply to part of the mind or when a blood vessel within the mind bursts.
  • In both cases, components of the mind emerge as broken or die. A stroke can cause lasting brain harm, long-term disability, or maybe loss of life.
  • A stroke is a lifestyle-threatening condition that happens whilst a part of your brain doesn’t have enough blood flow. This maximum usually occurs because of a blocked artery or bleeding to your brain. Without a regular delivery of blood, the mind cells in that area begin to die from a lack of oxygen.
  • A stroke is a life-threatening emergency situation where each second counts. If you or someone with you has signs of a stroke, IMMEDIATELY name 911 (or your nearby emergency services quantity). The faster stroke is handled, the more likely you’ll get better without incapacity.

Symptoms Stroke

If you or someone you're with is having a stroke, be especially attentive to the time when symptoms began. Some treatment options are most effective when given soon after a stroke begins.

Signs and symptoms of stroke include:

  • I am having trouble understanding what others are saying.You may have trouble understanding speech or words.

  • If someone experiences paralysis or numbness in one of their face, arm, or leg, that person may be experiencing a medical emergency.You may experience sudden numbness, weakness, or paralysis in one arm or leg. This can often affect just one side of your body. To test if you are having a stroke, try to raise both your arms over your head at the same time. If one arm begins to fall, you may be having a stroke. Additionally, when you try to smile, one side of your mouth may droop.

  • Problems seeing in one or both eyes.If you experience blurry or black vision, it could be due to either one or both of your eyes. In some rare cases, people may see double.

  • Headache.If you experience a severe headache, vomiting, dizziness, or altered consciousness, this may be an indication that you are having a stroke.

  • Trouble walking.You may feel unsteady or dizzy when wearing the glasses. You may also lose coordination suddenly.

When to see a doctor

Seek immediate medical attentionIf you notice any signs or symptoms of a stroke, even if they seem to come and go or they disappear completely, do the following:If you're in a hurry and need help, think FAST and call for help.

  • Face.Is the person's smile symmetrical on both sides of their face?

  • Arms.Do the person have good balance? Does one arm drift downward, or is one arm unable to raise?

  • Speech.Can the person speak clearly? Does his or her speech sound slurred or strange?

  • Time.If you see any of these signs, call 911 or emergency medical help immediately.

If you notice any signs of a stroke, don't wait to call 911. Every minute counts in treating a stroke. If the stroke is not treated quickly, the potential for brain damage and disability increases.

If you are with someone who you believe may have had a stroke, watch them carefully while you wait for emergency assistance.

Causes Stroke

Stroke can be caused by an obstruction of the arteries (ischemic stroke) or by a rupture of a blood vessel (hemorrhagic stroke). Some people may experience only a transient disruption of blood flow to the brain known as a transient ischemic attack (TIA) that doesn't cause long-term symptoms.

Ischemic stroke

This is the most common type of stroke. It happens when the brain's blood vessels become blocked, which reduces blood flow (ischemia). This can be caused by fatty deposits that build up in blood vessels, or by blood clots or other objects that travel. A stroke most often occurs when blood flows through the bloodstream and gets trapped in the brain's blood vessels.

Some initial research suggests that COVID-19 infection may increase the risk of ischemic stroke, but more research is needed to confirm this.

Hemorrhagic stroke

A hemorrhagic stroke occurs when a blood vessel in the brain leaks or ruptures. Brain hemorrhages can occur for many reasons, including conditions that affect the blood vessels. Some factors that may contribute to a hemorrhagic stroke include:

  • Uncontrolled high blood pressure

  • Not taking blood thinners (anticoagulants) properly can lead to overtreatment.

  • An aneurysm is a bulge in the wall of your blood vessel. These weak spots make it easier for blood to seep out, and this can lead to a heart attack or stroke.

  • Trauma (such as a car accident)

  • Protein deposits in blood vessel walls can lead to a weakening of the blood vessel wall (cerebral amyloid angiopathy).

  • Ischemic stroke leading to hemorrhage

A less common cause of bleeding in the brain is an abnormal tangle of thin-walled blood vessels (an arteriovenous malformation).

Transient ischemic attack (TIA)

A TIA (mini-stroke) is a period of symptoms that are similar to those in a stroke. A TIA does not cause permanent damage. A TIA is caused by a temporary decrease in blood supply to part of the brain. It can last for only a few minutes. It will take a few minutes for the decoupage to dry.

A TIA, or "transient ischemic attack," is a type of stroke that occurs when a clot or debris reduces or blocks blood flow to part of the nervous system.

