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
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
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
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.
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.
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
After either kind of stroke and 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 rehabilitation (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
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
Learning about stroke:
Living with stroke:
Health Tools help you make wise health decisions or take action to improve your health.
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.
hemorrhagic stroke is caused by bleeding in or around the
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
Symptoms can vary depending on whether the stroke is caused by
a blood clot (ischemic stroke) or bleeding (hemorrhagic stroke), where the stroke occurs in the brain, and how bad it is.
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.
hemorrhagic stroke, there is bleeding in the
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
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.
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:
complications of a stroke, such as
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
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, although they may last longer. 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:
Call your doctor for an appointment if you:
Doctors who can diagnose and treat stroke
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 neurologist, a neuroradiologist, 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
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.
Other initial tests recommended for ischemic stroke include:
If it seems that you may have a narrowing of
carotid artery, your doctor may want you to have a:
If your doctor
believes that the stroke may have been caused by a problem with your heart, an
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.
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
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.
rehab program as soon as possible after a
stroke increases your chances of regaining some of the abilities you
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.
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
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
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.
Antiplatelet medicines keep
platelets in the blood from sticking together.
Statins lower cholesterol and can greatly reduce your risk of having another stroke. Statins even protect against stroke in people who do not have heart disease or high cholesterol.2
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.
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.
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).
CardioSmart is an online education and support program that can be your partner in heart health. This website engages, informs, and empowers people to take part in their own care and to work well with their health care teams. It has tools and resources to help you prevent, treat, and/or manage heart diseases.
You can set health and wellness goals and track your progress with online tools. You can track your weight, waist measurement, blood pressure, and activity. You can use calculators to help you find your body mass index (BMI) and check your risk for heart problems. You can search for a cardiologist. And you can find medicine information and prepare for your next appointment. Also, you can join online communities to connect with peers and take heart-healthy challenges.
CardioSmart was designed by cardiovascular professionals at the American College of Cardiology, a nonprofit medical society. Members include doctors, nurses, and surgeons.
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.
This organization supports and assists
people who are providing long-term care at home. It also provides education,
research, services, and advocacy.
This association provides education, information,
referrals, and research on stroke. Information specific to survivors,
caregivers, family, women, and children is included.
CitationsAdams HP Jr, et al. (2007). Guidelines for the early management of adults with ischemic stroke. Stroke, 38(5): 1655–1711. Also available online: http://stroke.ahajournals.org/content/38/5/1655.full.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. Also available online: http://stroke.ahajournals.org/content/39/5/1647.full.pdf.Other Works ConsultedAbbott 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. Circulation, 108(10): 1278–1290. Also available online: http://circ.ahajournals.org/content/108/10/1278.full.Brott TG, et al. (2010). Stenting versus endarterectomy for treatment of carotid-artery stenosis. New England Journal of Medicine, 363(1): 11–23.Connolly ES Jr, et al. (2012). Guidelines for the management of aneurysmal subarachnoid hemorrhage. Also available online: http://stroke.ahajournals.org/content/early/2012/05/03/STR.0b013e3182587839.full.pdf+html.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). Also available online: http://stroke.ahajournals.org/content/42/2/517.full.Guyatt GH, et al. (2012). Executive summary: Antithrombotic therapy and prevention of thrombosis, 9th ed.—American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 141(2, Suppl): 7S–47S.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.Lansberg MG, et al. (2012). Antithrombotic and thrombolytic therapy for ischemic stroke. Antithrombotic therapy and prevention of thrombosis, 9th ed. American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 141(2, Suppl): e601S–e636S. Also available online:Latchaw RE, et al. (2003). Guidelines and recommendations for perfusion imaging in cerebral ischemia. Stroke, 34(4): 1084–1104. Also available online: http://stroke.ahajournals.org/content/34/4/1084.full.Morgenstern LB, et al. (2010). Guidelines for the management of spontaneous intracerebral hemorrhage. Stroke, 41(9): 2108–2129. Also available online: http://stroke.ahajournals.org/content/41/9/2108.full.Skinner JS, Cooper A (2011). Secondary prevention of ischaemic cardiac events, search date May 2010. BMJ Clinical Evidence. Available online: 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. Also available online: http://circ.ahajournals.org/content/124/22/2458.full.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/guidelines/default.aspx.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).
January 3, 2013
E. Gregory Thompson, MD - Internal Medicine & Karin M. Lindholm, DO - Neurology
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