Stroke: Symptoms, Diagnosis & Treatment
Know the basics
1. What is stroke?
A stroke occurs when the blood supply to part of your brain is interrupted or severely reduced. It is sometimes called a “brain attack.”
Blood flow cut off for longer than a few seconds deprives brain tissue of oxygen and nutrients, causing brain cell to die and leave the lasting effect.
2. How common is stroke?
Stroke can affect patients at any age. It can be managed by reducing your risk factors. Please discuss with your doctor for further information.
3. What are the symptoms of stroke?
The common symptoms of stroke are:
Sudden weakness or numbness in the face, arm, or leg on one side of the body.
You may develop sudden numbness, weakness or paralysis in your face, arm or leg, especially on one side of your body. 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. Similarly, one side of your mouth may droop when you try to smile.
Abrupt loss of vision, strength, coordination, sensation, speech, or the ability to understand speech. These symptoms may become worse over time.
The trouble with speaking and understanding. You may experience confusion like slur the words or have difficulty understanding speech.
Sudden dimness of vision, especially in one eye. You may suddenly have blurred or blackened vision in one or both eyes, or you may see double.
Sudden loss of balance, possibly accompanied by vomiting, nausea, fever, hiccups, or trouble with swallowing.
A sudden and severe headache with no other cause followed rapidly by loss of consciousness – indications of a stroke due to bleeding.
The trouble with walking. You may stumble or experience sudden dizziness, loss of balance or loss of coordination.
Brief loss of consciousness.
Unexplained dizziness or sudden falls.
There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.
4. When should I see my doctor?
If you notice any signs or symptoms of a stroke, even if they seem to fluctuate or disappear, seek immediate medical attention. A stroke is a medical emergency. Prompt treatment is crucial. Early action can minimize brain damage and potential complications.
Diagnosis & Treatments
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
1. How is stroke diagnosed?
Tests in the emergency room
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 it is ischemic or hemorrhagic. You may also have an MRI. Other initial tests recommended for ischemic stroke include:
– Electrocardiogram (ECG, EKG) to check for heart problems.
– Blood tests to help your doctor make choices about your treatment and to check for conditions that may cause symptoms similar to a stroke. Tests may include:
- Complete blood count (CBC).
- Blood sugar.
- Liver and kidney function.
- Prothrombin time and INR (a test that measures how long it takes your blood to clot).
Test you may have later
If it seems that you may have a narrowing of a carotid artery, your doctor may want you to have:
- Carotid ultrasound/Doppler scan to evaluate blood flow through the artery.
- Magnetic resonance angiogram (MRA).
- CT angiogram.
- Carotid angiogram.
- If your doctor believes that the stroke may have been caused by a problem with your heart, an echocardiogram or Holter monitoring or telemetry test may be done.
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.
2. How is stroke treated?
Emergency treatment for stroke depends on whether you’re having an ischemic stroke blocking an artery or a hemorrhagic stroke that involves bleeding into the brain.
To treat an ischemic stroke, doctors must quickly restore blood flow to your brain.
♦ Emergency treatment with medications:
Therapy with clot-busting drugs must start within 3 hours if they are given into the vein and the sooner, the better. Quick treatment not only improves your chances of survival but also may reduce complications. You may be given:
- Aspirin: Aspirin is an immediate treatment given in the emergency room to reduce the likelihood of having another stroke. Aspirin prevents blood clots from forming.
- Intravenous injection of tissue plasminogen activator (TPA): An injection of TPA is usually given through a vein in the arm. This potent clot-busting drug needs to be given within 4.5 hours after stroke symptoms begin if it’s given in the vein. TPA restores blood flow by dissolving the blood clot causing your stroke, and it may help people who have had strokes recover more fully. Your doctor will consider certain risks, such as potential bleeding in the brain, to determine if TPA is appropriate for you.
♦ Emergency procedures:
Doctors sometimes treat ischemic strokes with procedures that must be performed as soon as possible, depending on features of the blood clot:
- Medications delivered directly to the brain: doctors may insert a long, thin tube (catheter) through an artery in your groin and thread it to your brain to deliver TPA directly into the area where the stroke is occurring.
- Mechanical clot removal: doctors may use a catheter to maneuver a tiny device into your brain to physically break up or grab and remove the clot.
♦ Other procedures:
To decrease your risk of having another stroke or transient ischemic attack, your doctor may recommend a procedure to open up an artery that’s narrowed by fatty deposits (plaques). Doctors sometimes recommend the following procedures to prevent a stroke. Options will vary depending on your situation:
- Carotid endarterectomy: a surgeon removes plaques from arteries that run along each side of your neck to your brain (carotid arteries). The procedure may reduce your risk of ischemic stroke. However, a carotid endarterectomy also involves risks, especially for people with heart disease or other medical conditions.
- Angioplasty and stents: a surgeon gains access to your carotid arteries most often through an artery in your groin. Here, he or she can gently and safely navigate to the carotid arteries in your neck. A balloon is then used to expand the narrowed artery. Then a stent can be inserted to support the opened artery.
Emergency treatment of hemorrhagic stroke focuses on controlling your bleeding and reducing pressure in your brain. Surgery also may be performed to help reduce future risk.
♦ Emergency measures:
If you take warfarin (Coumadin) or antiplatelet drugs such as clopidogrel (Plavix) 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 pressure in your brain (intracranial pressure), lower your blood pressure, prevent vasospasm or prevent seizures.
Once the bleeding in your brain stops, treatment usually involves supportive medical care while your body absorbs the blood. Healing is similar to what happens while a bad bruise goes away. If the area of bleeding is large, your doctor may perform surgery to remove the blood and relieve pressure on your brain.