If you are experiencing symptoms that seem like a stroke, go to the emergency room even if you think you have had a TIA (transient ischemic attack). Symptoms that occur with a TIA can also be indicative of having a partially blocked or narrowed artery leading to the brain. Having a TIA (transient ischemic attack) increases your risk of having a full-blown stroke later.

Risk factors Stroke

There are many factors that can increase the risk of stroke. Some of these risk factors are treatable.

Lifestyle risk factors

  • Being overweight or obese

  • Physical inactivity

  • Heavy or binge drinking

  • Using illegal drugs such as cocaine and methamphetamine is wrong.

Medical risk factors

  • High blood pressure

  • Smoking or exposure to secondhand smoke can cause health problems.

  • High cholesterol

  • Diabetes

  • Obstructive sleep apnea

  • Cardiovascular diseases include heart failure, heart defects, heart infection, and irregular heart rhythm.

  • Having a personal or family history of stroke, heart attack, or transient ischemic attack may increase your risk for developing this condition.

  • COVID-19 infection

Certain factors that increase the risk of a stroke include:

  • Age —People 55 or older are more likely to have a stroke than are younger people.

  • Race or ethnicity —People of African American and Hispanic descent have a higher risk of stroke than do people from other races or ethnicities.

  • Sex —Strokes are more likely to occur in men than women. Women usually develop strokes later in life and they are more likely to die from a stroke than men are.

  • Hormones —Taking birth control pills or hormone therapies that include estrogen increases the risk of getting cancer.

Complications Stroke

A stroke can have different consequences depending on how long the brain does not receive blood flow and which part is affected. Complications may include: -Inability to speak or understand language -Inability to move certain body parts -Memory problems

  • Paralysis or loss of muscle movement.If you are paralyzed on one side of your body or lose control of some muscles, that might happen.

  • Difficulty talking or swallowing.A stroke may affect your ability to control your muscles in your mouth and throat, which can make it difficult for you to speak clearly or eat. You may also have difficulty understanding speech, reading or writing.

  • Memory loss or thinking difficulties.Many people who have had strokes experience some memory loss. Others may have difficulty thinking, reasoning, and comprehending concepts.

  • Problems that affect our emotions.People who have had strokes may have more difficulty controlling their emotions, or they may develop depression as a result.

  • Pain.After a stroke, people may experience numbness or unusual sensations in the parts of their body that were affected. For example, someone who has a stroke affecting their left arm might develop an uncomfortable tingling sensation in that arm.

  • Changes in behavior and self-care abilities may occur.People who have had strokes may become more withdrawn. They may need help with basic activities such as grooming and daily chores.

Prevention Stroke

Following your health care provider's recommendations and living a healthy lifestyle are the best steps you can take to prevent a stroke. If you have had a stroke or a transient ischemic attack (TIA), these measures might help prevent another stroke. A healthy lifestyle includes knowing your stroke risk factors, and following your health care provider's recommendations. Your follow-up care in the hospital and afterward may have a significant impact.

Many stroke prevention strategies are similar to heart disease prevention guidelines. In general, healthy lifestyle recommendations include:

  • Reducing high blood pressure.Lowering your blood pressure can help prevent a subsequent stroke. Healthy lifestyle changes and medications are often used to treat high blood pressure.

  • Eating a low-cholesterol and saturated fat diet.Eating less cholesterol and fat may reduce the amount of plaque in your arteries. If you can't decrease your cholesterol levels through dietary changes on your own, your doctor may prescribe a cholesterol-lowering medication.

  • Quitting tobacco use.Smoking raises the risk of stroke for smokers and nonsmokers who are in close proximity to secondhand smoke. Quitting tobacco use reduces the risk of stroke.

  • Managing diabetes.A healthy diet and exercise can help keep your blood sugar in a normal range. If lifestyle changes haven't worked to control your diabetes, your doctor may prescribe diabetes medication.

  • Maintaining a healthy weight.Being overweight increases your risk for other types of stroke, such as hypertension, cardiovascular disease, and diabetes.

  • Eat a diet that is rich in fruits and vegetables.A diet that includes five or more servings of fruits and vegetables each day may reduce the risk of stroke. The Mediterranean diet, which emphasizes olive oil, fruit, nuts, and vegetables, may be helpful.

  • Exercising regularly. Exercise can reduce the risk of stroke in many ways. By increasing good cholesterol levels, improving blood vessel health, reducing stress, and helping you lose weight, exercise can help you in many ways. Start with a low level of activity and work your way up gradually to 30 minutes or more per day. If you want to be healthy, you should do some moderate physical activity on most, if not all, days of the week.

