Everything You Need to Know About Stroke

The loss of blood flow to the brain damages tissues within the brain. Symptoms of a stroke show up in the body parts controlled by the damaged areas of the brain.

The sooner a person having a stroke gets care, the better their outcome is likely to be. For this reason, it’s helpful to know the signs of a stroke so you can act quickly. Stroke symptoms can include:

• paralysis
• numbness or weakness in the arm, face, and leg, especially on one side of the body (hemiparesis)
• trouble speaking or understanding others
• slurred speech
• confusion, disorientation, or lack of responsiveness
• sudden behavioral changes, especially increased agitation
• vision problems, such as trouble seeing in one or both eyes with vision blackened or blurred, or double vision
• trouble walking
• loss of balance or coordination
• dizziness
• severe, sudden headache with an unknown cause
• seizures
• nausea or vomiting

A stroke requires immediate medical attention

Recognizing the symptoms of a stroke in someone can play an important role in improving their outcome. Experts recommend you BE-FAST:

• Balance: Are they having trouble with balance or coordination?
• Eyes: Are they experiencing visual symptoms, like double vision or blurry vision?
• Face: Does one side of their face droop if they try to smile?
• Arms: Can they lift both arms or is one arm weak or numb?
• Speech: Is their speech slurred or difficult to understand?
• Time: If any of the above symptoms are present, time to call 911 or your local emergency services.

Prompt treatment is key to preventing brain damage, long-term disability, or death. It’s better to be overly cautious when dealing with a stroke, so don’t be afraid to get emergency medical help if you think you recognize the signs of a stroke.

The cause of a stroke depends on the type of stroke. Strokes fall into three main categories:

• ischemic stroke
• hemorrhagic stroke
• transient ischemic attack (TIA)

The type of stroke you have affects your treatment and recovery process.

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Ischemic stroke

During an ischemic stroke, the arteries supplying blood to the brain narrow or become blocked. Blood clots or severely reduced blood flow to the brain cause these blockages. Pieces of plaque breaking off and blocking a blood vessel can also cause them.

Two types of blockages can lead to ischemic stroke:

• A cerebral embolism (embolic stroke) occurs when a blood clot forms in another part of the body — often the heart or arteries in the upper chest and neck — and moves through the bloodstream until it hits an artery too narrow to let it pass. The clot gets stuck, stops the flow of blood, and causes a stroke.
• Cerebral thrombosis (thrombotic stroke) occurs when a blood clot develops at the fatty plaque within the blood vessel.

According to the National Heart, Lung, and Blood Institute (NHLBI), 87% of strokes are ischemic.

Hemorrhagic stroke

A hemorrhagic stroke happens when an artery in the brain breaks open or leaks blood. The blood from that artery creates excess pressure in the skull and swells the brain, damaging brain cells and tissues.

Doctors categorize hemorrhagic strokes into two primary types:

• An intracerebral hemorrhagic (ICH) stroke is the most common type of hemorrhagic stroke. It happens when the tissues surrounding the brain fill with blood after an artery bursts.
• A subarachnoid hemorrhagic (SAH) stroke is less common. It causes bleeding in the area between the brain and the tissues that cover it.

The NHLBI states that 10% of strokes are ICH, while 3% are SAH.

Transient ischemic attack (TIA)

A TIA, or ministroke, occurs when blood flow to the brain is blocked temporarily. Symptoms are similar to those of a full stroke. However, they typically disappear after a few minutes or hours when the blockage moves and blood flow is restored.

A blood clot usually causes a TIA. While it’s not technically a full stroke, a TIA serves as a warning that an actual stroke may happen. Because of this, it’s best not to ignore it. Seek the same treatment you would for a major stroke and get emergency medical help.

According to the American Stroke Association, close to 1 in 5 people with a TIA will have a full stroke within 3 months.

Read more: “What Are the Different Types of Strokes?”

Certain risk factors make you more susceptible to stroke, including:

• an unbalanced diet high in salt, saturated and trans fats, and cholesterol
• physical inactivity
• heavy alcohol use
• tobacco use
• a family history of stroke
• being assigned female at birth
• increasing age
• race or ethnicity, such as being African American, Alaska Native, or American Indian

Certain medical conditions can also increase your risk of stroke, including:

• a previous stroke or TIA
• high blood pressure
• high cholesterol
• diabetes
• carrying too much excess weight
• heart disorders, such as coronary artery disease
• heart valve defects
• enlarged heart chambers and irregular heartbeats
• sickle cell disease
• diabetes
• blood clotting disorder
• patent foramen ovale

Read more: “Understanding and Controlling Risk Factors for Stroke”

The complications after a stroke can vary, depending on which parts of the brain have experienced severe damage.

Some of these complications include:

• seizures
• loss of bladder and bowel control
• problems with speech and swallowing
• cognitive impairment, including dementia
• reduced mobility, range of motion, or ability to control certain muscle movements
• depression
• mood, emotional, or behavioral changes
• shoulder pain
• bed sores
• sensory or sensation changes

While you may be able to overcome some complications after time, some may be permanent.