♦ Surgical blood vessel repair:
Surgery may be used to repair blood vessel abnormalities associated with hemorrhagic strokes. Your doctor may recommend one of these procedures after a stroke or if an aneurysm or arteriovenous malformation (AVM) or other types of vascular malformation caused your hemorrhagic stroke:
- Surgical clipping: a surgeon places a tiny clamp at the base of an aneurysm, to stop blood flow to it. This clamp can keep an aneurysm from bursting, or it can prevent re-bleeding of an aneurysm that has recently hemorrhaged.
- Coiling (endovascular embolization): a surgeon inserts a catheter into an artery in your groin and guides it to your brain using X-ray imaging. Your surgeon then guides tiny detachable coils into an aneurysm (aneurysm coiling). The coils fill an aneurysm, which blocks blood flow into an aneurysm and causes the blood to clot.
- Surgical AVM removal: surgeons may remove a smaller AVM if it’s located in an accessible area of your brain, to eliminate the risk of rupture and lower the risk of hemorrhagic stroke. However, it’s not always possible to remove an AVM if its removal would cause too large a reduction in brain function, or if it’s large or located deep within your brain.
- Intracranial bypass: in some unique circumstances, surgical bypass of intracranial blood vessels may be an option to treat poor blood flow to a region of the brain or complex vascular lesions, such as aneurysm repair.
- Stereotactic radiosurgery: using multiple beams of highly focused radiation, stereotactic radiosurgery is an advanced minimally invasive treatment used to repair vascular malformations.
1. What causes stroke?
A stroke may be caused by a blocked artery (ischemic stroke) or the leaking or bursting of a blood vessel (hemorrhagic stroke). Some people may experience only a temporary disruption of blood flow to their brain (transient ischemic attack, or TIA).
♦ Ischemic stroke
Ischemic strokes occur when the arteries to your brain become narrowed or blocked, causing severely reduced blood flow (ischemia). The most common ischemic strokes include:
◊ Thrombotic stroke
A thrombotic stroke occurs when a blood clot (thrombus) forms in one of the arteries that supply blood to your brain. A clot may be caused by fatty deposits (plaque) that build up in arteries and cause reduced blood flow (atherosclerosis) or other artery conditions.
◊ Embolic stroke
An embolic stroke occurs when a blood clot or other debris forms away from your brain — commonly in your heart — and is swept through your bloodstream to lodge in narrower brain arteries. This type of blood clot is called an embolus.
♦ Hemorrhagic stroke
Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. Brain hemorrhages can result from many conditions that affect your blood vessels, including uncontrolled high blood pressure (hypertension), overtreatment with anticoagulants and weak spots in your blood vessel walls (aneurysms). A less common cause of hemorrhage is the rupture of an abnormal tangle of thin-walled blood vessels (arteriovenous malformation) present at birth. Types of hemorrhagic stroke include:
◊ Intracerebral hemorrhage
In an intracerebral hemorrhage, a blood vessel in the brain bursts and spills into the surrounding brain tissue, damaging brain cells. Brain cells beyond the leak are deprived of blood and also damaged. High blood pressure, trauma, vascular malformations, use of blood-thinning medications and other conditions may cause an intracerebral hemorrhage.
◊ Subarachnoid hemorrhage
In a subarachnoid hemorrhage, an artery on or near the surface of your brain bursts and spills into the space between the surface of your brain and your skull. This bleeding is often signaled by a sudden, severe headache. A subarachnoid hemorrhage is commonly caused by the bursting of a small sack-shaped or berry-shaped outpouching on an artery known as an aneurysm. After the hemorrhage, the blood vessels in your brain may widen and narrow erratically (vasospasm), causing brain cell damage by further limiting blood flow.
Transient ischemic attack (TIA) also known as a mini-stroke — is a brief period of symptoms similar to those you’d have a stroke. A temporary decrease in blood supply to part of your brain causes TIAs, which often last less than five minutes. Like an ischemic one, a TIA occurs when a clot or debris blocks blood flow to part of your brain. A TIA doesn’t leave lasting symptoms because the blockage is temporary.
2. What increases my risk for stroke?
There are many risk factors for stroke, such as:
Lifestyle risk factors:
- Being overweight or obese;
- Physical inactivity;
- Heavy or binge drinking;
- Use of illicit drugs such as cocaine and methamphetamines.
Medical risk factors:
- High blood pressure: the risk begins to increase at blood pressure readings higher than 120/80 millimeters of mercury (mm Hg). Your doctor will help you decide on a target blood pressure based on your age, whether you have diabetes and other factors.
- Cigarette smoking or exposure to secondhand smoke.
- High cholesterol.
- Obstructive sleep apnea: a sleep disorder in which the oxygen level intermittently drops during the night.
- Cardiovascular disease, including heart failure, heart defects, heart infection or abnormal heart rhythm.
Other risk factors:
- Personal or family history of brain attack, heart attack or transient ischemic attack.
- Being age 55 or older.
- Race: African-Americans have a higher risk of stroke than do people of other races.
- Gender: men have a higher risk of stroke than women. Women are usually older when they have strokes, and they’re more likely to die of strokes than are men. Also, they may have some risk from some birth control pills or hormone therapies that include estrogen, as well as from pregnancy and childbirth.
Need further information? Contact GO.CARE manage team to get more details from expert doctors and medical specialists.
GO.CARE does not provide medical advice, diagnosis or treatment.
Stroke. https://medlineplus.gov/ency/article/000726.htm. Accessed October 3, 2016.
Stroke. http://www.mayoclinic.org/diseases-conditions/stroke/home/ovc-20117264. Accessed October 3, 2016.
Stroke Health Center. http://www.webmd.com/stroke/stroke-treatment-directory. Accessed October 3, 2016.