  • Drinking alcohol in moderation is okay.Heavy alcohol consumption increases the risk of high blood pressure, ischemic strokes (a type of stroke caused by a sudden decrease in blood flow to the brain) and hemorrhagic strokes (a type of stroke caused by bleeding inside the brain). Alcohol may also interact with other drugs you're taking. However, drinking small to moderate amounts of alcohol such as one drink per day may help prevent ischemic stroke and decrease the risk of hemorrhagic stroke.Blood clotting ability. Speak with your doctor to see what type of blood clotting medication is best for you.

  • Treating obstructive sleep apnea (OSA).If you have symptoms of obstructive sleep apnea (OSA), your doctor may recommend a sleep study to determine the cause of your sleep problems. If the study finds that you have OSA, the doctor may prescribe a device that will deliver positive airway pressure through a mask to keep your airways open while you sleep.

  • Avoiding illegal drugs.Cocaine and methamphetamine are established risk factors for a stroke.

Preventive medications

If you've had an ischemic stroke or a transient ischemic attack (TIA), your doctor may prescribe medications to help reduce your risk of having another stroke. Some of these medications include:

  • Anti-platelet drugs.Platelets are cells in the blood that can form clots. Anti-platelet drugs make these cells less sticky, so they are less likely to clot. The most commonly used anti-platelet medication is aspirin. Your doctor can help you determine the right dose of aspirin for you.
    If you have a TIA (mini-stroke), your doctor may give you aspirin and an antiplatelet drug such as clopidogrel (Plavix) to reduce the risk of a second stroke. If you can't take aspirin, your doctor may prescribe clopidogrel alone.

  • Anticoagulants.These drugs slow blood clotting. Heparin is a fast-acting drug that may be used for short-term treatment in the hospital.
    Warfarin is a powerful blood thinner and needs to be taken exactly as directed. You will need to have regular blood tests to monitor its effects.
    Several newer blood-thinning medications are available for preventing strokes in people who have a high risk. These medications include dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), and edoxaban (Savaysa). They work shorter than warfarin and usually last for about four to six hours. These medications don't require regular blood tests or monitoring by your doctor. They also have a lower risk of bleeding complications than warfarin.

Diagnosis Stroke

When you arrive at the hospital, things will move quickly as your emergency team tries to determine the type of stroke you're having. That means you'll have a CT scan or other imaging test soon after arriving. Doctors also need to determine if your symptoms are due to another cause, such as a brain tumor. A tumor or drug reaction can happen.

Tests

Some of the tests you may have include:

  • A physical exam.Your doctor will do a number of tests that you are familiar with. These tests may include listening to your heart and checking your blood pressure. You may also have a neurological exam to see how a potential stroke is affecting your nervous system.

  • Blood tests.You may have several blood tests in order to check how fast the blood clots, whether your blood sugar is too high or low, and whether you have an infection.

  • Computerized tomography (CT) scan. A CT scan uses a series of X-rays to create a detailed image of your brain. It can show bleeding, an ischemic stroke (a blockage in the blood supply to the brain), or a tumor. Doctors may inject a dye into your bloodstream to see the blood vessels in greater detail (via a computer). X-rays are used to examine the inside of organs.

  • Magnetic resonance imaging (MRI). An MRI uses powerful radio waves and a magnetic field to create a detailed view of the brain. An MRI can detect changes in brain tissue due to an ischemic stroke or a blood clot. Your doctor may inject a dye into a blood vessel to view the arteries and veins and see how blood flow is occurring (magnetic resonance angiography). To visualize the veins in the liver, an ultrasound or MRI scan is done.

  • Carotid ultrasound.In this test, sound waves create detailed images of the inside of the carotid arteries in the neck. This test shows how fatty deposits (plaques) and blood flow are in the carotid arteries.

  • This is a test that uses x-rays to look at the blood vessels in your brain. In this test, your doctor inserts a thin, flexible tube (catheter) through a small incision in your groin and guides it into your major arteries.Your doctor will inject a dye into your blood vessels to make them visible under X-ray. An image is created during this procedure, which provides a detailed view of arteries in the brain and neck.

  • Echocardiogram.An echocardiogram uses sound waves to create detailed images of the heart. This can help find a source of clots in the heart that may have traveled to the brain and caused a stroke.

Treatment Stroke

If you have a stroke, the best treatment depends on the type of stroke you have. If it's an ischemic stroke, medical intervention may help to stop or reduce the damage to your brain. If it's a stroke that involves bleeding into your brain, then emergency medical care may be needed to stop the bleeding and protect your brain.

