Stroke

What Is a Stroke?

A stroke, also called a cerebrovascular or brain attack, is a loss of blood flow to part of the brain. This can be caused by a small clot or a burst blood vessel. It can severely affect brain health with the degree of damage caused by the lack of blood flow depending on the blockage’s size, location, and duration.

According to the National Institute of Child Health and Human Development in 2022, stroke affects about 800,000 people annually in the U.S.

What Are the Types of Stroke?

Strokes are classified based on whether they block (ischemic) or rupture (hemorrhagic) a blood vessel.

Ischemic stroke is the most common form, affecting 87% of people who have a stroke.

Although hemorrhagic strokes are less common, they are more dangerous. A study from the University of Miami Miller School of Medicine reported that hemorrhagic strokes cause death in up to 50% of people within 30 days and are the second leading cause of death in the U.S.

These two types of strokes will result in different levels of disability and require different treatments.

What Are the Symptoms of a Stroke?

Stroke symptoms depend on where in the brain the stroke occurred. For example, if the stroke occurs on the side of the brain responsible for producing speech (called Broca’s area), you will have difficulty speaking. Strokes located at the back of the brain could affect vision, whereas those affecting the front of the brain could affect decision-making.

Common symptoms that occur in several different regions of the brain are:

• Dizziness
• Weakness or numbness on one side of the body.
• Sudden, severe headache
• Vomiting
• Loss of consciousness
• Blurred vision
• Confusion or decreased awareness of your surroundings
• Difficulty speaking (slurred or garbled speech)
• Droopiness of the face
• Hearing loss (mild, moderate, severe or profound)

If you think someone might be having a stroke, you can quickly assess them using the BE-FAST acronym: balance, eyes, face, arms, speech, time. Determine the following:

• Is the person’s balance poor, or is their gait uncoordinated?
• Does the person have a problem with their eyes, such as blurred vision?
• Is the person’s face asymmetric when they smile?
• Do the person’s arms rise equally when you ask them to do so?
• Is the person’s speech unusual or slurred?
• Time is of the essence: if any of the above is true, seek emergency medical help immediately.

Identifying symptoms early and getting medical attention as soon as possible are key to recovering to the greatest extent possible.

How Long Does a Stroke Last?

There is no single length of time that a stroke lasts; it may last from a few minutes or up to several days. It will last as long as there is a blockage or bleeding and is considered resolved when blood flow is restored to the affected area of the brain.

When a stroke begins, you may experience symptoms suddenly. These symptoms can worsen if the stroke is not addressed medically over the next hours or days because the lack of blood flow can cause spreading damage. The length of time when blood flow is interrupted, whether by a clot or bleeding, determines the degree of brain damage and how long a stroke’s symptoms will persist.

What Causes a Stroke?

The most common cause of a stroke is a blockage in a blood vessel. Fatty deposits or plaques that build up on the inside walls of blood vessels are more common in people with conditions like atherosclerosis. The plaques can burst, causing components of the blood called platelets to form clots that can travel in the bloodstream. Clots can travel to the brain, where they block blood vessels and the supply of oxygen and nutrients to the brain tissue.

More rarely, a blood vessel may leak or burst because of health conditions that weaken the blood vessel walls.

How Are Strokes Diagnosed?

If a stroke is suspected, emergency healthcare providers will act quickly to diagnose and treat the stroke. A computed tomography (CT) scan or magnetic resonance imaging (MRI) will likely be performed to determine whether a stroke has occurred and where in the brain it is located. A dye may be injected into the bloodstream so that more detail can be seen with a CT scan or MRI. A similar technique called a cerebral angiogram can be used where the dye is injected close to the neck rather than through the whole body.

Other techniques might be used to determine the source of the stroke. For example, an echocardiogram may be performed to determine if a clot close to the heart has fractured and traveled to the brain.

How Are Strokes Treated?

Stroke treatment aims to restore blood flow to the region of the brain affected by the stroke. Medicines may be administered for ischemic strokes to break up the clot, or a minimally invasive procedure can be performed to manually open the blood vessel and dislodge the clot. These strategies may be combined with medicines that aim to protect brain tissue near the clot.