Read more: “What Are the Potential Complications of Stroke?”

The NHLBI estimates that 82% to 90% of strokes are preventable. While lifestyle changes can’t prevent all strokes, many of these changes can make a significant difference in lowering your risk.

Experts recommend you consider the following:

• Quit smoking: If you smoke, quitting now will lower your risk of stroke. You can reach out to a doctor to create a quit plan.
• Limit alcohol use: Heavy alcohol consumption can raise your blood pressure, which in turn increases the risk of stroke. If reducing your intake is difficult, contact a doctor for help.
• Keep a moderate weight: Overweight and obesity increase the risk of stroke. To help manage your weight, eat a balanced diet and stay physically active. Both steps can also reduce blood pressure and cholesterol levels.
• Get regular checkups: Talk with a doctor about how often to get a checkup for blood pressure, cholesterol, and any conditions you may have. They can also support you in making these lifestyle changes and offer guidance.

Read more: “10 Ways to Lower Your Risk of and Prevent Stroke”

To diagnose stroke, a doctor will first ask you or a family member about your symptoms and what you were doing when they arose. They’ll take your medical history to find out your stroke risk factors. They’ll also:

• ask what medications you take
• check your blood pressure
• listen to your heart

You’ll also have a physical exam, during which your doctor will evaluate you for:

• balance
• coordination
• weakness
• numbness in your arms, face, or legs
• signs of confusion
• vision issues

Your doctor will then do certain imaging and blood tests to help confirm a stroke diagnosis. These tests can help them determine whether you had a stroke and, if so:

• what may have caused it
• what part of the brain is affected
• whether you have bleeding in the brain

Read more: “What Tests Can Diagnose a Stroke?”

Proper medical evaluation and prompt treatment are vital to recovering from a stroke. Treatment will depend on the type of stroke.

Ischemic stroke and TIA

Since a blood clot or blockage in the brain causes these stroke types, doctors essentially treat them with similar techniques. They can include:

• thrombolytic drugs, namely tissue plasminogen activator (tPA or Atlepase), to break up blood clots in your brain’s arteries within 4.5 hours of the onset of symptoms
• mechanical thrombectomy to remove the blood clot within 24 hours of symptom onset
• stents to support weakened artery walls
• surgery to remove plaque from your arteries
• aspirin or other blood thinners to prevent further blood clots

Hemorrhagic stroke

Strokes caused by bleeds or leaks in the brain require different treatment strategies. Treatments for hemorrhagic stroke include:

• medications to reduce blood pressure, prevent seizures, and prevent blood vessel constriction
• surgery to repair the brain aneurysm, usually by processes called coiling or clipping
• craniotomy to relieve pressure on the brain

In addition to emergency treatment, your healthcare team will advise you on ways to prevent future strokes.

Read more: “A Complete Guide to Stroke Treatments”

Doctors use various medications both to treat stroke and prevent future strokes. The type of medication your doctor prescribes depends largely on the type of stroke you had.

Common stroke medications include:

• tPA, injected into a blood vessel to break up blood clots during a stroke
• anticoagulants like warfarin (Coumadin, Jantoven) to prevent blood clots or stop existing clots from getting larger
• direct-acting oral anticoagulants (DOACs), a newer drug class of anticoagulants that work faster and require less monitoring
• antiplatelets like aspirin and clopidogrel (Plavix) to make it more difficult for your blood to clot
• statins to lower high blood cholesterol levels and reduce plaque buildup on artery walls that could lead to a clot
• blood pressure medications, as high blood pressure is the leading risk factor for stroke

Read more: “Stroke Drugs”

Stroke is a leading cause of disability in the United States. While some people will fully recover, many will have long-term disabilities.

It’s important that recovery and rehabilitation from a stroke start as soon as possible. In fact, stroke recovery should begin in the hospital.

In a hospital, a care team can stabilize your condition and assess the effects of the stroke. They can identify underlying factors and begin therapy to help you regain some of your affected skills.

Stroke recovery typically focuses on four main areas:

• speech therapy to relearn how to speak and help with swallowing difficulties
• cognitive therapy to regain former patterns of thinking and behavior
• relearning sensory skills, such as temperature, pressure, and pain, often with the help of an occupational therapist
• physical therapy to regain strength and balance and adjust to any limitations

Read more: “Stroke Recovery: What to Expect”

If you suspect you may be experiencing symptoms of a stroke, it’s vital you seek emergency medical treatment as soon as possible.

Healthcare professionals can only provide clot-busting medication in the first few hours after the signs of a stroke begin. Early treatment is one of the most effective ways to reduce your risk of long-term complications and disability.

While it’s not always possible to completely prevent a stroke, certain lifestyle changes can significantly reduce your risk. Medications can also help reduce the risk of blood clots, which can lead to stroke.

If your doctor believes you might be at risk of stroke, they will work with you to find a prevention strategy that works for you, including medical intervention and lifestyle changes.