Ischemic stroke

To treat an ischemic stroke, doctors must quickly restore blood flow to the brain. This can be done with:

  • Emergency IV medication.If you are receiving treatment for a clot, the sooner the drugs that break it up are administered, the better. Quick treatment will improve both your chances of survival and the likelihood of complications.
    The gold standard treatment for ischemic stroke is an injection of recombinant tissue plasminogen activator (TPA). This injection is usually given through a vein in the arm within the first three hours. Sometimes TPA is also given through an intravenous (IV) line. After stroke symptoms have started, the medication can be taken up to 4.5 hours later.
    This drug helps dissolve the blood clot that caused the stroke. If this drug is used quickly, it may help people recover more fully from a stroke. Your doctor will consider certain risks, such as potential bleeding in the brain, to determine whether TPA is an appropriate treatment for you. You are doing this.

  • Emergency endovascular procedures.Doctors sometimes treat ischemic strokes by directly removing the blockage in the blood vessel. Endovascular therapy has been shown to improve outcomes and reduce long-term disability after ischemic stroke. The procedure must be performed as soon as possible:

    • This refers to medications that are delivered directly to the brain.Doctors use a long, thin tube (catheter) to enter an artery in the groin and deliver TPA directly to the area of the stroke. This treatment has a shorter time window than when TPA is injected, but it is still limited in time.

    • Remove the clot with a stent retriever.Doctors can use a device to remove a clot from a blocked blood vessel in the brain. This procedure is helpful for people with large clots that cannot be completely dissolved with TPA (tissue plasminogen activator). This procedure is often performed in combination with other treatments.TPA is injected.

Doctors may order blood flow imaging tests (using CT or MRI) to help determine if someone is a good candidate for endovascular therapy. The time window during which these procedures can be performed has been expanding because of newer technology.

Other procedures

Your doctor may recommend a procedure to open an artery that is narrowed by plaque in order to reduce your risk of having another stroke or transient ischemic attack. There are several possible procedures, depending on the situation, but all involve opening up the artery.

  • Carotid endarterectomy. The carotid arteries are the blood vessels that run along each side of the neck supplying blood to the brain (carotid arteries). This surgery removes plaque from a carotid artery, which could reduce the risk of a stroke. A carotid endarterectomy also has risks, especially for people with certain medical conditions. If you have heart disease or another medical condition, it could be because of this.

  • Angioplasty and stents.In an angioplasty, a surgeon thread a catheter to the carotid arteries through an artery in the groin. A balloon is then inflated to expand the narrowed artery. After the balloon has been inflated, a stent can be inserted to support the opened artery.

Hemorrhagic stroke

The emergency treatment of hemorrhagic stroke focuses on controlling the bleeding and reducing pressure in the brain. Treatment options include:

  • Emergency measures. If you take blood-thinning medications to prevent blood clots, you may be given drugs or transfusions of blood products to counteract the blood thinners' effects. You may also be given drugs to lower your blood pressure or to prevent spasms in the brain. Decorated leaves help to reduce blood flow and may help prevent seizures.

  • Surgery. If there is a lot of bleeding, your doctor may perform surgery to remove the blood and reduce pressure on your brain. Surgery may also be used to repair blood vessel problems that are associated with hemorrhagic strokes. After a stroke, your doctor may recommend one of these procedures: one of these procedures, or The hemorrhagic stroke was caused by an arteriovenous malformation or another type of blood vessel problem.

  • Surgical clipping.Surgeons place a clamp at the base of an aneurysm to stop blood flow. This clamp can prevent the aneurysm from bursting or it can stop a hemorrhaging aneurysm from bleeding again.

  • Coiling (endovascular embolization).The surgeon will insert a catheter into an artery in the groin and guide it to the brain. The catheter has tiny detachable coils, which will fill up the aneurysm and cause blood to clot.

  • Surgical AVM removal. If an AVM is located in an accessible area of the brain, a surgeon may be able to remove it. This decreases the risk of rupture and stroke, though it's not always possible to get to an AVM if it's located deep within the brain. Caffeine can have a negative impact on brain function.

  • Stereotactic radiosurgery.Stereotactic radiosurgery is an advanced, minimally invasive treatment that uses multiple beams of highly focused radiation to repair blood vessel malformations.

Stroke recovery and rehabilitation

After getting emergency treatment, you'll be closely monitored for at least a day. After that, stroke care focuses on helping you recover as much function as possible and return to living independently. The impact of the stroke depends on the area of the brain involved and the amount of tissue damaged.