Hemorrhagic stroke requires more intensive treatment because bleeding can cause pressure on the brain, and blood may be toxic to cells in the brain. Because the source of the bleeding is often difficult to access, treatment focuses on bleeding prevention medicines or the cessation of medicine that could increase bleeding. Medications may also be given to reduce swelling and decrease the pressure on the brain. If the bleeding is severe, surgery may be necessary to remove the blood.

What Medications or Treatments Are Used to Prevent Stroke?

Medicines that prevent blood clots are used to prevent strokes in people with a history of blood vessel blockages, namely antiplatelet and anticoagulant medications.

Antiplatelet medications block cells from sticking together and forming a clot. A common over-the-counter anti-platelet medicine is aspirin.

Anticoagulants also prevent clots by thinning the blood. Heparin is often given by healthcare providers when a stroke is suspected. Other anticoagulants may be prescribed long-term for people who are at high risk of stroke.

How Soon After Treatment Will I Feel Better?

A stroke will affect everyone differently depending on where the stroke took place, whether it results in a ruptured blood vessel, and how severe the bleeding is. A team of healthcare providers will assess your needs and support your recovery in the most efficient way possible. The brain takes time to heal, so you can expect most recovery to take place within the first three months, but further recovery is possible after three months, albeit more slowly.

Long-Term Side Effects

While some people recover fully after a stroke, long-term side effects are possible. Depending on the severity and location of the brain damage, these significant side effects include:

• Loss of vision
• Memory loss
• Difficulty understanding complex subjects
• Constant pain or numbness
• Trouble swallowing
• Seizures
• Depression
• Urinary tract infections (UTIs)
• Inadequate nutrition
• Heart problems
• Full or partial paralysis
• Locked-In syndrome
• Loss of muscle control
• Lack of reason and judgment
• Difficulty speaking or understanding speech
• Lack of emotional control
• Incontinence

Recovery from these long-term side effects can take months to years, and some may be permanent. Lifestyle changes and modifications, like making your home more accessible or receiving in-home therapy, can make it easier to adapt to these effects.

Who Does It Affect?

Strokes can affect anyone but are more likely to occur in some populations, such as:

• People who are 55 years of age and older
• Those with heart disease or chronic liver disease
• Those with a family history of stroke
• Hispanic and Black people are also more likely to suffer a stroke compared to other ethnicities and races.
• People assigned male at birth (AMAB) have a higher risk of stroke in young and middle age but the lifetime risk of stroke is higher in those assigned female at birth (AFAB). Additionally, if someone AFAB has a stroke, they are more likely to have a poorer outcome than a person AMAB who has a stroke. Hormone therapies containing estrogen, including those used for birth control and gender-affirming therapy, can also increase the risk of stroke.

How Can I Reduce My Risk of Having a Stroke?

Risk factors for strokes fall into one of two categories: those related to lifestyle choices and those that are related to health conditions. Lifestyle risk factors are also called modifiable because they can be changed to reduce your risk. Steps you can take to reduce your risk include:

• Quitting smoking
• Quitting substance misuse
• Maintaining a healthy weight
• Eating a balanced diet rich in fruits and vegetables
• Exercising regularly, like walking, 150 minutes per week
• Limiting alcohol intake

Health conditions associated with increased risk of stroke may also be modifiable. Seeking and complying with treatment for the following conditions may reduce your risk:

• Obstructive sleep apnea
• Type 2 Diabetes
• High blood pressure
• High cholesterol
• Migraine headaches
• Heart disease
• Obesity

Regular visits to your healthcare provider and completing recommended screening procedures will improve your chances of identifying these health-related risk factors.

When Should I See My Healthcare Provider?

If you are suffering from any of the symptoms of a stroke, especially if you have one or more risk factors, it is critical that you seek medical attention immediately. The faster a healthcare provider can assess you and provide treatment, the higher your chances of complete recovery. When in doubt, call your provider.

Time Is of the Essence

Strokes can come on quickly and have severe consequences, especially if a blood vessel ruptures. The clinical outcomes of a stroke depend heavily on how quickly medical attention is received. Many supportive therapies are available to support your recovery after a stroke, but patience is required because the brain takes time to heal.