If the stroke affected the right side of the brain, your movements and sensations on the left side of your body may be affected. If the stroke damages the brain tissue on the left side of your brain, your movements and sensations on the right side of your body may be affected. A deficiency of the brain's neurotransmitters may cause speech and language disorders.

  1. Rehabilitation of The Brain and Nerves

Most stroke survivors go to a rehabilitation program. Your doctor will recommend the most comprehensive therapy program you can handle, based on your age, overall health, and degree of disability from the stroke. Your doctor will take into consideration your lifestyle interests and priorities, as well as the nature of your stroke. Having access to family members or other caregivers is important.

After I leave the hospital, my rehabilitation might start before I leave the hospital. Later, I might continue my program at the same hospital or in another rehabilitation unit. Or I might go home as an outpatient.

Everyone's recovery from stroke is different. Depending on your condition, your treatment team may include:

Speech therapy is often used in stroke rehabilitation.

More Information

  • Stroke rehabilitation

  • Carotid angioplasty and stenting

  • Carotid endarterectomy

  • Coronary angioplasty and stents

  • Home enteral nutrition

Treatment outcomes

Measuring how well patients are treated after they have been diagnosed with a stroke is important. The goal is for everyone who gets this diagnosis to receive the best possible care.

The graphs below show the percentage of Mayo Clinic patients who were diagnosed with a stroke and received all of the necessary care.

Stroke Core Measure

See related graph.

Carotid Endarterectomy Mortality

See related graph.

Carotid Stenting Mortality

See related graph.

Comprehensive Stroke Measure

See related graph.

The comprehensive stroke should be performed as soon as possible after the skin puncture.

See related graph.

The comprehensive stroke rate is the percentage of people who experience a stroke after having a thrombolysis treatment.

See related graph.

Timing of IV t-PA therapy is important. Make sure to receive treatment as soon as possible after an acute stroke.

See related graph.

Visit Medicare Hospital Compare to get more information and data about hospitals.

For more information about the quality of care at Mayo Clinic, visit our Quality Measures page.

Coping and support

A stroke can be a life-changing event that can affect your emotional wellbeing in just as much as your physical function. You may sometimes feel helpless, frustrated, depressed, and apathetic. You may also experience mood changes and a lower sex drive.

Having a good self-image and caring about the world are important aspects of your recovery. Several strategies may help you, including:

  • Don't be hard on yourself.Physical and emotional recovery will take time and be very challenging. Be prepared for hard work and allow yourself plenty of time to rest. Look for a new normal and be proud of your progress. Allow yourself time to heal, especially after a difficult experience.

  • Join a support group.Talking with others who have experienced a stroke allows you to share experiences, exchange information, and build new friendships.

  • Tell your friends and family what you need.People may want to help, but they don't know what to do. Let them know how they can help, such as by bringing you a meal or staying with you and talking or attending social events or religious activities.

Communication challenges

When communication problems arise, it can be especially frustrating. Here are some tips to help you and your caregivers cope with speech challenges:

  • Practice.Try to have a conversation at least once a day. Talking with others will help you learn what works best for you. It will also help you feel connected and build your confidence.

  • Relax and take your time.Talking is easiest and most enjoyable when things are calm. Some stroke survivors find that after dinner is a good time to talk.

  • Say it your way.When you have a stroke, you may need to use fewer words or communicate through gestures.

  • Use props and communication aids.You may find it helpful to have cards with words or pictures that you often use, like your friends and family members, a favorite television show, or the bathroom.

Preparing for your appointment

If you are having a stroke, your doctor will diagnose it at the hospital. If you have not yet had a stroke, but are worried about your risk of having one in the future, you can talk to your doctor about your concerns at your next scheduled appointment. An appointment is something that you make to meet someone.

What to expect from your doctor

If you are in the emergency room, you may see a doctor who is specifically trained in brain conditions (a neurologist) as well as nurses and medical technicians.

Your emergency team's first goal will be to stabilize your symptoms and overall health. Then the team will determine if you're having a stroke. Doctors will try to find the cause of the stroke in order to determine the most appropriate treatment.

If you're visiting your doctor for a scheduled appointment, he or she will evaluate your risk factors for stroke and heart disease. The discussion will focus on ways to avoid these risks, such as not smoking or using illegal drugs. Your doctor will also discuss your lifestyle. There are various strategies or medications to help control high blood pressure, cholesterol, and other stroke risk factors.

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